Research on classification of Korotkoff sounds phases based on deep learning / 中国胸心血管外科临床杂志

@#Objective     To recognize the different phases of Korotkoff sounds through deep learning technology, so as to improve the accuracy of blood pressure measurement in different populations. Methods     A classification model of the Korotkoff sounds phases was designed, which fused attention mechanism (Attention), residual network (ResNet) and bidirectional long short-term memory (BiLSTM). First, a single Korotkoff sound signal was extracted from the whole Korotkoff sounds signals beat by beat, and each Korotkoff sound signal was converted into a Mel spectrogram. Then, the local feature extraction of Mel spectrogram was processed by using the Attention mechanism and ResNet network, and BiLSTM network was used to deal with the temporal relations between features, and full-connection layer network was applied in reducing the dimension of features. Finally, the classification was completed by SoftMax function. The dataset used in this study was collected from 44 volunteers (24 females, 20 males with an average age of 36 years), and the model performance was verified using 10-fold cross-validation. Results     The classification accuracy of the established model for the 5 types of Korotkoff sounds phases was 93.4%, which was higher than that of other models. Conclusion     This study proves that the deep learning method can accurately classify Korotkoff sounds phases, which lays a strong technical foundation for the subsequent design of automatic blood pressure measurement methods based on the classification of the Korotkoff sounds phases.

A non-contact continuous blood pressure measurement method based on video stream / 生物医学工程学杂志

Hypertension is the primary disease that endangers human health. A convenient and accurate blood pressure measurement method can help to prevent the hypertension. This paper proposed a continuous blood pressure measurement method based on facial video signal. Firstly, color distortion filtering and independent component analysis were used to extract the video pulse wave of the region of interest in the facial video signal, and the multi-dimensional feature extraction of the pulse wave was preformed based on the time-frequency domain and physiological principles; Secondly, an integrated feature selection method was designed to extract the universal optimal feature subset; After that, we compared the single person blood pressure measurement models established by Elman neural network based on particle swarm optimization, support vector machine (SVM) and deep belief network; Finally, we used SVM algorithm to build a general blood pressure prediction model, which was compared and evaluated with the real blood pressure value. The experimental results showed that the blood pressure measurement results based on facial video were in good agreement with the standard blood pressure values. Comparing the estimated blood pressure from the video with standard blood pressure value, the mean absolute error (MAE) of systolic blood pressure was 4.9 mm Hg with a standard deviation (STD) of 5.9 mm Hg, and the MAE of diastolic blood pressure was 4.6 mm Hg with a STD of 5.0 mm Hg, which met the AAMI standards. The non-contact blood pressure measurement method based on video stream proposed in this paper can be used for blood pressure measurement.

Oscillometric blood pressure measurement in a neonatal intensive care unit: a cross-sectional study

OBJECTIVE: The study aimed to evaluate how neonatal blood pressure measurement with the oscillometric method is performed by a nursing team, including patient preparation, documentation, materials, and equipment. METHOD: This cross-sectional study was conducted in a neonatal intensive care unit (NICU) through direct observation of procedures performed by nursing staff. A systematic script was used for observation and documentation of the procedure, patient reparation, and handling of equipment. The results were analyzed through inferential statistics. RESULTS: In a total of 150 observations, 60% or more of steps were classified as correct in 13 of the 26 target items. There was no difference between RNs and nurse technicians concerning the procedure´s success rate (p = 0.3933). Blood pressure measurement was obtained in the first attempt, according to the procedure´s adequacy (p <0.0001). CONCLUSION: Published recommendations for oscillometric blood pressure measurement were not followed completely. Continuing education should focus on routine procedures to ensure essential aspects of care.

Evaluation on the application of community hypertension screening model by automated blood pressure measurement / 上海预防医学

ObjectiveTo evaluate the effect of standardized blood pressure measurement in consulting room （SBPM） model on blood pressure screening of non-hypertensive patients in community. MethodsFour communities were randomly selected from Fengxian District of Shanghai， and non-hypertensive patients in the communities were included for screening. Based on the communities， participants were further classified into the intervention group and control group. A one-year intervention study was conducted from January 1， 2021 to December 31， 2021. The intervention group received the intervention measures of standardized measurement， and the control group remained the routine measurement. The distribution of blood pressure values and last digit of the values between the intervention group and control group were tested using Chi-square test and normality test. Then changes in abnormal blood pressure rate before and after the intervention were determined by double difference method. Statistical analysis was performed using SPSS 20.0. ResultsA total of 15 368 participants were included in the intervention group， and 19 811 participants in the control group. After the intervention， range of the last digit of blood pressure values in the intervention group was 9.55%‒10.41%， of which that of systolic and diastolic blood pressure were equally distributed （P=0.932 and 0.871， respectively）. The range of the last digit in the control group was 1.31%‒42.58%， of which that of systolic and diastolic blood pressure showed unequal distribution （P<0.001）. Through one-year standardized measurement intervention， the abnormal rate of blood pressure in the intervention group was 26.29%， which was 7.61 times as high as that in the control group （OR=7.55， 95%CI： 6.75‒8.57， P<0.001）. ConclusionStandardized blood pressure measurement in consulting room is suitable for the screening of blood pressure measurement in community， which has higher data quality than that of routine measurement.

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study) / Valores de referência para pressão arterial em adolescentes brasileiros: dados do Estudo dos Riscos Cardiovasculares em Adolescentes (Estudo ERICA)

Abstract Objective: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. Method: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. Results: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. Conclusions: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Resumo Objetivo Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. Método O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Resultados Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3-75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava-se das escolas públicas, com 84,2% (IC95%: 79,9-87,7), e os sedentários 54,8% (IC95%: 53,7-55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4-50,1]) e branca (37,8%: [IC 95% 36,1-39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. Conclusões São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.

Technique for non-invasive blood pressure measurement followed by the nursing staff working in a hospital in Guyana / Técnica de medição não invasiva da pressão arterial seguida pela equipe de enfermagem que trabalha em um hospital na Guiana

Background: Blood pressure is the force of blood pushing against a blood vessels traditionally measured non-invasively by auscultation using an aneroid gauge or mercury device. The objective of this study was to determine whether the nursing staff of a Public hospital in Guyana follow international guidelines for the measurement of blood pressure. Since the detection and subsequent management of patients with high blood require that the technique followed by nursing staff who measure patients' blood pressure produces accurate readings. Methods: This was a quantitative, cross sectional study, conducted in the national referral hospital GPHC in Guyana assessing a sample of 137 of the 781 nursing staff working in the five departments of this hospital. Data was collected through the use of a questionnaire developed following the guidelines for non-invasive blood pressure measurement published by Nerengberg 2018, by the researcher and validated by experts in blood pressure measurement technique and research methodology. Results: 5% of the participants was ward managers, 12% was RNM, 35% of the participants was registered nurses, 7%was qualified midwives, 18% of the participants was nursing assistants and 23% of the participants was patient care assistants. Most of the participants i.e. 39.4% had 4-6, years of experience 31.4% had more than 6 years of experience and 29.2% had 0-3ears of experience in their area off work which means that they all had education and experience in blood pressure measurement. When compared to the steps of the blood pressure measurement technique 72% allow the patient to rest for at least five minutes, 82% provided a calm and quiet environment, 37% explain to the patient not to talk during the procedure, 13% ask the patient to keep the legs uncrossed, 10% ask the patient to keep the feet flat on the floor and 31% of the participants ask the patient to keep the back against the chair. Conclusion: None of the nursing staff of GPHC Guyana followed all of the steps in the guidelines for the measurement of non-invasive blood pressure. While 15 of the 26 steps in guideline measured resulted in more than 75% adherence there were 9 of the 26 steps that had a less than 25% adherence by nursing staff. This means that the steps in the blood pressure guidelines are taken without a standardized guideline and so nursing staff.

Antecedentes: A pressão arterial é a força do sangue empurrando os vasos sanguíneos tradicionalmente medida de forma não invasiva por ausculta usando um medidor aneróide ou dispositivo de mercúrio. O objetivo deste estudo foi determinar se a equipe de enfermagem de um hospital público na Guiana segue as diretrizes internacionais para medição da pressão arterial. Já a detecção e posterior manejo de pacientes com hipertensão arterial exigem que a técnica seguida pela equipe de enfermagem que mede a pressão arterial dos pacientes produza leituras precisas. Métodos: Este foi um estudo quantitativo, transversal, realizado no hospital de referência nacional GPHC na Guiana, avaliando uma amostra de 137 dos 781 funcionários de enfermagem que trabalham nos cinco departamentos deste hospital. Os dados foram coletados por meio de questionário desenvolvido seguindo as diretrizes para medição não invasiva da pressão arterial publicadas por Nerengberg 2018, pela pesquisadora e validado por especialistas em técnica de medição de pressão arterial e metodologia de pesquisa. Resultados: 5% dos participantes eram gerentes de enfermaria, 12% eram RNM, 35% dos participantes eram enfermeiros registrados, 7% eram parteiras qualificadas, 18% dos participantes eram auxiliares de enfermagem e 23% dos participantes eram auxiliares de atendimento ao paciente. A maioria dos participantes, ou seja, 39,4% tinham 4-6 anos de experiência, 31,4% tinham mais de 6 anos de experiência e 29,2% tinham 0-3 anos de experiência em sua área fora do trabalho, o que significa que todos tinham formação e experiência em pressão arterial. medição. Quando comparados com as etapas da técnica de aferição da pressão arterial 72% permitem que o paciente descanse por pelo menos cinco minutos, 82% proporcionam um ambiente calmo e tranquilo, 37% explicam ao paciente para não falar durante o procedimento, 13% pedem ao paciente manter as pernas descruzadas, 10% pedem para o paciente manter os pés apoiados no chão e 31% dos participantes pedem para o paciente manter as costas apoiadas na cadeira. Conclusão: Nenhum membro da equipe de enfermagem do GPHC Guiana seguiu todas as etapas das diretrizes para medição da pressão arterial não invasiva. Embora 15 dos 26 passos medidos nas diretrizes tenham resultado em mais de 75% de adesão, houve 9 dos 26 passos que tiveram uma adesão inferior a 25% por parte da equipe de enfermagem. Isso significa que as etapas das diretrizes de pressão arterial são executadas sem uma diretriz padronizada e, portanto, pela equipe de enfermagem.

Survey on home blood pressure measurement and blood pressure control rate among hypertensive patients in Beijing Yuetan community / 中华全科医师杂志

Objective@#To survey on the home blood pressure measurement and blood pressure control rate among patients with hypertension in Beijing Yuetan community.@*Methods@#A questionnaire survey was conducted among 504 hypertensive patients, who were visiting Beijing Yuetan Community Health Service Center and selected by convenience-sampling method during June 2018 to January 2019. The status of home blood pressure measurement, the awareness of hypertension, the blood pressure control rate and factors related to not regularly measuring were surveyed.@*Results@#Of the 504 patients, 93.7% (472/504) took regular medication, but only 61.5% (310/504) had regular blood pressure measurements; 92.5% (466/504) had sphygmomanometers at home with electronic type mainly; 89.9% (453/504) patients knew the method of blood pressure measurement, but only 11.5% (52/453) had their sphygmomanometer calibrated. Among those who measured blood pressure, 77.4% (240/310) measured per week. The main reason for not measuring blood pressure regularly was that there was no need to measure blood pressure without any discomfort, accounting for 50.0% (97/194). The office blood pressure control rate (with desktop mercury sphygmomanometer) was 62.3% (314/504); the blood pressure control rate both in the morning and at bed time was 61.3% (73/119), that in the morning was 68.1% (81/119) and at bed time was 75.6% (90/119). The control rates of systolic blood pressure and heart rate by home measurement at morning and bedtime were significantly higher than those by office measurement (χ2=5.02, 9.97, 15.51, 13.72; all P<0.05).@*Conclusions@#The home blood pressure monitoring rate and knowledge level of hypertension among patients with hypertension in Yuetan community are relatively low. There are some differences in blood pressure control rate between office measurement and home measurement. Comprehensive evaluation is needed in the management process, and the treatment plan should be adjusted according to the specific condition of patients.

Blood pressure measurement by oscillometric and auscultatory methods in normotensive pregnant women / Evaluación de la presión arterial por los métodos oscilométrico e auscultatorio en embarazadas normotensas / Avaliação da pressão arterial pelos métodos oscilométrico e auscultatório em gestantes normotensas

ABSTRACT Objective: to compare blood pressure values obtained by auscultatory and oscillometric methods in different gestational periods, considering cuff width. Method: it is a cross-sectional and quasi-experimental study approved by the Research Ethics Committee. The sample consisted of 108 low-risk pregnant women. Blood pressure measurements were performed in gestational periods of 10-14, 19-22 and 27-30 weeks. Results: The oscillometric device presented values similar to the auscultatory method in systolic blood pressure, but overestimated diastolic blood pressure. Underestimation of blood pressure occurred when using the standard width cuff rather than the correct width cuff in both measuring methods. Conclusion: Verification of brachial circumference and use of adequate cuffs in both methods are indispensable to obtain reliable blood pressure values in pregnant women. We recommend performance of additional studies to evaluate diastolic blood pressure overestimation by the Microlife 3BTO-A.

RESUMEN Objetivo: Comparar los valores de presión arterial obtenidos por los métodos auscultatorio e oscilométrico en distintos períodos del embarazo, en función del ancho del manguito. Método: Se trata de un estudio transversal y cuasiexperimental aprobado por el Comité de Ética en Investigación. Se analizó una muestra compuesta por 108 embarazadas de bajo riesgo. Las medidas de presión arterial se obtuvieron en los períodos gestacionales de 10-14, 19-22 y 27-30 semanas. Resultados: El aparato oscilométrico presentó valores similares al método auscultatorio en la presión arterial sistólica, sin embargo sobreestimó la presión arterial diastólica. Hubo subestimación de la presión arterial al utilizar el manguito de anchura estándar en lugar del manguito de anchura adecuada, en los dos métodos de medida. Conclusión: La verificación de la circunferencia braquial y el uso de manguitos adecuados en los dos métodos son indispensables para obtener valores confiables de la presión arterial en embarazadas. Recomendamos que se realicen nuevos estudios para evaluar la sobreestimación de la presión arterial diastólica por el aparato Microlife 3BTO-A.

RESUMO Objetivo: Comparar os valores de pressão arterial, obtidos pelos métodos auscultatório e oscilométrico em diferentes períodos gestacionais, em função da largura do manguito. Método: Trata-se de um estudo transversal e quase-experimental aprovado pelo Comitê de Ética em Pesquisa. A amostra foi composta por 108 gestantes de baixo risco. As medidas de pressão arterial foram realizadas nos períodos gestacionais de 10-14, 19-22 e 27-30 semanas. Resultados: O aparelho oscilométrico apresentou valores similares ao método auscultatório na pressão arterial sistólica, porém superestimou a pressão arterial diastólica. Houve subestimação da pressão arterial ao utilizar o manguito de largura padrão ao invés do manguito de largura correta, nos dois métodos. Conclusão: A verificação da circunferência braquial e o uso de manguitos adequados nos dois métodos são indispensáveis para obter valores confiáveis da pressão arterial em gestantes. Recomendamos que novos estudos sejam realizados para avaliar a superestimação da pressão arterial diastólica pelo aparelho Microlife 3BTO-A.

Application study on improving the methods of endotracheal cuff pressure measurement to prevent ventilator-associated pneumonia / 中华危重病急救医学

To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. Methods① Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.② Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. Results ① Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. ② Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.

Comparison of auscultatory and oscillometric BP measurements in children with obesity and their effect on the diagnosis of arterial hypertension / Comparación de la medición de PA auscultatoria y oscilométrica en niños con obesidad y su efecto en el diagnóstico de hipertensión arterial

Abstract: Objective: The level of agreement between two blood pressure (BP) reading methods, auscultatory vs oscillometric, was examined using a mercury sphygmomanometer and an electronic device in children and adolescents with different levels of obesity. The readings were compared to determine their impact on the diagnosis of pre-hypertension/hypertension. Methods: Blood pressure readings were taken in children with obesity (body mass index ≥ 95th percentile) and severe obesity (≥120% 95th percentile). Bland-Altman analysis and Intraclass Correlation Coefficient were used to determine the agreement between measurements. Results: The mercury sphygmomanometer readings were lower than those obtained with the electronic device for both systolic and diastolic BP (P = .01 and P = .001, respectively). The mean systolic and diastolic BP differences between the oscillometric vs first mercury reading were 4.2/10.2 mm Hg, respectively. A large difference was observed between the BP measurement methods. The ICC showed regular to moderate reliability for the systolic BP (.595), but poor for the diastolic BP (.330). Screening using the first of three mercury measurements showed that 10.4% of the children and adolescents had BPs within the pre-hypertension/hypertension range. This was reduced to 5.2% when the mean of three mercury readings was used. Conclusions: Large discrepancies were observed in both the systolic and diastolic BP. These differences are not clinically acceptable as to consider the two instruments interchangeable. The electronic device readings were higher, and they overestimated the diagnosis of hypertension. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma Mèxico S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen: Objetivo: Para conocer el grado de concordancia entre 2 métodos de medición de presión arterial (PA), auscultatorio vs oscilométrico se utilizó un esfigmomanómetro de mercurio y un dispositivo electrónico en niños y adolescentes con diferentes grados de obesidad. Las lecturas fueron comparadas para conocer su impacto en el diagnóstico de prehipertensión/hipertensión. Método: Se midió la PA a niños con obesidad (percentil 95 del índice masa corporal) y obesidad severa (120% del percentil 95). Utilizamos análisis de Bland-Altman y Coeficiente de Correlación Intraclase (CCI) para conocer acuerdo entre mediciones. Resultados: Las lecturas con esfigmomanómetro de mercurio fueron más bajas que con el electrónico para la PA sistólica y diastólica (p = 0.01 y 0.001, respectivamente). El promedio de las diferencias en sistólica y diastólica entre oscilométrico vs. primera medición con mercurio fue de 4.2/10.2 mm Hg respectivamente. Se observó una gran diferencia de las mediciones entre los métodos de medición de PA. El CCI mostró una confiabilidad regular a moderada para la sistólica (0.595) pero pobre para la diastólica (0.330). El tamizaje con una medición mediante mercurio mostró que el 10.4% de los niños y adolescentes tenían PA en el rango de prehipertensión/hipertensión, pero se redujo a un 5.2% con el promedio de 3 mediciones. Conclusiones: Se observaron grandes discrepancias en la PA sistólica y diastólica. Tales diferencias no son clínicamente aceptables como para considerar equivalentes los 2 instrumentos. Las mediciones realizadas en este estudio con dispositivo electrónico fueron más altas y sobre estimaron el diagnóstico de hipertensión. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Wearable Device for Non-Invasive Continuously Blood Pressure Monitoring / 中国医疗器械杂志

In aging society the development of non-invasive continuously blood pressure monitors which are suitable for homes, communities and nursing homes has a wide range of applications. This paper proposes a non-invasive continuously blood pressure monitoring based on wearable device which uses MSP430F5529 as the central processor. The design is divided into signal acquisition module, central control module, display module, power supply module and host computer module. The experimental results showed that DBP (375/390, 96.15%) and SBP estimation values (377/390, 96.67%) are in 95% confidence interval, which means our design passes Bland-Altman test with high accuracy and stability.

Práticas adotadas por profissionais de enfermagem para medida indireta e registro da pressão arterial / Practices adopted by nursing professionals for indirect measurement andrecording of blood pressure / Prácticas adoptadas por profesionales de enfermeria para la medición indirecta y registro de la presión arterial

Objetivou-se identificar como é realizado o procedimento de medida indireta e registro da pressão arterial por profissionais de enfermagem e as condições técnicas dos dispositivos utilizados. Trata-se de estudo quantitativo, observacional, de delineamento transversal. A amostra compôs-se de 80 servidores observados no período de agosto de 2013 a janeiro de 2014, em cinco unidades de saúde de Londrina, Paraná. Na coleta de dados utilizou-se instrumento fundamentado nas VI Diretrizes Brasileiras de Hipertensão e, para o registro do procedimento, instrumento construído conforme recomendações do COREn-SP.Na análise dos dados usou-se o Programa Statistical Package for the Social Science versão1.6. Os resultados mostraram altos índices de “não realização” (93,8 a 100%) das etapas de preparo do paciente para a medida da pressão. A calibração dos equipamentos não era aferida e não havia manguitos disponíveis de tamanhos variados. Concluiu-se que há importantes lacunas nos procedimentos adotados pela enfermagem para a medida da pressão arterial, indicando a necessidade de medidas educativas.

The aim of this study was to identify how the procedure for indirect measurement and recording of blood pressure by nursing professionals isperformed and the technical conditions of the devices used. It is a quantitative, observational, cross-sectional study. The sample consisted of 80servers, observed from August 2013 to January 2014, in five health units in Londrina, Paraná. In the data collection, it was used as a reference tomeasure an instrument made from the steps described in the VI Brazilian Guidelines on Hypertension and, for the record of the proceeding, a toolbuilt according to the recommendations of the COREn, São Paulo. For data analysis, we used the Program Statistical Package for Social Scienceversion 1.6. The results showed high rates of "non-performance" (93.8% to 100%) of the steps for preparing the patient for measurement of pressure. The calibration of the equipment is not measured, and there are not cuffs of varied sizes. It is concluded that there are important gaps related to the practice adopted by nurses to measure blood pressure, indicating the need for implementation of educational measures.

El objetivo del presente estudio fue identificar cómo el personal de enfermería realiza el procedimiento de medición indirecta y registro de la presiónarterial y cuáles son las condiciones técnicas de los dispositivos utilizados. Se trata de un estudio cuantitativo observacional transversal. La muestra estuvo formada por 80 empleados observados de agosto 2013 a enero 2014 en cinco unidades de salud en Londrina, Paraná. En la recogida de datos seutilizó un instrumento basado en las VI Directrices Brasileñas de Hipertensión y, para el registro del procedimiento, un instrumento construido segúnlas recomendaciones del COREn - SP. Para el análisis de datos se utilizó el Programa Statistical Package for the Social Science versión 1.6. Los resultadosmostraron altos índices de "no realización" (93,8% a 100%) de las etapas de preparación del paciente para la medición de la presión, que no se evaluaba la calibración de los equipos y que no había manguitos disponibles de distintos tamaños. Se llegó a la conclusión de que hay deficiencias significativa.

Comparison between the intraocular pressure fluctuations measured at home versus in the clinic / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare intraocular pressure (IOP) fluctuations measured at home and in the clinic over a 24-hour period.METHODS: A prospective investigational study.A total of 120 Chinese participants were selected from five communities in the Chengdu area.Patients underwent a clinical interview and IOP was measured both at home and in the clinic.IOP were measured at 8 a.m., 10 a.m., 12 a.m., 2 p.m., 4 p.m., 6 p.m., 8 p.m., 10 p.m., 2 a.m., 6 a.m.using the same pneumatonometer.Measurements were taken in the sitting position.RESULTS: The average 24-hour IOP measured in the clinic was slightly lower than that at home.The mean difference in 24-hour IOP measurements between home and clinic was 0.27 mmHg.The IOP fluctuation in the clinic was higher than at home (the mean difference was 0.01 mmHg).There was no statistically significant difference in the average 24-hour IOP measured at home vs in the clinic.The average IOP measured at 2 p.m.at home (16.04±5.95 mmHg) was significantly higher compared with the measurement in the clinic (15.43±5.16 mmHg) (P<0.05).The overall agreement between 24-hour IOP measurements made in the clinic and at home in diagnosis of primary open angle glaucoma was 85.0% (K coefficient: 0.68).CONCLUSION: The 24-hour IOP measured in the clinic was similar to that measured at home, and the method of measuring IOP in the clinic is acceptable in diagnosing primary open angle glaucoma.

Endoscopic ultrasound-guided vascular intervention for portal hypertension

As endoscopic ultrasound (EUS) equipment improves, the diagnostic and therapeutic applications of EUS in patients with portal hypertension (pHTN) have been increasingly explored. Various EUS-guided vascular interventions for pHTN have been evaluated in human or animal studies. EUS has been shown to be useful in variceal and perforating feeding veins identification, prediction of variceal recurrence/rebleeding, and assessment of response to pharmacological therapy for pHTN. When compared to conventional endoscopic therapies, EUS-guided therapy for varices and/or perforating feeding veins can ensure intra-variceal delivery of injection therapy, allow real-time monitoring of variceal obliteration, and provide injection therapy under pure EUS guidance when the target varix is endoscopically obscured. While the feasibility of EUS-guided assessment of portal hemodynamics and creation of intrahepatic portosystemic shunt has been evaluated, further studies would be needed to assess the long term outcomes before routine application.

A Comparison Study For The Road Condition With Hand Grip Force And Muscle Fatigue

The purpose of this study is to compare the road conditions (straight road, winding road and hill road) with the hand grip pressure force and muscle fatigue for male and female drivers. Ten subjects were participated in this study. The force measurement and electromyography (EMG) responses were taken and evaluated by using the tactile grip and pressure measurement (Grip System) and Electromyography (EMG) device. The result indicated that the winding road produced more muscle fatigue and high hand grip pressure force compared than downhill road, hill up road, and straight road for both male and female subjects. The result compared the muscle fatigue and hand grip pressure force between the first 15 minutes and last 15 minutes of driving activity. The muscle fatigue increasingly high for the last 15 minutes compared to first 15 minutes. However, the hand grip pressure forces become high during the winding road for first 15 minutes of driving session. The muscle fatigue become high as the hand grip pressure force value is high. Furthermore, the male drivers exert higher hand grip pressure force and higher muscle fatigue compared to female drivers. This study can be used as a guideline for the future studies, primarily in solving the driving fatigue problem among the Malaysian’s drivers. The method of this study could also be used for early detection of driver fatigue issues. Indirectly, the findings could reduce the number of car accidents in Malaysia.

The impact of plantar pressure distribution characteristics on balance ability during backward walking / 医用生物力学

Objective To study the changes of plantar pressure during backward walking, so as to explore its effects on balance ability of human gait. Methods Plantar pressure measurement system (Pedar-X pressure insoles) was used to collect the plantar pressure data from 10 subjects during forward walking and backward walking, respectively. The experiment was conducted on the treadmill, and the forward walking was set as the control group. According to the test conditions and intuitive feeling of test participants, 4 speed values (2.0, 2.5, 3.0, 3.5 km/h) were selected to carry out the experiment under two walking modes, respectively. The changes in parameters such as plantar pressure center trajectory, plantar pressure and foot-ground contact time under different speed were analyzed. Results Under two walking modes at different walking speed, subjects showed different plantar pressure during walking. During backward walking, the plantar pressure center transferred from the front foot to the heel and from inside to outside. Compared with forward walking, the plantar pressure during backward walking decreased significantly while the foot-ground contact time increased. Conclusions The study on pressure distribution during backward walking contributes to comprehensively understanding the mechanism of dynamic balance and provides a new perspective for related study on walking stability.

Application of a Pressure-measuring and Stone-extracting Ureteral Access Sheath in Flexible Ureteroscopy For Renal Stones / 昆明医科大学学报

Objective To investigate the application value of a pressure-measuring and stone-extracting ureteral access sheath (UAS) used together with negative pressure suction system during flexible ureteroscopy in the treatment of renal caculus.Methods A retrospective analysis was performed on the 98 cases of renal caculus who received flexible ureteroscopic holmium laser lithotripsy (FURS) in the Department of Urology of the Kunming General Hospital of Chengdu Military Command from November 2014 to September 2015,and the enrolled cases were divided into two groups:group A and group B.The new UAS was used in group A combined with vacuum suction during lithotripsy,and simple manometry type UAS was used in group B.The infusion pump flow rate of 0.2 L/min was set in the operation,the perfusion pressure limit was set to 100 mmHg,the suction pressure of group A was 10 kPa.Perfusion flow rate and pressure was adjusted in a timely manner based on the clear vision and the internal pressure force on the kidney.Then we recorded and compared the internal pressure and variation trend of renal and perfusion time of two groups.Results Two groups of patients were successfully completed surgery.The renal pressures in group A were adjusted duly and were lower than the that in group B in the whole process of operation.The average renal pressure in group A was 10.88 ± 5.91 1mmHg.The average renal pressure in group B was 20.10 ± 7.68 mmHg,the pressure control was difficult and unsteady.Conclusion The new type of UAS in the flexible ureteroscopic holmium laser lithotripsy (FURS) can make the renal pressure in surgery controllable and is safe for the FURS.

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.

Time points for obtaining representative values of 24-hour blood pressure in chronic kidney disease

BACKGROUND/AIMS: Ambulatory blood pressure (BP) monitoring has been widely recommended for evaluating the status of BP, but is lacking in practicality. Determination of the specific time points for BP measurement that are representative of 24-hour mean BP could be useful and convenient in hypertensive patients with chronic kidney disease (CKD). METHODS: A total of 1,317 patients for whom 24-hour ambulatory BP monitoring was performed were enrolled in a multicenter study on hypertensive CKD. We analyzed the time points at which systolic blood pressure (SBP) values exhibited the smallest differences from 24-hour mean SBP (mSBP). We included office mSBP and analyzed the relationships between SBPs at the office and the time points with the smallest differences from 24-hour mSBP using several methods. RESULTS: The time points with the smallest differences from 24-hour mSBP were 7:00 AM, 2:00 PM, and 9:30 PM. In regression analysis, SBPs at 7:00 AM and 9:30 PM were better correlated with 24-hour mSBP than SBPs at 2:00 PM and the office. The proportions of patients with SBPs within 30% of 24-hour mSBP were higher at 7:00 AM and 9:30 PM. The best consistency between the uncontrolled hypertensive groups, defined as > or = 135 mmHg of 24-hour mSBP and higher values of SBPs corresponding to 135 mmHg of 24-hour mSBP, were observed at the 7:00 AM and 9:30 PM time points. CONCLUSIONS: The specific time points for SBPs that correlated well with 24-hour mSBP in hypertensive CKD patients were 7:00 AM and 9:30 PM.

Advances in intraocular pressure measurement after corneal refractive surgery / 中华实验眼科杂志

After corneal refractive surgery,patients need to use glucocorticoids for a long time to control the wound healing,However,it can cause elevated intraocular pressure,even glucocorticoid-induced glaucoma,therefore properly evaluating patients' postoperative intraocular pressure (IOP) to avoid missing diagnosis of glucocorticoidinduced glaucoma and timely find glaucoma patients after corneal refractive surgery has an important clinical significance.The central corneal thickness (CCT),corneal curvature (CC),ablation depth,preoperative IOP and corneal biomechanics are responsible for IOP changes after corneal refractive surgery.To obtain accurate IOP value after corneal refractive surgery,this article reviewed the IOP measurements and their influential factors after surface,lamellar and all-in-one femtosecond laser refractive surgery.