Development of Human Vital Signs and Body Posture Monitoring and Positioning Alarm Systems / 中国医疗器械杂志

In view of the high incidence of malignant diseases such as malignant arrhythmias in the elderly population, accidental injuries such as falls, and the problem of no witnesses when danger occurs, the study developed a human vital signs and body posture monitoring and positioning alarm system. Through the collection and analysis of electrocardiogram (ECG), respiration (RESP) and acceleration (ACC) signals, the system monitors human vital signs and body posture in real time, automatically judges critical states such as malignant arrhythmias and accidental falls on the local device side, and then issues alarm information, opens the positioning function, and uploads physiological information and patient location information through 4G communication. Experiments have shown that the system can accurately determine the occurrence of ventricular fibrillation and falls, and issue position and alarm information.

Development of Vital Signal Monitoring System Based on Accelerometer / 中国医疗器械杂志

OBJECTIVE@#Reduce the number of false alarms and measurement time caused by movement interference by the sync waveform of the movement.@*METHODS@#Vital signal monitoring system based on motion sensor was developed, which collected and processed the vital signals continuously, optimized the features and results of vital signals and transmitted the vital signal results and alarms to the interface.@*RESULTS@#The system was tested in many departments, such as digestive department, cardiology department, internal medicine department, hepatobiliary surgery department and emergency department, and the total collection time was 1 940 h. The number of false electrocardiograph (ECG) alarms decreased by 82.8%, and the proportion of correct alarms increased by 28%. The average measurement time of non-invasive blood pressure (NIBP) decreased by 16.1 s. The total number of false respiratory rate measurement decreased by 71.9%.@*CONCLUSIONS@#False alarms and measurement failures can be avoided by the vital signal monitoring system based on accelerometer to reduce the alarm fatigue in clinic.

Voiding diary predicts the therapeutic effects on primary monosymptomatic nocturnal enuresis / 现代泌尿外科杂志

【Objective】 To investigate the possibility of using voiding diary (VD) to predict desmopressin diacetate arginine vasopressin (DDAVP) and enuresis alarm (EA) in the treatment of primary monosymptomatic nocturnal enuresis (PMNE). 【Methods】 A total of 100 children (aged 6 to 14 years) with PMNE treated during Jan.2018 and Oct.2022 were involved. Bladder type was classified with two-week VD. Pseudo-randomization was performed using the Danish REDCap system to group patients into the randomized group and VD group. All patients were treated for 8 weeks. 【Results】 A total of 82 cases met the inclusive criteria. The effective rate was 82.50% (33/40) and 59.52% (25/42) in the VD and randomized groups, respectively, with significant difference (χ2=5.224, P=0.022). In the randomized group, if VD was not considered, the effective rate in the DDAVP and EA subgroups was 81.82% (18/22) and 25.00% (5/20), respectively, with significant difference (χ2=13.625, P=0.000). 【Conclusion】 VD can predict the therapeutic effects of PMNE. It is necessary to record VD for two weeks before selecting appropriate treatment methods. For patients who choose treatment without reference to VD, DDAVP shows better response than EA, but the recurrence rate after discontinuation of treatment requires further follow-up.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

Effect of different connection schemes of continuous renal replacement therapy and extracorporeal membrane oxygenation on arterial and venous pressure: an in vitro and in vivo study / 中华危重病急救医学

Objective:To investigate the effects of different connection schemes of continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) on arterial pressure (PA), venous pressure (PV), and transmembrane pressure (TMP), and to provide a theoretical basis for choosing a suitable connection scheme.Methods:① In vitro study: the different connection schemes of CRRT and ECMO were simulated and divided into 6 schemes according to the connection between CRRT and ECMO circuits at different positions. Scheme A: connected to the front and back points of the oxygenator; scheme B: connected to the points behind and in front of the oxygenator; scheme C: connected to the points in front of the oxygenator and in front of the centrifugal pump; scheme D: connected to the points behind the oxygenator and in front of the centrifugal pump; scheme E: connected to the points in front of the oxygenator and the return catheter; scheme F: connected to the points after the oxygenator and the return catheter. Each set of ECMO circuits was measured 5 times under each connection scheme and different flow rates (2, 3, 4, 5, 5.5 L/min). Six ECMO circuits for a total of 30 measurements, and the PA, PV, and TMP of the 6 schemes were compared. ② In vivo study: the patients who were treated with ECMO combined with CRRT in the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from August 2017 to August 2021 changed the connection scheme due to high PA or PV (from scheme A or B to scheme E or F) were retrospectively analyzed. The changes of PA and PV before and after changing the scheme were compared. Results:① In vitro study results: there was no significant difference in PA between schemes A and B, C and D, E and F under different ECMO blood flow (2-5.5 L/min). The PA of schemes C and D was the lowest, followed by schemes E and F. PV of scheme B was higher than that of scheme A under different ECMO blood flow (2-5.5 L/min). There was no significant difference in PV between schemes C and D, E and F under high ECMO blood flow (3-5.5 L/min), and the absolute value of PV was lowest in schemes E and F. Compared with schemes A and B [partial PA > 300 mmHg (1 mmHg≈0.133 kPa) at high flow rate], C and D (partial PV > 350 mmHg at high flow rate), schemes E and F were more reasonable connection schemes. TMP was negative in schemes C and D at ECMO blood flow of 5 L/min and 5.5 L/min (mmHg; 5 L/min: scheme C was -29.14±11.42, scheme D was -42.45±15.70; 5.5 L/min: scheme C was -35.75±13.21, scheme D was -41.58±15.42), which indicated the presence of dialysate reverse filtration. Most of the differences in TMP among schemes A, B, E, and F under different ECMO blood flow (2-5.5 L/min) were statistically significant, and the absolute value of mean fluctuation was 9.89-49.55 mmHg, all within the normal range. ② In vivo study results: a total of 10 patients who changed the connection scheme (from scheme A or B to E or F) due to high PA or PV were enrolled, including 8 males and 2 females; 7 cases of venous-arterial ECMO (VA-ECMO) and 3 cases of venous-venous ECMO (VV-ECMO), all used continuous veno-venous hemodiafiltration (CVVHDF) mode. After changing the scheme, both PA and PV decreased significantly as compared with those before changing [PA (mmHg): 244.00±22.58 vs. 257.20±21.92, PV (mmHg): 257.20±18.43 vs. 326.40±15.41, both P < 0.01], and PV decreased more significantly than PA [difference (mmHg): 69.20±6.55 vs. 13.20±5.45, P < 0.01]. Conclusion:For patients treated with ECMO in combination with CRRT, the scheme of connecting the access line of CRRT to the pre-oxygenator or post-oxygenator and connecting the return line to the point of the return catheter can significantly reduce PA and PV and maintains normal CRRT operation even running high-flow ECMO.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

Depredación de huevos de la mirla pechi pálida por el tucán Ariel in Brasil: fallo de la estrategia antidepredatoria / Predation of pale-breasted thrush eggs by the ariel toucan in brazil: failure of the anti-predatory strategy

ABSTRACT The Channel-billed Toucan (Ramphastos vitellinus) is an omnivorous bird that eventually is nest-robbers. Several birdsongs display anti-predatory strategies such as attacks and mobbing calls to face this kind of predator. This note reports a predatory event of one Channel-billed Toucan upon eggs of Pale-breasted Thrush (Turdus leucomelas) and describes the anti-predatory behavior, principally alert and mobbing calls of the thrush. Even though the Pale-breasted Thrush displayed the anti-predatory behaviors to harass the toucan, the egg predation was not avoided. Although the predation upon eggs by Ramphastos vitellinus has been reported several times, the majority of reports lack the identity of the bird species affected, this being the first confirmed record in Turdus leucomelas.

RESUMEN El tucán de Ariel (Ramphastos vitellinus ariel) es un ave omnívora que eventualmente es ladrona de nidos. Varias aves paseriformes muestran estrategias anti-depredatorias, tales como ataques y llamadas de acoso para enfrentarse a este tipo de depredadores. Esta nota reporta un evento de depredación de un tucán de Ariel sobre huevos de la mirla pechi pálida (Turdus leucomelas), y describe el comportamiento antipredador, principalmente el relacionado con las llamadas de alerta y de acoso de la mirla. A pesar de que la mirla pechi pálida mostró un comportamiento anti-depredatorio acosando al tucán, no se evitó la depredación de los huevos. Aunque la depredación de huevos por parte del Ramphastos vitellinus se ha registrado varias veces, la mayoría de los reportes carecen de la identidad de la especie de ave afectada, siendo este el primer registro confirmado en Turdus leucomelas.

A Survey of Patient Monitoring Alarms in Cardiac Care Units / 中国医疗器械杂志

OBJECTIVE@#The patient monitors were used to explore the alarm fatigue in a cardiac care unit and to investigate the awareness and reaction of nurse to alarms.@*METHODS@#A semi-structured survey was taken to acquire nurses' feeling and knowledge about monitoring alarm. Three full-time researchers were scheduled to track the alarms with annotations, and analyze the alarm data of 12 patient monitors using central monitoring system.@*RESULTS@#A total of 72 310 unique alarms occurred in the 67-day study period. About 75.7% of them were physiological alarms and less than 10% of medium-low alarms were false positives. The average alarm rate was 128 alarms/patient-day.@*CONCLUSIONS@#There remains alarm fatigue in CCU, the alarm accuracy has improved than the past by applying new technologies. In some cases, clinicians will pay more attention to trend alarm and combination alarm.

Gains from no real PAINS: Where 'Fair Trial Strategy' stands in the development of multi-target ligands

Compounds that selectively modulate multiple targets can provide clinical benefits and are an alternative to traditional highly selective agents for unique targets. High-throughput screening (HTS) for multitarget-directed ligands (MTDLs) using approved drugs, and fragment-based drug design has become a regular strategy to achieve an ideal multitarget combination. However, the unexpected presence of pan-assay interference compounds (PAINS) suspects in the development of MTDLs frequently results in nonspecific interactions or other undesirable effects leading to artefacts or false-positive data of biological assays. Publicly available filters can help to identify PAINS suspects; however, these filters cannot comprehensively conclude whether these suspects are "bad" or innocent. Additionally, these

Research on Patient Monitoring Alarms in ICU and NICU / 中国医疗器械杂志

OBJECTIVE@#The patient monitors were used to explore the alarm actuality in a ICU and NICU to investigate the awareness and reaction of medical staff to alarms.@*METHODS@#A series of surveys and interviews were taken to acquire clinicians' feelings and attitudes to monitoring alarms. The researchers were scheduled to track the alarms with annotations, and collect the alarm data of patient monitors using central monitoring system.@*RESULTS@#A total of 235 387 and 67 783 alarms occurred in ICU and NICU respectively. The average alarm rate was about 142 alarms/patient-day in ICU and 96 alarms/patient-day in NICU.@*CONCLUSIONS@#There remains alarm fatigue in ICU and NICU, the main reason is the large number of false alarms and clinically irrelevant alarms. In addition, patient monitor is still in the level of threshold alarms or combined alarms, the data integrity and intelligence level need to be improved in future.

Design and Realization of Remote Infusion Monitoring System / 中国医疗器械杂志

In order to reduce the working intensity of medical staff in inspecting patients during traditional infusion, a remote monitoring system for intravenous infusion is designed for solving the problem of delay in handling treatment during infusion process and to reduce the incidence of medical accidents. The system uses Visual Basic.NET language to develop the upper computer platform for infusion monitoring. It uses the Arduino control board and infrared photoelectric sensor to form a monitoring device to detect relevant information. At the same time, it uses Zigbee wireless sensing technology to transmit data and upload it to the software platform. The results show that the system can receive data from multiple monitoring terminal devices in the upper computer platform application interface at the same time. It can display the data in the nurse station in a graphical way, and perform alarm warning and information storage during the infusion process. The infusion monitoring system can observe the monitoring situation in real time, reduce the workload of medical staff, and further improve the operating efficiency and safety of the hospital.

Caracterización clínica de pacientes internados por Dengue en el Hospital Regional de Encarnación 2018

Resumen Introducción: El Dengue ha sido prominente entre las enfermedades reemergentes y se considera la más importante de las enfermedades virales transmitidas por artrópodos, siendo la arbovirosis más común y distribuida en el mundo. En Paraguay posee una de las tasas de incidencias de dengue más altas de la región, con 444.5 casos por cada 100.000 habitantes, en el 2018 se registraron un total de 29.162 casos. Objetivo: Caracterizar clínicamente los pacientes internados por Dengue en el Hospital Regional de Encarnación año 2018. Materiales y Métodos: Estudio de tipo observacional, descriptivo de corte trasversal, con muestreo intencional, se incluyeron a todos los pacientes internados con diagnostico confirmado de dengue en el servicio de clínica médica, fueron incluidas las fichas clínicas de pacientes con diagnostico confirmado de dengue. Resultados: El total de casos confirmados por dengue internados en el Hospital Regional de Encarnación en el servicio de clínica médica, año de 2018 fue de 47 pacientes. El rango etario con mayor número de casos fue >45 años con el 36,1%. Tuvo picos relevantes de casos en el mes de marzo, 38%, y mayo con 43%. En el análisis de las formas clínicas de presentación, prevalecieron los pacientes clasificados con clase C: Dengue con signos de alarma Conclusión: La prevalencia de la clasificación de la forma grave con signos de alarma de dengue fue alta, significando una relación entre el manejo clínico precoz y una evolución satisfactoria, por los tanto la caracterización clínica constituye una herramienta eficaz para la toma de decisiones.

Abstract Introduction: Dengue has been prominent among reemerging diseases and it is considered the most important of the viral diseases transmitted by arthropods, being the most common and distributed arbovirosis in the world. Paraguay has one of the highest incidence rates of dengue in the region, with 444.5 cases per 100,000 inhabitants, in 2018 a total of 29,162 cases were recorded. Objective: To clinically characterize the patients admitted by Dengue in the Encarnacion Regional Hospital year 2018. Materials and Methods: An observational, descriptive, cross-sectional study, with intentional sampling, all hospitalized patients with a confirmed diagnosis of dengue were included in the medical clinic service, the clinical records of patients with a confirmed diagnosis of dengue were included. Results: The total hospitalized cases of dengue confirmed in the Encarnacion Regional Hospital in the medical clinic service, year of 2018 was 47 patients. The age range with the highest number of cases was> 45 years old with 36.1%. Tube relevant peaks of cases in the month of March, 38%, and May with 43%. In the analysis of the clinical forms of presentation, patients classified with class C prevailed: Dengue with warning signs Conclusion: The prevalence of the classification of the severe form with dengue alarm signs was high, meaning a relationship between early clinical management and a satisfactory evolution, therefore clinical characterization is an effective tool for decision making.

Cancer burden and alarm signals: a community based study from Kerala, India

Background: Cancer is emerging as a major public health concern in many countries including India. Kerala state has the highest burden of cancer in the country. Objective of this study was to estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Kadapra Panchayath of Pathanamthitta district, Kerala.Methods: A total of 16,391 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases.Results: The mean age of the population was 40.9+21 years. The prevalence of diagnosed cases of cancer in our study population was 776/100,000 population. Breast cancer was the most common cancer (43.5%) identified in the population. The prevalence of any warning sign among the study population was 220/100,000 population. Breast lump was the common warning sign identified. Increasing age and female gender were the factors found to be significantly associated with cancer.Conclusions: As prevalence of cancer was found to be high in this population, an active community based screening along with teaching self-breast examination to the women in the community are required. Improving community awareness could help in early diagnosis, treatment and prevention. Soil and water testing for carcinogens is recommended.

Analysis and Processing of Flow Alarm about Fresenius 4008 S Hemodialysis Machine / 中国医疗器械杂志

The Fresenius 4008 S hemodialysis machine is one of the main hemodialysis machines in our hospital. Because of its longer service life, the probability of malfunction is larger. For flow alarm is the typical fault of this model, we combined with practical maintenance experience and theoretical technology, then briefly analyzed and summarized the malfunction. On the principle of easy to difficult, we check in order from five aspects, they are pipeline blockage, aging of the degassing pump or flow pump, the float switch malfunction, valve abnormality and the control circuit problem. Through this one-by-one and systematic troubleshooting, the flow alarm can usually be solved, also we can save the maintenance time and the cost.

Research of Methods to Reduce Alarm Fatigue of Monitoring System / 中国医疗器械杂志

OBJECTIVE@#In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms.@*METHODS@#A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study.@*RESULTS@#The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724.@*CONCLUSIONS@#To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.

Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis / Estudo do perfil dos problemas de comportamento e dos índices de qualidade de vida numa coorte pediátrica de enurese monossintomática

Abstract Objective: To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. Method: After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. Results: Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. Conclusions: Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.

Resumo Objetivo: Avaliar e relacionar, pré e pós-intervenção terapêutica, em pacientes com enurese noturna monossintomática, os escores de problemas de comportamento, avaliados pelo questionário CBCL/6-18, e os índices de qualidade de vida, avaliados pelo PedsQL™ 4.0. Método: Após avaliação inicial e preenchimento CBCL6/18, procedeu-se avaliação multidisciplinar e preenchimento do PedsQL™ 4.0. Das 140 crianças e adolescentes de 6 a 16 anos inicialmente avaliados, 58 foram excluídos por enurese não monossintomática ou comorbidades associadas. Dos 82 pacientes inicialmente incluídos e randomizados em três grupos de tratamento, 59 preencheram o CBCL/6-18 e PedsQL™ 4.0 no fim do tratamento e puderam ser incluídos neste trabalho. O erro alfa foi estabelecido em 5% para descarte da hipótese de nulidade. Resultados: Dos 59 participantes 45,8% responderam com sucesso total, 23,7% tiveram sucesso parcial, 23,7% não atingiram critério de melhoria e 6,8% desistiram do tratamento. Verificou-se aumento significativo dos índices de qualidade de vida e redução dos escores de problemas de comportamento pós-intervenção, nas três modalidades propostas, nos pacientes que obtiveram resposta total ou parcial ao tratamento. Não se demonstrou correlação entre maiores escores de problemas de comportamento pré-tratamento e insucesso terapêutico. Conclusões: Apenas os participantes que responderam com sucesso às intervenções melhoraram em sua qualidade de vida e problemas comportamentais, o que indica que a enurese é um problema primário que impacta negativamente esses parâmetros. Sugere-se que é viável obter sucesso no tratamento da enurese monossintomática, mesmo em pacientes com altos escores de problemas de comportamento pré-intervenção.

BMAG interlock troubleshooting of Varian clinac Ⅸ linear accelerator / 中华放射肿瘤学杂志

Through the analysis of 3 maintenance of Bmag interlocking fault of Varian Clinac Ⅸ Linear Accelerator,it is found that the full wave rectifier diode breakdown in the bend magnet power supply,the improper setting of the bend magnet interlock,and the failure of the modulator CB3 air switch can cause the bmag interlocking.Through the replacement of accessories,adjustment parameters,etc.,so that the fault is resolved.

A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children / 临床儿科杂志

Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95％ CI :1.5～5.4; success rate: OR=3.5, 95％ CI :1.7～7.5) and alarm (complete response rate: OR=2.7, 95％ CI :1.1～6.6; success rate: OR=3.8, 95％ CI: 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI: 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI: 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.

Development of an Al-load-cell-based wireless ringer's solution monitoring and alarm system: insight into vibrational error correction

In this study, we developed an aluminum-load-cell-based wireless Ringer's solution monitoring and alarm (WRMA) system. The Al load cell was designed with a rectangular shape, and the load was concentrated in the lower beam part of the load cell because of the anisotropic thickness. From the static analysis, we identifi ed the appropriate location for a Wheatstone bridge circuit consisting of four strain gauges. In addition, the modal and harmonic analyses showed that the vibrational frequencies of the hospital environment do not seriously interfere with the output voltage of the Al load cell. However, random vibrations generated by the movement of the WRMA system on various surfaces severely increase the standard deviation of the measured solution weight by ± 10 g or more. Such vibrational error is too large because the average weight of Ringer's solution is 30–40 g at the time of replacing Ringer's solution. Thus, this error could be confusing for nurses and result in mistakes in the timely replacement of the Ringer's solution. However, the standard deviation of the measured weight was dramatically reduced to ± 3 g or less by using the vibration correction algorithm developed in the present study.

Enuresis alarm therapy for preschool children with primary monosymptomatic nocturnal enuresis: A report of 95 cases / 中国实用儿科杂志

OBJECTIVE: To explore the effectiveness of enuresis alarm therapy on preschool children with primary monosymptomaticnocturnal enuresis(PMNE). METHODS: Totally 95 PMNE preschool children aged 3.5 to 6 years admitted between January 2017 and July 2018 to Department of Nephrology,Affiliated Children's Hospital of Capital Institute of Pediatrics,were randomly divided into two groups:alarm group(53 cases)and control group(42 cases). The alarm group was managed by enuresis alarm therapy,while the control group received basic treatment. Treatment ceased after 12 weeks of training or when the cases achieved 14 consecutive dry nights(meaning successful treatment). The relapse cases were recorded 1 month after stopping treatment. The alarmtherapy was performed again in the relapse cases for another course. RESULTS: Seven cases(13.2%)discontinued intervention in the alarm group. The response of the alarm therapy in the remaining 46 patients was as follows:full response(FR)in 29 cases(63.0%),partial response(PR)in 7 cases(15.2%),no response(NR)in 10 cases(21.7%). A total of 25 patients achieved 14 consecutive dry nights in FR cases. Successful treatment requires a minimum course of treatment for 42 days. Relapse occurred in 11 cases within the first 1 month after stopping treatment,and 8 relapse patients responded to another course of alarm therapy. Three cases(7.1%)lost to follow-up in the control group. The response of the control group in the remaining 39 patients was as follows:FR in 0 case,PR in 17 cases(43.6%)and NR in 22 cases(56.4%). No cases achieved successful treatment in the control group. The full response rate was significantly different between two groups(Fisher's exact test χ~2=55.10,P=0.00). Half(5 cases)of NR patients were less than 4 years old,while in the FR+PR patients,the percentage of children under 4 years old was only 8.3%(3 cases)in alarm therapy group(Pearson chi-square test,χ~2=9.457,P=0.007). No severe adverse events occurred in all cases. CONCLUSION: Enuresis alarm therapy is a safe and effective way to treat PMNE preschool children. The enuresis alarm provided gradual effects and require more than 1 month in achieving successful effect. The appropriate age for alarm treatment is over four years old.