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Lwin TC, Zin TT, Tin P, Kino E, Ikenoue T. Advanced Predictive Analytics for Fetal Heart Rate Variability Using Digital Twin Integration. SENSORS (BASEL, SWITZERLAND) 2025; 25:1469. [PMID: 40096274 PMCID: PMC11902867 DOI: 10.3390/s25051469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 02/24/2025] [Accepted: 02/25/2025] [Indexed: 03/19/2025]
Abstract
Fetal heart rate variability (FHRV) is a critical indicator of fetal well-being and autonomic nervous system development during labor. Traditional monitoring methods often provide limited insights, potentially leading to delayed interventions and suboptimal outcomes. This study proposes an advanced predictive analytics approach by integrating approximate entropy analysis with a hidden Markov model (HMM) within a digital twin framework to enhance real-time fetal monitoring. We utilized a dataset of 469 fetal electrocardiogram (ECG) recordings, each exceeding one hour in duration, to ensure sufficient temporal information for reliable modeling. The FHRV data were preprocessed and partitioned into parasympathetic and sympathetic components based on downward and non-downward beat detection. Approximate entropy was calculated to quantify the complexity of FHRV patterns, revealing significant correlations with umbilical cord blood gas parameters, particularly pH levels. The HMM was developed with four hidden states representing discrete pH levels and eight observed states derived from FHRV data. By employing the Baum-Welch and Viterbi algorithms for training and decoding, respectively, the model effectively captured temporal dependencies and provided early predictions of the fetal acid-base status. Experimental results demonstrated that the model achieved 85% training and 79% testing accuracy on the balanced dataset distribution, improving from 78% and 71% on the imbalanced dataset. The integration of this predictive model into a digital twin framework offers significant benefits for timely clinical interventions, potentially improving prenatal outcomes.
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Affiliation(s)
- Tunn Cho Lwin
- Interdisciplinary Graduate School of Agriculture and Engineering, University of Miyazaki, Miyazaki 889-2192, Japan;
| | - Thi Thi Zin
- Graduate School of Engineering, University of Miyazaki, Miyazaki 889-2192, Japan;
| | - Pyke Tin
- Graduate School of Engineering, University of Miyazaki, Miyazaki 889-2192, Japan;
| | - Emi Kino
- Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan; (E.K.); (T.I.)
| | - Tsuyomu Ikenoue
- Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan; (E.K.); (T.I.)
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Zwanenburg F, Bos TA, Ten Harkel ADJ, Haak MC, Hahurij ND, Poelmann RE, van Munsteren CJ, Wisse LJ, Blom NA, DeRuiter MC, Jongbloed MRM. Development of autonomic innervation at the venous pole of the heart: bridging the gap from mice to human. J Transl Med 2025; 23:73. [PMID: 39815264 PMCID: PMC11734484 DOI: 10.1186/s12967-024-06049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 12/25/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Prenatal development of autonomic innervation of sinus venosus-related structures might be related to atrial arrhythmias later in life. Most of the pioneering studies providing embryological background are conducted in animal models. To date, a detailed comparison with the human cardiac autonomic nervous system (cANS) is lacking. The aim of this study was to compare the morphological and functional development of the cANS between mouse and human, specifically aimed at the venous pole. METHODS Wildtype mouse embryos (E9.5-E18.5) and healthy human fetuses (6-38 weeks gestational age (WGA)) were studied at sequential stages to obtain a comparative developmental series. Cardiac autonomic function was assessed through heart rate variability (HRV) analysis using ultrasound. Morphological assessment of the venous pole was performed using immunohistochemical stainings for neural crest cells and autonomic nerve markers. RESULTS Murine cANS function did not definitively establish in utero as HRV parameters depicted no trend prior to birth. In contrast, human HRV parameters greatly increased from 20 to 30 WGA, indicating that human cANS function is established prenatally around 20 WGA and matures thereafter. Morphologically, cANS development followed a similar sequence with neural crest-derived nerves entering the venous pole in proximity to the developing pulmonary vein in both species. However, the timing of differentiation into sympathetic or parasympathetic phenotype was markedly distinct, as human autonomic markers emerged relatively later when related to major cardiogenesis. Structures related to arrhythmogenicity in humans, such as the ligament/vein of Marshall and the myocardium surrounding the pulmonary veins, become highly innervated during embryonic development in both mice and humans. CONCLUSION Although early morphological cANS development at sinus venosus-related structures follows a similar sequence in mice and humans, there are substantial differences in the timing of functional establishment and differentiation in sympathetic and parasympathetic phenotypes, which should be taken into account when extrapolating mouse studies of the cANS to humans. The abundant innervation of sinus venosus-related structures may play a modulatory role in arrhythmogenesis under pathological conditions.
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Affiliation(s)
- Fleur Zwanenburg
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Thomas A Bos
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Nathan D Hahurij
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Robert E Poelmann
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands
- Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Conny J van Munsteren
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands
| | - Lambertus J Wisse
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy & Embryology, Leiden University Medical Center, P.O. Box 9600, Postal Zone: S-1-P, 2300 RC, Leiden, The Netherlands.
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Center of Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands.
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Park MS, Kim EJ. A Correlative Relationship Between Heart Failure and Cognitive Impairment: A Narrative Review. J Korean Med Sci 2023; 38:e334. [PMID: 37821090 PMCID: PMC10562184 DOI: 10.3346/jkms.2023.38.e334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 10/13/2023] Open
Abstract
Heart failure (HF) is a chronic condition affecting millions of people worldwide. While the cardinal manifestations of HF are related to the cardiovascular system, it has become progressively evident that mild cognitive impairment (MCI) is also a significant complication of the disease. In fact, a significant number of patients with HF may experience MCI, which can manifest as deficits in attention, memory, executive function, and processing speed. The mechanisms responsible for cognitive dysfunction in HF are intricate and multifactorial. Possible factors contributing to this condition include decreased cerebral blood flow, thrombogenicity associated with HF, systemic inflammatory conditions, and proteotoxicity. MCI in HF has significant clinical implications, as it is linked to poorer quality of life, increased morbidity and mortality, and higher healthcare costs. Additionally, MCI can disrupt self-care behaviors, adherence to medication, and decision-making abilities, all of which are crucial for effectively managing HF. However, there is currently no gold standard diagnostic tool and follow-up strategy for MCI in HF patients. There is limited knowledge on the prevention and treatment of MCI. In conclusion, MCI is a common and clinically important complication of HF. Considering the substantial influence of MCI on patient outcomes, it is imperative for healthcare providers to be cognizant of this issue and integrate cognitive screening and management strategies into the care of HF patients.
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Affiliation(s)
- Myung Soo Park
- Department of Medicine, Korea University Graduate School, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Donaldson AC, Meyer LCR, Fuller A, Buss PE. Comparison of the cardiovascular effects of immobilization with three different drug combinations in free-ranging African lions. CONSERVATION PHYSIOLOGY 2023; 11:coac077. [PMID: 36655170 PMCID: PMC9835075 DOI: 10.1093/conphys/coac077] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/11/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Thirty-six free-ranging lions (12 per group) were immobilized with tiletamine-zolazepam (Zoletil 0.6 mg/kg i.m.) plus medetomidine (0.036 mg/kg i.m.) (TZM), ketamine (3.0 mg/kg i.m.) plus medetomidine (0.036 mg/kg i.m.) (KM) or ketamine (1.2 mg/kg i.m.) plus butorphanol (0.24 mg/kg i.m.) plus medetomidine (0.036 mg/kg i.m.) (KBM). During immobilization cardiovascular variables were monitored at 5-minute intervals for a period of 30 minutes. Lions immobilized with all three drug combinations were severely hypertensive. Systolic arterial pressure was higher at initial sampling in lions immobilized with KM (237.3 ± 24.8 mmHg) than in those immobilized with TZM (221.0 ± 18.1 mmHg) or KBM (226.0 ± 20.6 mmHg) and decreased to 205.8 ± 19.4, 197.7 ± 23.7 and 196.3 ± 17.7 mmHg, respectively. Heart rates were within normal ranges for healthy, awake lions and decreased throughout the immobilization regardless of drug combination used. Lions immobilized with TZM had a higher occurrence (66%) of skipped heart beats than those immobilized with KBM (25%). The three drug combinations all caused negative cardiovascular effects, which were less when KBM was used, but adverse enough to warrant further investigations to determine if these effects can be reversed or prevented when these three combinations are used to immobilize free-living lions.
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Affiliation(s)
| | - Leith Carl Rodney Meyer
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Pretoria, Gauteng, South Africa, 0110
- Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Pretoria, South Africa, 0110
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa, 2193
| | - Andrea Fuller
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Pretoria, Gauteng, South Africa, 0110
- Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Pretoria, South Africa, 0110
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa, 2193
| | - Peter Erik Buss
- Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Pretoria, South Africa, 0110
- Veterinary Wildlife Services, South African National Parks, Kruger National Park, Skukuza, South Africa, 1350
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Soutpan Road, Onderstepoort, Gauteng, South Africa, 0110
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Widatalla N, Khandoker A, Yoshida C, Nakanishi K, Fukase M, Suzuki A, Saito M, Kimura Y, Kasahara Y. Correlation between maternal and fetal heart rate increases with fetal mouse age in typical development and is disturbed in autism mouse model treated with valproic acid. Front Psychiatry 2022; 13:998695. [PMID: 36518366 PMCID: PMC9743798 DOI: 10.3389/fpsyt.2022.998695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is considered a significant behavioral problem that is characterized by impairment in social interaction and communication. It is believed that some cases of ASD originate in the intrauterine maternal environment. Therefore, we hypothesized that there might be qualitative changes in the interaction between the mother and fetus in ASD during the prenatal period, hence, we investigated the similarity patterns between maternal and fetal heart rate (HR). METHODS In this study, we first demonstrate the presence and formation of similarities between maternal and fetal RR interval (RRI) collected from typical developmental mice at different embryonic days (EDs), ED13.5, ED15.5, ED17.5, and ED18.5. The similarities were quantified by means of cross-correlation (CC) and magnitude-squared coherence (MSC) analyses. Correlation analysis between the CC coefficients and EDs and between MSC coefficients and EDs showed that the same coefficients increase with EDs, suggesting that similarities between maternal and fetal RRI are associated with typical fetal development. Next, because maternal and fetal similarities were indicative of development, a comparison analysis between the autism mouse model (injected with valproic acid (VPA)), and the control group (injected with saline) was performed for ED15.5 and ED18.5. RESULTS The results of the comparison showed that the CC and MSC coefficients of VPA fetuses were significantly lower than that of the control group. The lower coefficients in VPA-treated mice suggest that they could be one of the features of ASD symptoms. The findings of this study can assist in identifying potential ASD causes during the prenatal period.
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Affiliation(s)
- Namareq Widatalla
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Ahsan Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Chihiro Yoshida
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kana Nakanishi
- Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miyabi Fukase
- Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Arisa Suzuki
- Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatoshi Saito
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan.,Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Maternal and Child Health Care Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Kimura
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan.,Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kasahara
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan.,Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Maternal and Child Health Care Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Cerritelli F, Frasch MG, Antonelli MC, Viglione C, Vecchi S, Chiera M, Manzotti A. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci 2021; 15:721605. [PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors-i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure-may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
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Affiliation(s)
- Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Marta C. Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis”, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Viglione
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Stefano Vecchi
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
- Department of Pediatrics, Division of Neonatology, “V. Buzzi” Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
- Research Department, Istituto Osteopatia Milano, Milan, Italy
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