Frontiers in Physiology

Neural temporal point processes (NTPPs) are powerful tools for modeling sequences of timestamped events with statistical temporal structure. Density-based NTPPs, in particular, are an interesting opportunity to merge the universal function approximation capability of neural networks with a defined statistical model in a way that has many potential applications. We demonstrate one such application to heartbeat dynamics, a physiologic point process. We specifically apply a lognormal mixture NTPP to compute instantaneous estimates of the mean and standard deviation of beat-to-beat intervals. We compare our results to the state of art (Barbieri et al.) point process model for heartbeat dynamics, which uses a more physiologically rigorous inverse Gaussian model. We find that the NTPP model maintains reasonable accuracy while improving upon robustness to noise.

BACKGROUND: Atrial fibrillation (AF) remains difficult to explain using a single focal driver or rotor-centered mechanism across disease stages. We tested whether progressive atrial substrate remodeling can drive a critical transition toward turbulence-like, decentralized multi wavelet electrical activity. METHODS: We constructed a controlled two-dimensional atrial reaction-diffusion model with six graded substrate-remodeling stages. We evaluated effective wavelength, theoretical wavelet capacity, AF inducibility, vulnerable-window dynamics, spatial randomness, temporal memory, spectral dispersion, nonlinear indices, virtual ablation response and ERP-prolongation reverse mechanistic testing. RESULTS: Progressive remodeling shortened effective wavelength from 12.0 to 2.4 cm and increased theoretical wavelet capacity from 0.69 to 17.36. Inducibility rose sigmoidally as wavelength shortened, with a model-derived transition near lambda50=4.5 cm. Advanced substrates showed increased wavebreak, spatial randomness, short-memory dynamics, broad spectral dispersion, positive nonlinear indices and resistance to random local ablation. Culprit atrial premature beats within the vulnerable window efficiently triggered AF, whereas counter pacing at 20 to 35 ms reduced inducibility from 52% to 11% in stage 2. CONCLUSIONS: In this controlled model, AF initiation and maintenance were linked to substrate-dependent wavelength, wavelet capacity and vulnerable-window triggering. The model-derived transition provides a testable framework for future high-density mapping, patient30 specific modeling and device-based studies. Key Words atrial fibrillation; turbulence-like electrical activity; substrate remodeling; critical wavelength; multi-wavelet re-entry; vulnerable window; culprit premature atrial beat; counter pacing

The features of the PPG (photoplethysmography) morphology are known to reflect age-related cardiac and vascular changes. In most contemporary wearables, PPG signals are acquired from distal sites such as the wrist and finger. The superficial temporal artery (STA), accessible at the temple region, is reached via a shorter arterial path from the aortic root than the radial circulation, and may therefore carry hemodynamic and aging information with less distance-dependent attenuation. We hypothesized that the morphology of the PPG at temple region (STA) would show stronger and more numerous age correlates than the PPG at the wrist. To test this, we extracted a common set of 89 pulse-morphology features, spanning raw-waveform timing/amplitude/area measures, ratios among them, derivative-based ratios, and spectral harmonic-ratio features. We compared an in-house temple-worn device which has PPG as one of the sensors, with a publicly available Microsoft Aurora-BP wrist-worn PPG dataset, and tested each feature's association with age. We identified 14 robust age correlates at the temple region, compared to 3 at the wrist. The temple's correlates spanned multiple morphological categories and showed a larger age-association than at the wrist. These results support the hypothesis that the temple region may be a more robust PPG measurement site than the wrist to extract age-related cardiovascular information, which motivates further investigation of temple-based cardiovascular sensing.

Globally, hypercholesterolemia affects over 20% of the population; and while many studies have examined its impact on cardiovascular health, little is known about its effects on the lymphatic system. In mice, hypercholesterolemia has been linked to multiple aspects of lymphatic dysfunction; and a recent study demonstrated that cholesterol depletion by cyclodextrins promoted lymphatic vessel regeneration and restored lymphatic drainage in mouse models of lymphedema. Collecting lymphatic vessels rely on the spontaneous and highly entrained contractions of lymphatic muscle cells (LMCs) and competent unidirectional on-way valves to propel lymph forward. Critical to lymphatic pacemaking and contractility is the proper functioning of ion channels, which are known to be modulated by the cholesterol content in the plasma membrane. Therefore, we sought to understand the role cholesterol plays in regulating lymphatic contractility. The effects of cholesterol depletion by the cyclodextrins M{beta}CD and HP{beta}CD were assessed in cannulated and pressurized inguinal-axillary collecting lymphatic vessels (CLVs) from C57BL6/J (WT) mice. Noteworthy, studies have shown that HP{beta}CD is safe for human use, and in fact, it is commonly used as a drug excipient. Acute treatment with both cyclodextrins significantly increased the pumping capacity of CLVs, as demonstrated by the increased contraction amplitudes by [~]50{+/-}12% and calculated fluid volume displacement by each contraction by [~]35{+/-}11%. Calcium imaging demonstrated that HP{beta}CD increased the amplitude and duration of the large Cav1.2-mediated calcium events (termed calcium flashes. In contrast, cholesterol supplementation by incubation with BODIPY-cholesterol, which presumably incorporates cholesterol into the cell membrane, significantly impaired the contractile activity of CLVs compared to controls by decreasing contraction amplitude (control: 42{+/-}2 {micro}m versus BODIPY-cholesterol: 20{+/-}7{micro}m) and calculated fluid volume displacement (control: 9.2{+/-}3.9nL versus BODIPY cholesterol: 3.3{+/-}1.2nL) which were significantly restored with subsequent cholesterol depletion using HP{beta}CD (amplitude: 36{+/-}11{micro}m, volume displacement: 5.5{+/-}2.4nL). Similarly, treatment with HP{beta}CD significantly improved the contractile capacity of dysfunctional CLVs isolated from hypercholesterolemic ApoEKO mice. In conclusion, changes to cell membrane cholesterol content acutely and significantly altered CLV contractility with depletion improving contractility associated with recruitment of voltage-gated Cav1.2 channels in lymphatic muscle cells (LMCs). Future studies from our lab will determine whether pharmacological depletion of membrane cholesterol can be therapeutic strategy to improve and/or restore lymphatic contractile function in secondary lymphedema, including obesity/hypercholesterolemia-induced and cancer-related lymphedemas.

Cardiac tissue is primarily made up of cardiomyocytes, which are regulated by the autonomic nervous system. We have used and developed approaches such as patch clamping and electrical stimulation-combined calcium imaging, computer modeling, optogenetics and chemogenetics combining with video-based Short-Time Fourier transformation (STFT) method to study the physiological activities of cardiomyocytes. The action potential of cardiomyocytes was found to be synchronized with calcium signals, which can be grouped into two categories by STFT. A mathematical model was developed to simulate the changes in electrical activities within cardiomyocytes caused by energy depletion, especially for 2-deoxy-D-glucose (2DG) treatment. Optogenetic and chemogenetics tools, such as ChR2(H134R), OptoXR-{beta}2AR and hM3Dq accelerated beating, while GR, ACR1 and hM4Di inhibited cardiomyocytes beating. A video-based STFT method was developed to visualize the beating frequency during these manipulations. An in vitro co-culture method was developed to study the relationship between sympathetic neuronal firing and calcium dynamics in cardiomyocytes. In vivo, electrocardiograph (ECG) measurements showed that Clozapine N-oxide (CNO) caused heart rates increasement in cTnT-hM3Dq virus injected mouse. However, it had no impact on cTnT-hM4Di virus injected mouse. This study provides comprehensive methodologies for studying cardiomyocyte physiology and manipulating heart rates in vitro and in vivo.

Scar-related ventricular tachycardia (VT) is sustained by patient-specific structural and functional remodeling of the ventricular substrate, and the optimal substrate-based ablation strategy remains debated. We present an image-based computational framework for conducting controlled in silico trials of VT ablation strategies. Patient-specific left ventricular electrophysiology models were generated from late gadolinium enhancement cardiac magnetic resonance images by incorporating image-derived scar, border-zone tissue with structural fibrosis, fiber orientation, and physiologically plausible Purkinje-driven sinus activation. A dedicated standalone graphical user interface was developed to perform interactive virtual ablation based on imaging-derived or simulated electrophysiological data. We implemented standardized VT reinducibility testing to compare different lesion sets in terms of residual VT inducibility and ablation burden. As a proof of concept, the framework was applied to 20 patients with ischemic or non-ischemic cardiomyopathy undergoing VT ablation. Sustained VT was inducible in 17 patients, yielding 127 sustained VT episodes and 88 unique reentrant circuits at baseline. Four substrate-based ablation strategies were compared: scar homogenization, primary deceleration-zone ablation, primary plus secondary deceleration-zone ablation, and CMR-guided scar dechanneling. All strategies significantly reduced VT inducibility compared with baseline. Scar homogenization achieved the largest reduction in residual unique sustained VTs but required the largest ablated myocardial volume. Conversely, CMR- guided scar dechanneling showed the most favorable efficiency profile by reducing VT inducibility while limiting ablated viable myocardium. The proposed framework enables quantitative comparison of ablation efficacy, ablation burden, and mechanisms of ablation success or failure in image-guided VT therapy planning.

Animals use long-range signals, such as hormones and neural signals, to coordinate the actions of distant organs. There is no precise, quantitative framework that explains the problems these control systems must solve and thus predicts their behavior under varied conditions. We consider this problem in the context of blood glucose regulation by the hormone insulin, the failure of which produces diabetes. We show that existing mathematical models of glucose regulation admit equivalent control strategies with no hormones at all, and thus cannot explain the need for hormonal regulation. We therefore introduce a minimal model of inter-organ variations in local glucose, and show that control strategies based on local glucose measurements face severe trade-offs between different control objectives. In contrast, we show that hormonal control signals from the pancreas can overcome these limitations. By exposing the benefits of hormonal control, our work paves the way to a detailed understanding of physiological design principles, with possible implications for the engineering of an artificial pancreas.

Scaling laws help determine the optimal data size for training large models but are established in domains where the target is deterministic. Physiological signals are different: heartbeat sequences are stochastic, so part of the error is irreducible even with large amounts of data. Metrics such as MAE do not account for non-deterministic behavior, and therefore assessing scaling requires evaluating distributional calibration (measuring how well predicted probability densities capture true conditional characteristics). We formulate a scaling law metric(n) = E + A n- and evaluate it with five metrics: accuracy (MAE, RMSE), distributional calibration (KS distance, goodness-of-fit), and training objective (negative log loss) using a neural temporal point process trained on a cohort of four-ECG datasets. The law fits all five metrics. While point accuracy is near saturation at n = 183, KS distance and goodness-of-fit improve by 6% and 12% respectively when extrapolated to 10,000 subjects, showing that scaling decisions in stochastic domains must be guided by distributional calibration rather than point accuracy.

Background: Heart failure (HF) is classified by ejection fraction: reduced EF (<40%) is HFrEF and preserved EF (>50%) is HFpEF. Unlike HFrEF, no therapeutic agent improves mortality in HFpEF. The molecular mechanism that produces HFpEF is not completely understood, but the cascade of pathology that produces HFpEF is thought to begin with changes in vascular reactivity, including a decrease in NO mediated vasodilatation, which coupled with subsequent changes in contractility, energetics and coronary blood flow produce HFpEF. If abnormal vascular reactivity is the initial step in the pathological cascade that produces HFpEF, restoring and/or improving vascular reactivity could represent a novel treatment strategy. Vascular reactivity is primarily regulated by myosin light chain phosphatase, which has catalytic, myosin targeting (MYPT1) and 20kDa subunits. Alternative mRNA splicing of exon24 (E24) of the MYPT1 transcript produces MYPT1 isoforms that differ by the presence or absence of a COOH-terminal leucine zipper (LZ+/LZ-); E24 exclusion produces an NO responsive LZ+ MYPT1, while E24 inclusion produces an NO unresponsive LZ- MYPT. Methods: We used the mouse two-hit model of HFpEF (high fat diet and L-NAME) and treated mice with an antisense octo-guanidine targeting the 5' splice site of E24 (ASO-E24) to increase the expression of the NO responsive, LZ+ MYPT1 isoform in vascular smooth muscle. Invasive and noninvasive hemodynamics were used to determine LV function. Results: Compared to mice with HFpEF, ASO-E24 treatment maintains LZ+ MYPT1 expression (4.7{+/-}0.7au v 1.0{+/-}0.4au v 2.0{+/-}0.4au, control v HFpEF v ASO-E24 Rx, p<0.05), improves diastolic function; LVEDP (10{+/-}1mmHg v 20{+/-}4mmHg v 14{+/-}3mmHg, p<0.05), dP/dtmin (-8000{+/-}300mmHg/s v 6000{+/-}500mmHg/s v 8500{+/-}700mmHg/s, p<0.05), both early (E; 0.60{+/-}0.05m/s v 0.42{+/-}0.06m/s v 0.64{+/-}0.06m/s, p<0.05) and late diastolic filling (A; 0.38{+/-}0.03m/s v 0.24{+/-}0.02m/s v 0.47{+/-}0.04m/s, p<0.050 and also prevents the increase in lung weight (167{+/-}5g v 175{+/-}7g v 166{+/-}5g, p<0.05). Further, mice treated with ASO-E24 maintained normal relaxation to 8Br-cGMP (65{+/-}5% v 44{+/-}9% v 72{+/-}9%, p=0.05). Conclusion: These data demonstrate that maintaining normal LZ+ MYPT1 expression and vascular reactivity prevent the development of HFpEF. These results are consistent with the hypothesis that abnormal vascular reactivity is the initial and primary step in the pathological cascade that produces HFpEF and ASO-E24, which is designed to preserve normal LZ+ MYPT1 expression and vascular reactivity, could represent a novel and effective treatment strategy for HFpEF.

The energetic cost of building human skeletal muscle has never been explicitly calculated or measured. We developed a quantitative bottom-up accounting model that integrates human skeletal-muscle composition with empirically informed estimates of tissue synthesis, physiological deposition, maintenance during accretion, and diet-induced thermogenesis. The calculation was expressed per kg of wet skeletal muscle and organized into five additive components: stored tissue energy, biochemical synthesis cost, physiological deposition cost, resting maintenance during accretion, and diet-induced thermogenesis. Stored tissue energy was approximately 5670 kJ/kg (1355 kcal/kg). Adding biochemical synthesis cost gave 6340 kJ/kg (1515 kcal/kg). Applying empirically derived deposition-efficiency parameters yielded a physiological deposition requirement of 9780 to 11690 kJ/kg (2338 to 2793 kcal/kg), centrally 10830 kJ/kg (2587 kcal/kg). Adding resting maintenance during accretion and diet-induced thermogenesis produced a final additional metabolizable energy intake of 13410 to 15520 kJ/kg (3204 to 3710 kcal/kg), centrally 14570 kJ/kg (3481 kcal/kg). This value provides a first quantitative reference estimate for the energetic cost of human skeletal-muscle accretion.

Objective: Circadian rhythms are frequently disrupted in patients in the intensive care unit (ICU), potentially worsening clinical outcomes. Continuous enteral nutrition throughout the day and night is common in the ICU, but eliminates feeding-fasting cycles that serve as important timing cues for the circadian system. The objective of this study was to determine the effect of providing enteral nutrition in a cyclic daytime pattern, compared with continuous administration, on circadian rhythmicity in critically ill patients in the ICU. Design: Single-center randomized controlled trial Setting: Mixed medical-surgical tertiary intensive care unit in the Netherlands Patients: Adult ICU patients ([&ge;]18 yr) receiving enteral nutrition. Intervention: Patients were randomized to receive either continuous, or cyclic daytime enteral feeding (08:00-20:00), initiated from the start of nutritional support. Measurements and Main Results: Sixty-two ICU patients were enrolled, of whom 51 were included in the per-protocol analysis. While the amplitude of the 24-hour rhythm in core body temperature did not differ significantly between the cyclic daytime and continuous feeding groups (0.17 [interquartile range: 0.09-0.24] vs. 0.20 [0.13-0.30], p=0.182), the 24-hour rhythm in heart rate was enhanced in patients receiving cyclic daytime feeding, as reflected by significantly higher amplitudes and more synchronized peak times. No significant differences in 24-hour rhythmicity were observed between groups for the other vital signs or melatonin. Conclusions: Our findings suggest that cyclic daytime feeding may strengthen circadian rhythms in critically ill patients. Further studies are warranted to evaluate its impact on clinical outcomes.

Background: Pulmonary arterial hypertension (PAH) is a serious disease with poor prognosis, especially in infants or preterm babies and there is still no optimal treatment for this disease. Noradrenalin (NE) is a vasoactive mediator which is released by sympathetic ganglion. According to previous studies, NE/1-adrenoreceptors is not only in regulating normal physiologic responses, but also in the pathogenesis of PAH. However, the mechanisms of NE in PAH are not fully understood. Methods: Human PASMC (PASMC) was used in this study. Cell viability assay and Wound healing assay were used to evaluate the proliferation and migration of PASMC. Immunoprecipitation and western blots analysis were used to investigate the mechanisms which involved in NE-induced PASMC proliferation. Results: We investigated that NE could induce human PASMC proliferation and migration. Furthermore, we first find that endothelin 1 (ET-1) signaling pathway plays an important role in NE-induced PASMC proliferation. ET1 is a critical molecular which is known for regulating cell growth and migration. We investigated that NE could increase NE-1 secretion, further enhancing ET-1 bind to its receptors. For further clarifying the downstream signals in NE/ET-1 induced PASMC proliferation, we detected the phosphorylation and expression levels of ERK and JNK. Conclusions: By combining the results from ours and previous studies, we believed that JNK/c-jun pathway may play an important role in NE-induced PASMC proliferation. Key Words: Noradrenaline; Pulmonary Arterial Hypertension; Pulmonary Artery Smooth Muscle Cells; Endothelin-1; JNK/c-Jun Signaling.

Background: Non-motor symptoms, including sleep and cognitive dysfunction, are major contributors to reduced quality of life in people with Parkinsons disease (PwPD). Dance has been proposed as a promising intervention to improve quality of life in PwPD. Previously, we reported longitudinal trajectories of global cognition following community-based dance; however, little is known about its long-term influence on sleep-related non-motor symptoms and their relationship with global cognitive performance. Objective: We examined the six-year trajectories of sleep and overall non-motor symptom severity among PwPD participating in weekly community-based dance classes compared to a sedentary Reference group. As a secondary objective, we evaluated their association with global cognitive performance as a functional outcome. Methods: This longitudinal observational study followed PwPD engaged in community dance participation as well as a matched sedentary control group from the Parkinsons Progression Markers Initiative database over six years. Generalized estimating equations (GEE) were used to model group-level trends, with sensitivity analyses conducted to assess the robustness of the findings. Results: Non-motor outcomes showed that insomnia worsened significantly within the Reference group (p = .003) but improved among dancers (p = .005), with daytime sleepiness remaining stable across both groups. When sleep was used as a predictor of cognition, global cognitive performance trended to improve in the Dance group (p = .078) and declined mid-period in the Reference group (p = .014). In addition, overall non-motor symptom severity worsened in the Reference group (p = .011) but remained stable in the Dance group. Constipation also worsened significantly in the Reference group (p = .012) compared to the Dance group. Conclusion: The present study demonstrates that community-based dance may support select non-motor symptoms, including insomnia, and cognitive resilience in PwPD. Findings reinforce dance as a valuable, real-world, non-pharmacological approach to slow functional decline in PD.

Heart Failure with Preserved Ejection Fraction (HFpEF) is more prevalent in females and is associated with altered cardiac glucose metabolism. However, whether these metabolic alterations are conserved across sexes and between humans and widely used cardiometabolic mouse model of HFpEF remains unclear. We investigated species-, sex-, and ventricle-specific conserved and divergent features of HFpEF. Cardiometabolic HFpEF was induced in mice using the 'two-hit' model (high-fat diet + L-NAME), followed by assessment of cardiac function, RNA sequencing, and protein expression in the right (RV) and left (LV) ventricles. Published human HFpEF RV and LV RNA-seq datasets were reanalyzed and compared with our mouse data. Only male HFpEF mice recapitulated human phenotype of increased RV GLUT1 protein. In contrast, mouse GLUT1 was downregulated in RV of females and in the LV of both sexes, whereas GLUT4 protein remained unchanged. Cardiac PDK4 transcript and protein levels increased in the RV and LV of mice. Conversely, human PDK4 mRNA levels were reduced in the RV with HFpEF and unchanged in LV. Cardiac transcriptome analysis in mice revealed extensive alterations in LV, particularly in females, with enrichment of inflammatory pathways. Cross-species analysis demonstrated greater conservation of HFpEF-associated signatures in the RV than the LV. Furthermore, number of differentially expressed transcripts in human LV increased substantially after excluding patients with atrial fibrillation or diabetes. Overall, the RV of the 'two-hit' model more closely resembles human HFpEF. The cardiac transcriptome reflects sexual dimorphism, and conserved signatures are primarily associated with metabolic alteration, mitochondrial dysfunction, and cellular stress.

BackgroundInsular damage leads to marked cardiovascular alterations and the mechanisms need to be understood. Mouse models provide unique opportunities to gain insights into pathophysiological mechanisms. Here, we evaluated the effects of rilmenidine, a centrally acting antihypertensive drug, on the cardiac functional parameters and cardiac inflammatory cell infiltration in a newly developed mice model of insular hemorrhagic stroke. MethodsC57BL/6J mice were instrumented for injection of blood or vehicle into the insular cortex (IC). Immediately after IC stroke induction, separate groups received intraperitoneal treatment with vehicle (0.9% NaCl, 0.1 mL/100 g) or rilmenidine (10 g/kg) for three days. Electrocardiogram recording,cardiac catecholamine levels and myocardial accumulation of immune cells were evaluated. ResultsMice subjected to hemorrhagic stroke exhibited higher baseline heart rate (HR) (control: 296 {+/-} 33 bpm vs. stroke: 349 {+/-} 38 bpm; P < 0.01) and prolonged QTc interval (control: 89 {+/-} 11 ms vs. stroke: 100 {+/-} 7 ms; P < 0.01). Stroke also increased cardiac norepinephrine levels (control: 9 {+/-} 4 ng/mg vs. stroke: 25 {+/-} 14 ng/mg; P < 0.05), as well as the number of myocardial CD68+ macrophages (control: 7 {+/-} 4 vs. stroke: 16 {+/-} 6 cells/field; P < 0.0001) and Ly6G+ neutrophils (control: 0.5 {+/-} 0.7 vs. stroke: 1.5 {+/-} 1 cells/field; P < 0.001). Rilmenidine treatment markedly prevented all major stroke- induced myocardial functional and inflammatory changes ConclusionsInsular hemorrhagic stroke in mice induces centrally mediated cardiac noradrenergic hyperactivation accompanied by myocardial accumulation of immune cells. These findings support the relevance of this murine model for investigating mechanisms associated with insular stroke.

Conventional electrocardiography is highly effective for waveform and rhythm diagnosis, but it is less suited to showing how the internal shape of hundreds or thousands of consecutive heartbeats changes over time. We introduce FOXTAIL, a complementary view that represents each cardiac cycle as an ordered sequence of changes in signal direction. Overlaying these sequences in a fixed visual field makes beat-to-beat organization visible and allows the density, size, stability, and scale persistence of those changes to be measured. We evaluated the representation in recordings containing normal sinus rhythm, paroxysmal atrial fibrillation, severe heart failure, ventricular tachyarrhythmia, and controlled electrode-motion noise. Paired recordings showed that FOXTAIL descriptors can reveal within-person state changes that are not conveyed by a single average beat. The noise and pre-fibrillation analyses also showed that a dense event pattern is not automatically equivalent to physiological complexity, measurement artifact, or impending disease. FOXTAIL is therefore not proposed as a replacement for the diagnostic ECG or as a new classifier, but as an observation and measurement domain for asking a more basic question: how is the electrical organization of the heart changing from one beat to the next, and which of those changes persist across scale?

T cell repertoire sequencing has unveiled a vast, complex array of T cells responsible for the human immune responses. Traditional analytic methodology fails to fully characterize and quantify the diversity of T cell receptors constituting the T cell repertoire. T cell receptor clonal frequency measured in terms of T cell receptor beta (TRB) V gene segment usage when arrayed in correspondence with the respective V gene segment positions on the TRB loci yields a periodic, undulating curve in the spatial domain of the TRB genomic locus. Using the genomic distance from the TRB-D1 segment to the TRB-V1-29 segments, Fourier analysis was performed utilizing Lomb-Scargle periodogram to obtain Spectral Power curves quantifying the TRB V clonal frequencies from 6 allogeneic stem cell transplant donors (baseline) and recipients (>/=100 days) using a variety of analytic software. Spectral Power curves revealed dominant spectral peaks at wavelengths ranging from 4-9 kb (113-252 millicycles/kb) in the six donors, with consistent frequency domain spectral patterns. This is consistent with similar use of V segments across healthy individuals. Recipients on the other hand demonstrated more dispersed spectra, with a spectral centroid shifted towards higher frequencies compared to donors (260 vs. 247 millicycles/kb). Consistent with this observation, the Low Frequency Index was lower in the recipients (0.18 vs 0.20). Power was concentrated in the <3 kb and 3-12 kb wavelengths in both groups. The analyses reported here demonstrate that the healthy SCT donors have a remarkably similar spectral signature occupying short to intermediate wavelegnths in the frequency domain, whereas recipients tend to shift towards higher frequencies. These findings are consistent with a normal organized distribution of TRB V segment usage in healthy individuals (by analogy other loci), and a more diffuse and disorderly usage in recipients, consistent with the notion of T cell responses constituting a dynamical system which evolves as a function of time. Fourier analysis of TRB (and potentially TRA) sequencing data provides a repertoire wide summary of T cell clonal distribution.

Background: Blood volume (BV) in patients with chronic heart failure (HF) is characterized by heterogeneity in volume profiles; one profile being "normal BV". While overall intravascular volume may be considered normal clinically, the relative contributions of red blood cell (RBC) mass and plasma volume (PV) may not be. Objective: Assess how normal is a "normal BV" based on quantitative measures of RBC mass and PV. Methods: Retrospective analysis was undertaken in 395 patients with Class II-III HF. BV was quantitated using indicator-dilution methodology. Cohort was stratified by normal and hypervolemic BV. Results: Of the cohort, 31% (123/395) demonstrated normal total BV and 62% (244/395) hypervolemic BV. Of patients with "normal BV", 36% (44/123) demonstrated normal RBC mass and 60% normal PV (74/123). Importantly, 60% (74/123) demonstrated a deficit in RBC mass (true anemia), while a low hemoglobin (<12 g/dL) was present in just 29% (36/123). An excess in RBC mass (erythrocytosis) in 4% (5/123). Notably, true normal BV (i.e., normal RBC mass and normal PV) was observed in only 30% (37/123) of patients with an overall "normal" intravascular volume. Conclusions: Findings reveal that "normal BV" can be misleading by concealing substantial variability in RBC mass (including unrecognized anemia and erythrocytosis) as well as different degrees of PV expansion and contraction. An actual normal BV was identified in a minority of "normal BV" patients. This underscores the importance of looking beyond overall "normal BV" to the contributing elements of RBC mass and PV with significant implications for patient management and outcomes.

Objectives To validate two computational fluid dynamics (CFD) models derived from computed tomography angiography (CTA) for estimating trans-stenotic pressure gradients, using invasive intra-arterial pressure measurements as the reference standard in patients with renal artery stenosis (RAS). Background We assessed whether non-invasive assessment of the pressure gradient using CFD could be a reliable alternative to intra-arterial measurements for identifying hemodynamically significant RAS. Methods We performed intra-arterial measurements at rest and during dopamine-induced hyperemia to assess the trans-stenotic pressure gradient in 28 patients with RAS. A pre-intervention CTA scan was used to simulate the pressure gradient with a CFD model using a strategy based on Murray's law (CFD-Mu) and cortical volume (CFD-C). The agreement between the simulated and measured pressure gradients was assessed using intraclass correlation coefficients (ICC), Bland-Altman analysis and diagnostic agreement on the presence of a hemodynamically significant stenosis. Results In 20 patients, successful measurements and simulations were obtained. The ICC between measured pressure gradient and the CFD pressure gradient was 0.78 and 0.94 during baseline and 0.86 and 0.72 during hyperemia, for CFD-Mu and CFD-C, respectively. The sensitivity of CFD-Mu and CFD-C was 70% for both models at rest and 100% compared to the hyperemic measurements, whereas the specificity was 90% and 70% at rest and 79% and 72% during hyperemia, respectively. Conclusions The results support the use of individualized CFD simulations for hemodynamic assessment of RAS using CTA as input. The CFD models demonstrated high accuracy for the identification of a hemodynamically significant stenosis.

AimThe present study investigated the significance of iron in regulating megakaryopoiesis, by a diet-based intervention in an in-vivo model. MethodsMale C57BL/6 mice, aged 4-5 weeks were fed on varying iron diets. Following sacrifice, blood samples collected in EDTA tubes were used to analyse haematological parameters, and iron content of liver and spleen was assessed by biochemical analyses. Megakaryocyte-erythroid progenitors (MEPs) were isolated from bone marrow by magnetic bead-based selection. RNA isolated from bone marrow cells and MEPs were used for gene expression analyses, and RNA Sequencing to identify differentially expressed genes (DEGs) and associated pathways. ResultsMice fed on an iron-deficient diet had reduced hepatic iron content after 5 weeks (p < 0.01), while both the hepatic and spleen iron content increased after 3 weeks in mice on an iron-rich diet (p < 0.05) and developed iron overloading. Hb and RBC counts increased (p < 0.05) in iron-rich mice and decreased in iron-deficient mice (p < 0.05), which also showed elevated platelet counts (p < 0.01). This may be explained by increased expression of Gata1, Tal1 (p < 0.01) Mds1 and Pdpk1 (p < 0.05) in bone marrow cells from iron-deficient mice. MEPs isolated from these mice showed elevated expression of genes associated with megakaryocytic differentiation, platelet functions, and genes encoding TGF-{beta}R1 and Smad 2,3 and 4. ConclusionsIron deficiency may activate TGF-{beta} signalling and downstream Smad-mediated transcriptional programs within MEPs. This may promote a shift in lineage commitment towards megakaryopoiesis through elevated expression of megakaryopoiesis related genes.