1/f-like scaling in normal neutrophil dynamics: implications for hematologic monitoring

The developing optic tectum: An asymmetrically organized system and the need for a redefinition of the notion of sensitive period

The present article summarizes the main events involved in the isthmic organizer and optic tectum determination and analyses how optic tectum patterning is translated, by the organized operation of several specific cell behaviors, into the terminally differentiated optic tectum. The paper proposes that this assembling of temporally/spatially organized cell behaviors could be incorporated into a wider notion of patterning and that, given the asymmetric organization of the developing optic tectum, the notion of "sensitive period" does not capture the whole complexity of midbrain development and the pathogenesis of congenital disorders. The cell behaviors involved in the optic tectum development are organized in time and space by the isthmic organizer. A comprehensive description of the normal optic tectum development, and also its alterations, should consider both domains. Significantly, the identity of each neuronal cohort depends critically on its "time and place of birth". Both parameters must be considered at once to explain how the structural and functional organization of the optic tectum is elaborated. The notion of "patterning" applies only to the early events of the optic tectum development. Besides, the notion of "sensitive period" considers only a temporal domain and disregards the asymmetric organization of the developing optic tectum. The present paper proposes that these notions might be re-defined: (a) a wider meaning of the term patterning and (b) a replacement of the term "sensitive period" by a more precise concept of "sensitive temporal/spatial window".

Hidden Signals-The History and Methods of Heart Rate Variability

The understanding of heart rate variability (HRV) has increased parallel with the development of modern physiology. Discovered probably first in 1847 by Ludwig, clinical applications evolved in the second part of the twentieth century. Today HRV is mostly used in cardiology and research settings. In general, HRV can be measured over shorter (e.g., 5-10 min) or longer (12 or 24 h) periods. Since 1996, most measurements and calculations are made according to the standard of the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. As the first step, the series of times between successive R-peaks in the ECG are in milliseconds. It is crucial, however, to identify and remove extrasystoles and artifacts according to standard protocols. The series of QRS distances between successive heartbeats can be analyzed with simple or more sophisticated algorithms, beginning with standard deviation (SDNN) or by the square root of the mean of the sum of squares of differences between adjacent normal RR (rMSSD). Short-term HRV is frequently analyzed with the help of a non-parametric fast Fourier transformation quantifying the different frequency bands during the measurement period. In the last decades, various non-linear algorithms have been presented, such as different entropy and fractal measures or wavelet analysis. Although most of them have a strong theoretical foundation, their clinical relevance is still debated.

Early dynamic changes in pulse oximetry signals in preterm newborns with histologic chorioamnionitis

OBJECTIVE

No reliable clinical markers of histologic chorioamnionitis (HCA), a major and often subclinical cause of prematurity leading to high neonatal morbidity and mortality, are available to date. Increasing evidence indicates myocardial dysfunctions in affected fetuses and newborns. We sought to assess the value of nonlinear dynamics from pulse oximetry signals in identifying affected newborns.

DESIGN

Prospective case-control study.

SETTING

Tertiary level neonatal intensive care unit, Brindisi Hospital.

PATIENTS AND INTERVENTION

Pulse oximetry-derived signals (pulse rate, oxygen saturation, and perfusion index), recorded within the first 1.5 hrs of life, were analyzed for 110 very low-birth-weight infants, of whom 54 had histopathological evidence of HCA.

MEASUREMENTS AND MAIN RESULTS

Four different time series parameters were determined for nonlinear dynamical (NLD) analysis. Significantly decreased Lempel-Ziv, Lyapunov largest exponent, and correlation dimension, with significantly increased Hurst values for heart rate and perfusion index (p < .00001), were observed in newborns with HCA. Heart rate Lempel-Ziv </=0.218 showed 100% sensitivity (95% confidence interval, 98.8-100) and 100% specificity (95% confidence interval, 98.6-100) in distinguishing cases from controls, with positive and negative predictive values of 100% and 95.7%, respectively.

CONCLUSIONS

Our findings indicate that early autonomic tone balance abnormalities are present in newborns with HCA and suggest that early dynamic analysis of pulse oximetry signals could be useful in identifying affected infants.

Decreased physiologic variability as a generalized response to human endotoxemia*

OBJECTIVE

To test the effect in normal human volunteers of transient systemic inflammation on the variability in time-series behaviors of widely divergent physiologic measures of the human inflammatory response.

DESIGN

Prospective study of human volunteers who were tested on 2 consecutive days, a control day and a treatment day. Each participant served as his or her own control.

SETTING

Critical care facility of a university medical center.

SUBJECTS

Subjects were eight healthy human volunteers.

INTERVENTIONS

Participant subjects were tested on both a baseline day with no intervention and on a treatment day when they received 4 ng/kg intravenous Escherichia coli endotoxin.

MEASUREMENTS AND MAIN RESULTS

Continuous electrocardiographic recordings and serial blood sampling (performed every 5 mins) were used to create time-series of heart rate (R-R intervals), neutrophil function (phagocytosis), and plasma cortisol concentrations. For each primary measure, we recorded a significant increase in the regularity (decreased variability) of the functional measurement as assessed by the statistical entity, approximate entropy.

CONCLUSIONS

Increased regularity, or decreased variability, of organ functions is a generalized response to systemic inflammation that occurs in widely divergent systems during endotoxemia.

Complex systems and the technology of variability analysis

Characteristic patterns of variation over time, namely rhythms, represent a defining feature of complex systems, one that is synonymous with life. Despite the intrinsic dynamic, interdependent and nonlinear relationships of their parts, complex biological systems exhibit robust systemic stability. Applied to critical care, it is the systemic properties of the host response to a physiological insult that manifest as health or illness and determine outcome in our patients. Variability analysis provides a novel technology with which to evaluate the overall properties of a complex system. This review highlights the means by which we scientifically measure variation, including analyses of overall variation (time domain analysis, frequency distribution, spectral power), frequency contribution (spectral analysis), scale invariant (fractal) behaviour (detrended fluctuation and power law analysis) and regularity (approximate and multiscale entropy). Each technique is presented with a definition, interpretation, clinical application, advantages, limitations and summary of its calculation. The ubiquitous association between altered variability and illness is highlighted, followed by an analysis of how variability analysis may significantly improve prognostication of severity of illness and guide therapeutic intervention in critically ill patients.

Homeokinesis and short-term variability of human airway caliber

We hypothesized that short-term variation in airway caliber could be quantified by frequency distributions of respiratory impedance (Zrs) measured at high frequency. We measured Zrs at 6 Hz by forced oscillations during quiet breathing for 15 min in 10 seated asthmatic patients and 6 normal subjects in upright and supine positions before and after methacholine (MCh). We plotted frequency distributions of Zrs and calculated means, skewness, kurtosis, and significance of differences between normal and log-normal frequency distributions. The data were close to, but usually significantly different from, a log-normal frequency distribution. Mean lnZrs in upright and supine positions was significantly less in normal subjects than in asthmatic patients, but not after MCh and MCh in the supine position. The lnZrs SD (a measure of variation), in the upright position and after MCh was significantly less in normal subjects than in asthmatic patients, but not in normal subjects in the supine position and after MCh in the supine position. We conclude that 1) the configuration of the normal tracheobronchial tree is continuously changing and that this change is exaggerated in asthma, 2) in normal lungs, control of airway caliber is homeokinetic, maintaining variation within acceptable limits, 3) normal airway smooth muscle (ASM) when activated and unloaded closely mimics asthmatic ASM, 4) in asthma, generalized airway narrowing results primarily from ASM activation, whereas ASM unloading by increasing shortening velocity allows faster caliber fluctuations, 5) activation moves ASM farther from thermodynamic equilibrium, and 6) asthma may be a low-entropy disease exhibiting not only generalized airway narrowing but also an increased appearance of statistically unlikely airway configurations.

Chaos in multi-looped negative feedback systems

Non-linear control systems with multiple negative feedback loops display periodicity, quasiperiodicity and period-doubling bifurcations leading to chaos. The possibility that normal fluctuations in physiological control may result from deterministic chaos in multi-looped negative feedback systems is discussed.

The effects of burn injury on vasoactivity in hamster peripheral microcirculation

The effects of mild thermal shock on the vasoactivity of microvessels were studied in the hamster skin flap window preparations. Diameter fluctuations in arterioles and venules, varying in size from 10 to 50 microns and at different branching order sites, were measured prior and subsequent to a local surface skin burn. The experimental vasomotion data were characterized in terms of mean, standard deviation, skewness, and kurtosis, and by the Prony spectral line estimator (PSLE), fast Fourier transform (FFT), and auto regression (AR) methods of spectral analysis. Following a mild burn the A1 (37-50 microns), A2 (30-50 microns), and A3 (25-41 microns) arterioles relaxed to a larger diameter by an average of 58, 20, and 13%, respectively. Dispersion statistics postburn showed a skewness close to normal while the kurtosis became more negative, indicating that the transient diameter curves were flatter. Both FFT and PSLE analyses indicate less energy in the signals postburn accompanied by a shift toward lower frequencies with decreased amplitude. In addition, there was a loss of certain frequencies from the spectrum and an increase in the interval for rhythmic activity. FFT analysis gave an idea of the trend while PSLE analysis was found to be highly unstable and dependent on the window size. AR results indicate that the process is stable and definite trends exist in the data, however, the data are not purely periodic.

Applications of nonlinear dynamics to clinical cardiology

(1) Nonlinear mechanisms may apply both to the understanding of SA-AV node interactions and to bifurcations leading to certain types of AV block. (2) The fractal His-Purkinje system serves as the structural substrate for the generation of the broadband, inverse power-law spectrum of the stable ventricular depolarization (QRS) waveform. (3) Fractal anatomy is also seen in multiple other systems: pulmonary, hepatobiliary, renal, etc. Fractal morphogenesis may reflect a type of critical phenomenon that results in the generation of these irregular, but self-similar structures. (4) Self-similar (fractal) scaling may underlie the 1/f-like spectra seen in multiple systems (e.g., interbeat interval variability, daily neutrophil fluctuations). This fractal scaling may provide a mechanism for the "constrained randomness" that appears to underlie physiological variability and adaptability. (5) Behavior consistent with subharmonic bifurcations is seen in cardiac electrophysiology (e.g., sick sinus syndrome) and hemodynamic perturbations (e.g., swinging heart phenomenon in pericardial tamponade). (6) Ventricular tachyarrhythmias associated with sudden cardiac death (e.g., torsades de pointes, ventricular fibrillation) appear to reflect relatively periodic, not chaotic (turbulent) processes resulting from disruption of the physiologic fractal depolarization sequence. (7) Spectral analysis of Holter monitor data may help in the detection of patients at high risk for sudden death.