A microscopia eletrônica de varredura pode ser usada para medir quantitativamente a rugosidade da dentina? / Can Scanning Electron Microscopy be used to quantitatively measure dentine roughness?

Objective: The aim of this study was to determine if SEM used with imaging software could be used to quantitatively determine the extent of dentine roughness due to tooth-brushing. Material and methods: Flat, polished dentine surfaces were subjected to 25,000 cycles of simulated tooth-brushing at 2 strokes per second with a load of 200 g. At the end of the brushing cycle, dentine surfaces were first assessed using profilometry and then subjected to SEM analysis. Ra (average roughness) readings were obtained for profilometric assessment. Using imaging software, the horizontal distance between adjacent characteristic grooves noted on micrographs was measured, ensuring that the middle of each crest of the associated groove was used as the reference point, the Crest-to-Crest distance (C-C distance). These two parameters were examined statistically for correlation. Results: When Spearman Rank tests were utilized the correlation between average Ra and crest to crest measurements was 0.709 (p <0.01). The Bland Altman plot, however, showed poor agreement between the two test parameters. Conclusion: Further work is needed to validate the use of this methodology in the quantitative assessment of tooth surface loss due to abrasion (AU)

Objetivo: O objetivo deste estudo foi determinar se o MEV usado com software de imagem poderia ser usado para determinar quantitativamente a extensão da rugosidade da dentina devido à escovação dentária. Material e Métodos: Superfícies dentinárias planas e polidas foram submetidas a 25.000 ciclos de escovação dentária simulada a 2 movimentos por segundo com uma carga de 200g. No final do ciclo de escovação, as superfícies dentinárias foram primeiro avaliadas por perfilometria e depois submetidas à análise MEV. Leituras de Ra (rugosidade média) foram obtidas para avaliação perfilométrica. Utilizando um software de imagem, foi medida a distância horizontal entre sulcos característicos adjacentes observados nas micrografias, garantindo que o meio de cada crista do sulco associado fosse usado como ponto de referência, a distância crista a crista (distância CC). Esses dois parâmetros foram examinados estatisticamente para correlação. Resultados: Quando foram utilizados os testes de Spearman Rank, a correlação entre a média de Ra e as medidas de crista a crista foi de 0,709 (p<0,01). O gráfico de Bland Altman, no entanto, mostrou fraca concordância entre os dois parâmetros de teste. Conclusão: Mais trabalhos são necessários para validar o uso desta metodologia na avaliação quantitativa da perda da superfície dentária devido à abrasão(AU)

Reproducibilidad de parámetros radiográficos para determinar el éxito quirúrgico de fracturas de radio distal / Reliability of radiographic parameters to determine the surgical success in distal radius fractures

Resumen: Introducción: las fracturas del radio distal son las más comunes en extremidades superiores. Estandarizar las mediciones radiográficas para su abordaje quirúrgico es importante. Este estudio midió la reproducibilidad intra/interobservador de parámetros radiográficos asociados al éxito quirúrgico en estas fracturas. Material y métodos: diseño transversal retrospectivo con datos secundarios de expedientes clínicos. Se evaluaron radiografías de 112 fracturas en planos posteroanterior y lateral por dos traumatólogos estandarizados en toma de mediciones para calcular cinco parámetros indicativos de éxito postquirúrgico: altura radial, inclinación radial, inclinación volar, varianza cubital y escalón articular. La reproducibilidad de distancias y ángulos se evaluó con el método de Bland-Altman calculando: diferencia media entre mediciones, rango a ± 2 DE y proporción de mediciones fuera de ± 2 DE. El éxito postquirúrgico se comparó en pacientes con/sin obesidad según la media de las dos mediciones de cada evaluador. Resultados: el evaluador 1 tuvo la mayor diferencia intraobservador en altura radial (0.16 mm) y la mayor proporción fuera de ± 2 DE en varianza cubital (8.1%); el evaluador 2 tuvo la mayor diferencia en inclinación volar (1.92o) y la mayor proporción en inclinación radial (10.7%). La mayor diferencia interobservador fue en varianza cubital (1.02 mm) y la mayor proporción fuera de ± 2 DE en altura radial (5.4%). La inclinación radial tuvo la mayor diferencia (1.41o) con 4.5% de mediciones fuera de ± 2 DE. La varianza cubital y la inclinación volar tuvieron la mayor diferencia de éxito postquirúrgico entre evaluadores, sobre todo en pacientes con obesidad. Conclusión: mejorar la calidad radiográfica y estandarizar las mediciones resulta en indicadores más reproducibles.

Abstract: Introduction: distal radius fractures are the most common in upper extremities. Therefore, it is important to standardize radiographic measures for their surgical approach. This study assessed the intra/interobserver reproducibility of radiographic parameters associated with surgical success of distal radius fractures. Material and methods: retrospective cross-sectional design of secondary data extracted from clinical records. Posteroanterior and lateral X-rays of 112 distal radius fractures were assessed by two trauma specialists standardized in the measurements required to compute five parameters indicative of postoperative success: radial height, radial inclination, volar tilt, ulnar variance, and articular stepoff. The reproducibility of distances and angles was evaluated using the Bland-Altman method, calculating the mean of the difference between measurements, the range at ± 2 SD, and the proportion of measurements outside ± 2 SD. Postoperative success was also compared between patients with and without obesity according to the mean of the two measures made by each evaluator. Results: evaluator 1 had the largest intra-observer difference in radial height (0.16 mm) and the largest proportion outside ± 2 SD in ulnar variance (8.1%); evaluator 2 had the largest difference in volar tilt (1.92o) and the highest proportion in radial inclination (10.7%). The largest inter-observer difference was for ulnar variance (1.02 mm) and the largest proportion outside ± 2 SD. for radial height (5.4%). Radial tilt had the largest difference (1.41o) with 4.5% of measurements outside ± 2 SD. Ulnar variance and volar tilt had the largest difference in postoperative success between evaluators, especially in patients with obesity. Conclusion: improving the radiographic quality and standardizing the measurements results in more reproducible indicators.

Exploration of an Efficient Simultaneous Molecular Detection Method of HIV, HCV, and Syphilis from a Single Dried Blood Spot / 生物医学与环境科学（英文）

Objective@#The aim of the present study was to evaluate the performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one dried blood spot (DBS) as an alternative sample to plasma.@*Method@#A total of 571 paired DBS/plasma samples were collected from men who have sex with men (MSM) and injection drug users (IDUs), and serological and molecular assays were performed. Using plasma results as the reference standard, the performance of DBS tests for HIV-1 RNA, HIV-1 DNA, and HCV RNA was evaluated. Pearson's correlation coefficients and Bland-Altman analysis were performed to assess the correlation and concordance between DBS and plasma.@*Results@#Among paired plasma/DBS samples with detectable HIV-1 RNA and HCV RNA, five samples (5/32) were not detectable in DBS, while measurable HIV-1 RNA levels were present in plasma (1.44 to 3.99 log @*Conclusion@#The performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one DBS was acceptable. DBS, as an alternative sample to plasma, may be a viable option for the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA in resource-limited settings or for individuals living in areas that are difficult to access.

Establishment of antioxidative activity determination for Achnatherum inebrians by graphene nanoenzyme / 中草药

Objective: To develop a new method for the determination of anti-oxidant activity of drugs by using the peroxidase activity of graphene nanoenzyme, and apply it for the determination of the anti-oxidant activity of the national medicine Achnatherum inebrians. Methods: The anti-oxidant activity of 18 batches of samples was measured after optimizing H2O2 concentration and reaction time. At the same time, the anti-oxidative activity was measured again using the DPPH method. The Bland-Altman and Passing-Bablok regression methods were used to compare the detection data of the two methods. Results: Using the nanoenzyme method, the inhibition rates of 18 batches of A. inebrians were between 37.28% and 71.58%, with an average of 50.87% and a median of 47.09%. Free radical scavenging rates of 18 batches of A. inebrians measured by the DPPH method were between 36.06% and 83.11%, with an average of 54.89% and a median of 50.83%. The statistical results showed that the measured values of nanoenzyme method and DPPH method were similar; There was a linear relationship between the two methods, and different methods can be transformed by Passing-Bablok regression method. Conclusion: The graphene nanoenzyme was successfully applied to the detection of anti-oxidant activity, and the anti-oxidant activity of A. inebrians was also found. The nanoenzyme method can avoid the problem of light sensitivity of the reagent, shorten the reaction time, reduce the amount of medicinal solution, and the results are consistent with the DPPH method, which is suitable for the determination of antioxidant activity.

Validity and Acceptability of Image-based Food Record in Assessing Nutrient Intake among selected Malaysian Undergraduates

@#Introduction: Recognising the limitations of present dietary assessments method, recent attention had been drawn to image-based food record (IBFR) to assess dietary intake of the population. Thus, the present study aimed to compare nutrient intake assessed using IBFR with 24-hour diet recall (24DR) among nutrition and dietetics student. Method: There were 46 nutrition and dietetic undergraduates participated in the study, and information on the socio-demographic background and acceptability toward IBFR were obtained. Respondents were trained to complete one-day IBFR, and they were interviewed by researchers on the following day for their 24DR. Result: The mean age of respondents was 21.4±1.7 years old. The present study revealed that there were significantly higher protein and beta-carotene, but lower vitamin C reported by IBFR compared to 24DR. Medium to strong correlations were found between IBFR and 24DR for energy and nutrients intakes. The Bland-Altman analysis demonstrated a good level of agreement between IBFR and 24DR for energy and macronutrients (carbohydrates, protein and fat), respectively. The mean differences between IBFR and 24DR were -36 kcal for total daily energy intake, while mean differences of -12.24g, 0.79g, and 1.52g were reported for carbohydrates protein, and fat, respectively. Moderate level of agreement toward acceptability was demonstrated, and most of them (67.4%) preferred IBFR method. Conclusion: The present study revealed that IBFR showed a good level of agreement with 24DR in assessing nutrient intake. However, more extensive works should be considered to improve IBFR in assessing the energy and nutrients intake for the general population.

A Light Adaptive Heart Rate Detection Method Based on Webcam / 中国医疗器械杂志

In order to extract the pulse wave signal of blood volume effectively in the case of uneven light, a light-adaptive heart rate detection method based on webcam was proposed. In this method, adaptive gamma transform is applied to face image sequence to eliminate the influence of illumination. The pulse wave source signal was extracted from the forehead area and the blood volume pulse wave was obtained by wavelet filtering. The heart rate is estimated by Fourier transform analysis. The Bland-Altman analysis indicates that the method used in this paper is in good agreement with the measurement results of the electronic sphygmomanometer, and the adaptive gamma transformation used in this paper eliminates the influence of light interference, and the measurement error of heart rate is significantly reduced, which is completely able to meet the requirements of daily heart rate monitoring.

Ecuaciones para la estimación del agua corporal total por el método de análisis de impedancia bioeléctrica a 50 kHz / Equations for the estimate of total body water by the method of bioelectric impedance at 50 kHz

Introducción: El agua mantiene un rango normal en personas aparentemente sanas, el cual se altera ante la existencia de diversas enfermedades. Objetivo: Conocer cuánto se diferencian los valores de agua corporal total estimados por las ecuaciones de agua corporal total, de Kushner, de Deurenberg y de Heitman, con respecto a los obtenidos clínicamente por el método de impedancia bioeléctrica a 50 kHz. Métodos: Se realizó un estudio descriptivo y transversal, de abril a diciembre del 2018, en 62 individuos: 31 adultos aparentemente sanos y 31 niños y adolescentes con diferentes enfermedades, ingresados en el Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba (24 en el Servicio de Misceláneas y 7 en el de Oncopediatría). El agua corporal total y los parámetros bioeléctricos se estimaron con el analizador de impedancia bioeléctrica Bodystat® 1500-MDD, a 50 kHz, por el método tetrapolar ipsilateral derecho. Se utilizó el criterio de Bland-Altman, para un 95 % de confianza, a fin de conocer si las ecuaciones de Kushner, de Deurenberg y de Heitman podían sustituir a la ecuación de referencia. Resultados: Las ecuaciones de agua corporal total, de Kushner y de Deurenberg no mostraron diferencias significativas respecto a la ecuación de referencia, mientras que la ecuación de Heitman sí presentó diferencias significativas en relación con el resto de las ecuaciones. El método de Bland-Altman demostró que la ecuación de Kushner posee mayor concordancia con la ecuación de referencia. Conclusiones: La ecuación de Kushner es la de mayor exactitud para la estimación del agua corporal total en personas sanas y en las afectadas por entidades clínicas.

Introduction: The water maintains a normal range in apparently healthy people, which changes with the existence of diverse diseases. Objective: To know how the values of total body water estimated by Kushner, Deurenberg and Heitman equations of total body water, differ regarding those obtained clinically by the method of bioelectric impedance at 50 kHz. Methods: A descriptive and cross-sectional study was carried out, from April to December, 2018, in 62 individuals: 31 apparently healthy adults and 31 children and adolescents with different diseases, admitted to "Dr. Antonio María Béguez César" Southern Teaching Children Hospital in Santiago de Cuba (24 in the Miscellaneous Service and 7 in Oncopediatrics Service). The total body water and the bioelectric parameters were considered with the analyzer of bioelectric impedance Bodystat® 1500-MDD, at 50 kHz, for the right ipsilateral tetrapolar method. The approach of Bland-Altman was used, for 95% of confidence in order to know if Kushner, Deurenberg and Heitman equations could substitute the reference equation. Results: Kushner and Deurenberg equations of total body water didn't show significant differences regarding the reference equation, while Heitman equation presented significant differences related to the rest of the equations. The Bland-Altman method demonstrated that the equation of Kushner has higher concordance with the reference equation. Conclusions: Kushner equation has the highest accuracy for the estimate of total body water in healthy people and in those affected by diseases.

Comparison of human body surface area calculation formulas with three-dimensional anthropometry / 解剖学报

Objective To observe the difference of the human body surface area (BSA) formula based on three-dimensional measurement in practical application. Methods The data of 1249 college students (639 males, 610 females) from physical health examination in 2018 were selected. Using the one-way factorial analysis of variance (ANOVA), correlation analysis and Bland-Altman comparative analysis, comparisons between the BSA values using four BSA calculation formulas based on three-dimensional measurement and with the traditional formula measurement by Yongmei Hu's were made as well. Results There were significant statistical differenes between the BSA values of the formulas (P 0. 985) were also rather high. Results from Hu Yong-mei's formula were higher than the other four 3D formulas in both genders, with the BSA of males 7. 32%-12. 11% higher than the mean while female BSA values were 5. 53%-11.72% above the average. It has been shown from the Bland-Altman analysis that the formula from ChiYuang Yu had the highest consistency score (95 % CI 1.021-1.034) among the selected four 3D measurement formulas. Conclusion Within the four BSA formulas based on 3D measurement principle, ChiYuang Yu's formula is relatively more suitable to estimate the BSA values of both Chinese males and females.

Study on Respiratory Rate Monitoring Method Based on Breath Sounds / 中国医疗器械杂志

The article aims to discuss the feasibility of using respiratory sounds to monitor respiratory rate. The average power of respiratory sounds was created firstly, the autocorrelation algorithm was used to calculate the respiratory cycle. The respiratory cycle of nasal flow pressure signal was calculated simultaneously, and the result was taken as a reference standard, then, two groups of respiratory cycle data were analyzed by correlation analysis and Bland-Altman analysis. The respiratory rate is relatively stable, using respiratory sounds monitor respiratory rate is feasible, the respiratory rate changes obviously, the existing methods and algorithm using respiratory sounds are temporarily unable to accurately reflect the changes of respiratory rate, further research is needed.

Reporting items of agreement evaluation using Bland-Altman Method:RiBAM / 医学研究生学报

With the promotion and application in medicine and sanitary fields,the reporting quality of Bland-Altman agreement evaluation is worrying.This study aimed at developing a set of reporting standards for Bland-Altman agreement evaluation as the guidance for proper application to improve the reporting quality.A research group was launched to work on reporting standards for Bland-Altman agreement evaluation,and all the requirements for personnel on various levels were made clear.Early in the study,we carried out articles reviews,regular meetings,expert consultations,literary evaluation,item integration and extraction.Then,we invited a multi-disciplinary panel of experts to improve overall design,evaluate reporting items and form the first draft by brainstorming method.Multiple rounds of expert consultations were also conducted with reference to Delphi method to integrate expert advice and form the basic framework of reporting items.Finally,through the thorough analysis and demonstration,we proposed the reporting items for the agreement evaluation of Bland-Altman method (RiBAM) as the recommended report.A list of recommended items called RiBAM was formed,which consisted of 17 first-level items and 23 secondary-level items.RiBAM is more comprehensive and systematic as an important reference for improving the quality of reports by avoiding the omission of reporting contents and achieving the clarity,integrity and transparency of the report.RiBAM recommended items can be a guide for authors in reporting Bland-Altman agreement evaluation as well as a basic reference for journal editors,peer reviewers and readers.

Association between pulse pressure variation of radial artery and pulse pressure variation of dorsal pedal artery in neurosurgery operation / 临床麻醉学杂志

Objective To discuss the agreement between pulse pressure variation of radial artery and pulse pressure variation of dorsal pedalartery in neurosurgery.Methods Twenty-five patients undergoing selective craniotomy under general anesthesia were enrolled.The following data were monitored and recorded respectively after tracheal intubation general anesthesia under different time:radial artery pulse pressure variability (PPV1) and dorsalis pedis pulse pressure variation (PPV2).Tidal volume was set to 8 ml/kg.Bland-Altman plots were created to assess agreement between PPV1 and PPV2.Results The mean differences and the limits of agreement between PPV1 and PPV2 are 20 min after induction of anesthesia 0.5% (-1.9%-2.8%), boneless flap instantly-0.5% (-3.8%-2.9%), Cut the dura mater instantly-0.1% (-3.2%-3.0%), and bone flap 0.1% (-2.4%-2.6%).Conclusion Dorsal pedal artery pulse pressure variation in neurosurgery craniotomy has certain guiding significance to the monitoring and management.

Cardiac index by thermodilution or transthoracic echocardiography in dogs at different hemodynamic states / Índice cardíaco pelos métodos de termodiluição ou ecocardiografia transtorácica em cães sob diferentes situações hemodinâmicas

ABSTRACT: Proper monitoring of cardiac index (CI) in critically ill patients requires accurate and minimally invasive methods. The aim of this study was to compare the CI values obtained by thermodilution or echocardiography using different methods in dogs in different hemodynamic states. Nine dogs weighing 19.6±1.3kg were anesthetized with isoflurane at 1.4V% (Baseline) and subjected to mechanical ventilation (MV),a hypodynamic state (Hypo) with isoflurane at 3.5V% and hyperdynamic state (hyper) with dobutamine infusion at 5μgkg-1min-1. CI analysis was performed by thermodilution (TD) and using the modified Simpson's method, aortic velocity-time integral (A-VTI) method and pulmonary VTI (P-VTI) method. We performed Pearson's correlation and Bland-Altman analysis. The CI values (Lm-2min-1) of the animals in the Baseline, MV, Hypo and Hyper states were 4.3±1, 3.6±0.7, 2.9±0.66 and 6.1±2, for TD; 2.8±0.7, 2.4±0.3, 1.7±0.7 and 4.4±1.2, for Simpson's method; 3.4±0.9, 3.1±0.7, 2.6±3.4, 6.1±1.8 for A-VTI; and 3.6±0.8, 3.6±0.8, 2.7±0.6 and 6.2±1.5, for P-VTI. The CI values using Simpson's method were lower than those obtained by TD in all states, and it was observed a significant correlation in the Hypo (r=0.89) and Hyper (r=0.76) groups. In addition,the percent error in the Hypo group using Simpson's method was 26% relative to TD, which allowed for the identification of the different hemodynamic states. With respect to the other methods and states, there was no agreement or correlation between the methods and TD. We concluded that none of the tested echocardiography methods exhibited acceptable agreement with thermodilution at different hemodynamic states.

RESUMO: A adequada monitoração do índice cardíaco (IC) em pacientes críticos requer métodos acurados e minimamente invasivos. O objetivo deste estudo foi comparar o IC obtido por termodiluição ou ecocardiografia em cães sob alterações hemodinâmicas. Utilizaram-se nove cães pesando 19,6±1,3kg, os quais foram anestesiados com isofluoranoa1,4V% (Basal) e submetidos à ventilação mecânica (VM) e estados hipodinâmico (Hipo) com isofluoranoa3,5V% e hiperdinâmico (Hiper), com dobutaminaa5µgkg-1min-1. O IC foi obtido por termodiluição (TD) e pelos métodos ecocardiográficos de Simpson modificado, e pela velocidade em tempo integral (VTI) nas valvas aórtica (VTI-A) e pulmonar (VTI-P). Realizou-se a análise de correlação de Pearson e de concordância de Bland-Altman. O IC (Lm-2min-1) nas fases Basal, VM, Hipo e Hiper foi de 4,3±1, 3,6±0,7, 2,9±0,66 e 6,1±2 para TD; 2,8 ±0,7, 2,4±0,3, 1,7±0,7 e 4,4±1,2 para Simpson; 3,4±0,9, 3,1 ±0,7, 2,6±3,4, 6,1±1,8 para VTI-A e 3,6±0,8, 3,6±0,8, 2,7±0,6 e 6,2±1,5 para VTI-P. O método de Simpson foi menor que a TD em todas as fases, mas com correlação significativa nos estados Hipo (r=0,89) e Hiper (r=0,76) e percentagem de erro de 26% no Hipo em relação à TD, identificando os diferentes estados hemodinâmicos. Nos demais, não houve concordância ou correlação com a TD. Conclui-se que nenhum dos métodos testados apresentou concordância aceitável com a termodiluição nos diferentes estados hemodinâmicos.

Can higher end tonometers be used interchangeably in routine clinical practice.

Context: Precise intraocular pressure (IOP) measurement is important in glaucoma practise. Various instruments are available today to accurately measure IOP. Thus, the question arises about which instrument to use and whether all of them can be used interchangeably. Aims: To assess the agreement between noncontact tonometer (NCT), rebound tonometer (RBT), Goldmann applanation tonometer (GAT), and dynamic contour tonometer (DCT) in measuring IOP. Subjects and Methods: 499 eyes of 250 patients were evaluated during a period of 24 months from September 2010 to August 2012 and measurement of IOP by NCT, RBT, GAT, and DCT was done in the given sequence. The agreement was assessed by use of the Bland–Altman plot keeping GAT as a gold standard technique. Results: The mean IOP value of NCT, RBT, GAT, and DCT was 15.9 ± 5.5, 15.9 ± 5.8, 15.9 ± 4.9, and 16.0 ± 4.7 mm of Hg, respectively. The limits of agreement of GAT with DCT, NCT, and RBT were found to be +5.4 to −5.2, −4.7 to +4.6, and −5.2 to +5.1 mm of Hg, respectively. Conclusions: A positive and strong correlation was found between newer tonometers and GAT, but the limit of agreement was clinically unacceptable. The use of a single tonometer should be practised at a glaucoma clinic for a patient at each follow‑up.

Comparison of calculated and measured resting energy expenditure in patients with type 2 diabetes mellitus / 中华临床营养杂志

Objective To evaluate the accuracy of prediction equations in calculating energy expenditure in elderly patients with type 2 diabetes mellitus (T2DM).Methods In 75 elderly T2DM patients hospitalized in our hospital between August 2014 and August 2015,the resting energy expenditure (REE)measured with indirect calorimetry was compared with those calculated with six different prediction equations.Statistical analysis was performed with paired t-test,the percentage of individual coincidence,and BlandAltman method.Results The measured REE of the patients was (1 513.2 ± 240.6) kcal/d.There were statistically significant differences between the measured REE and the values predicted with Harris-Benedict,Owen,Mifflin,and Liu equations (all P ＜ 0.05),while no statistically significant differences were observed between the measured REE and the values predicted with FAO/WHO/UNU and Schofield equations (both P ＞0.05).FAO/WHO/UNU equation showed the smallest average difference from the measured value (-18.9 kcal/d),but the 95％ consistency limit (-363.3 kcal/d,325.5 kcal/d) was still beyond the acceptable clinical range.Conclusion The accuracy of prediction equations in estimating REE in elderly patients with T2DM may be dissatisfactory.

Calorimetria indireta na monitoração hemodinâmica e metabólica em cães sob diferentes situações hemodinâmicas / Indirect calorimetry in hemodinamic and metabolic monitoring in dogs under different hemodynamic states

A monitoração do estado hemodinâmico visa ao equilíbrio entre a oferta e a demanda de oxigênio tecidual. O objetivo deste estudo foi avaliar a utilização da calorimetria indireta (CI) frente à termodiluição (TD) em cães sob diferentes estados hemodinâmicos. Utilizaram-se nove cães pesando 19,6±1,3kg, os quais foram anestesiados com isofluorano a 1,4V% (Basal), submetidos à ventilação mecânica (VM) e estados hipodinâmico (Hipo), com isofluorano a 3,5V%, e hiperdinâmico (Hiper), com dobutamina a 5µg/kg/min. Utilizou-se um cateter de Swan-Ganz para aferição do índice cardíaco (IC) por TD, cálculo do consumo de oxigênio pelo método de Fick (VO2Fick) e para coleta de sangue venoso central e misto. Com a CI, obtiveram-se os valores de consumo de oxigênio (VO2), produção de CO2(VCO2) e expirado de CO2 (EtCO2). Para a determinação do IC por CI, utilizou-se o princípio de Fick com os valores de VO2 e os sangues arteriais e venosos misto (Fickmix) ou central (Fickvc), e pela relação dos valores de VCO2 e EtCO2(FickCO2). A análise estatística compreendeu os testes de Dunnet, para diferença entre as fases, e Tukey, para diferenças entre os métodos (P≤0,05). Foram realizadas as análises de correlação de Pearson e de concordância de Bland-Altman. A CI forneceu valores de VO230 a 40% maiores que VO2Fick, mas identificou a redução no VO2 após a VM e Hipo, o que não ocorreu com VO2Fick. Os valores de VCO2diminuíram nas fases VM e Hipo. Houve redução do IC na fase Hipo com todos os métodos e aumento na fase Hiper com TD e Fickvc. Os valores de IC pelos métodos de Fickmixe Fickvc foram maiores que TD em todos os momentos, e FickCO2foi menor que TD na fase Hiper. Nenhum dos métodos apresentou concordância e correlação com a TD. Conclui-se que a CI pode ser utilizada na mensuração do VO2 e VCO2 de cães sob diferentes estados hemodinâmicos. Contudo, embora seja possível a identificação dos diferentes estados hemodinâmicos, os valores de IC não podem ser comparados à termodiluição.

Monitoring the hemodynamic state seeks a balance between the supply and demand of oxygen by tissues. The aim of this study was to evaluate the use of indirect calorimetry (IC) compared to thermodilution (TD) in dogs under different hemodynamic states. Nine dogs weighing 19.6±1.3kg were anesthetized with isoflurane at 1.4 V% (Baseline) and subjected to mechanical ventilation (MV), a hypodynamic state (Hypo) with isoflurane at 3.5V% and hyperdynamic state (Hyper) with dobutamine infusion at 5μg/kg/min. We used a Swan-Ganz catheter for measurement of cardiac index (CI) by TD, calculation of oxygen consumption by Fick's method (VO2Fick) and to collect central and mixed venous blood. With the IC we obtained oxygen consumption (VO2), CO2 production (VCO2) and end tidal CO2(EtCO2). For the determination of CI by IC we used the Fick's principle with VO2values, and arterial and mixed venous blood (Fickmix)or arterial and central venous blood (Fickvc); and by the ratio of the values of VCO2 and EtCO2(FickCO2). We performed the statistical analysis by Dunnet tests, for the difference between the states, and Tukey for differences between methods (P≤0.05). Pearson correlation and Bland-Altman analysis was performed for correlation and agreement analysis. IC provided VO2values 30 to 40% higher than the VO2Fick but identified the reduction in VO2after VM and Hypo, which did not occur with VO2Fick. The VCO2 values decreased in VM and Hypo. CI values decreased in Hypo with all methods and increase in Hyper with TD and Fickvc. The CI values for Fickmix and Fickvc were greater than TD at all times and FickCO2 was lower than TD in the Hyper. None of the methods presented agreement and correlation with TD. Thus, indirect calorimetry can be used to measure the VO2 and VCO2 in dogs in different hemodynamic states. However, although it is possible to identify the hemodynamic status, cardiac index values cannot be compared to thermodilution.

Bland-Altman analysis for determining the coincidence between two methods for measuring emergency department crowding: visual analogue scale versus national emergency department overcrowding scale / 中华急诊医学杂志

Objective To establish a practicable and easily mastered emergency department overcrowding (EDO) assessment system suitable for domestic ED setting by determining the validity and usefulness of the national emergency department over-crowding study (NEDOCS) tool in a 2000-bed tertiary care academic institution in China in comparison with visual analogue scale (VAS) in order to address the worldwide grave concern of EDO.Methods In a period of 6 months,data of subjective and objective EDO assessed simultaneously three times a day (1:00,9:00,17:00) were collected.The data were analyzed by using Bland-altmann method and Kappa test to determine the coincidence between VAS and NEDOCS assessments.Results The VAS-p value evaluated by physicians was significantly lower than VAS-n value evaluated by nurses [(6.49 ± 1.82) vs.(7.12 ± 1.78),P ＜ 0.01].The reliability analysis showed that Kappa value was as low as 0.112 (P ＜0.01) suggesting there was a great discrepancy between VAS-p value and VAS-n value.VAS-m (average value of VAS-p and VAS-n) was taken for comparing different evaluation systems.The significant correlation was found between the VAS-m and NEDOCS (r =0.7l4,P ＜0.01).However,the Bland-Altman plot showed the 95％ limit of coincidence was in an extensive range (-32.47 to 71.42) suggesting discrepancy existed between two methods.Conclusions The present study suggested there was a significant discrepancy between the two subjective assessments of ED crowding (VAS-p vs.VAS-n).There might be a fatal flaw existed in the assumptions of the original VAS method for EDO measurement.Using the Bland-Altman plot analysis,the results showed that NEDOCS did not authentically reflect the staff' s sense of overcrowding in the ED.It is very important and urgent to establish an objective and effective EDO evaluation system for ED management.

Consistency evaluation for quantitative measurements by Bland-Altman method and its clinical application / 医学研究生学报

The Bland-Altman method has been widely used for consistency evaluation in the field of medicine .However, fre-quent errors in the application of the method seriously affect the quality of researches .This review focuses on the studies of the Bland-Altman method , the status quo and common problems in its application , and standards for related reports .

Use of the 6-minute walk/run test to predict peak oxygen uptake in adolescents / Teste de corrida/caminhada de 6 minutos para a predição do consumo de oxigênio de pico em adolescentes

This study aimed to create an equation to predict peak oxygen uptake from data of the 6-minute walk/run test and demographic and anthropometric variables in adolescents. The results of the 6-minute walk/run (6WRT), peak oxygen uptake, height, body weight and body mass index (BMI) in 125 adolescents age 10 to 14, of which 66 were female, were assessed. They were divided into a validation and a cross-validation group. A linear regression analysis was conducted to assess the associations between the independent variables 6WRT, age, gender, anthropometric measurements and the dependent variable peak oxygen uptake in the validation group. The Bland-Altman method was used to test agreement between measured and estimated values. It was found that the best model to predict peak oxygen uptake included the 6-minute walk/run test, BMI, and gender. These variables presented a multiple correlation coefficient of 0.77 and a standard error of estimate of 3.99 [(mL/kg)/min]. The accuracy of the model was tested by applying the equation created in the validation group to the cross-validation group and total sample. The Bland-Altman method results did not indicate any systematic bias or heteroscedasticity in both the validation and cross-validation groups. In conclusion, our multiple regression equation [peak oxygen uptake = 41.946 + 0.022(6WRT) ­ 0.875(BMI) + 2.107(gender)] is adequate for predicting peak oxygen uptake in adolescents age 10 to 14.

Este estudo objetivou criar uma equação para a predição do consumo de oxigênio de pico em adolescentes a partir do teste de corrida/caminhada de 6 minutos, variáveis demográficas e antropométricas. Os resultados do teste de corrida/caminha de 6 minutos (6-min), consumo de oxigênio de pico, estatura, massa corporal e índice de massa corporal (IMC) de 125 adolescentes de 10 a 14 anos de idade (66 moças) foram avaliados. A amostra foi dividida em um grupo validação e um grupo validação cruzada. A análise de regressão linear múltipla foi utilizada para analisar as associações entre o 6-min, idade, sexo e medidas antropométricas (variáveis independentes) e o consumo de oxigênio de pico (variável dependente) no grupo validação. O diagrama de Bland-Altman foi utilizado para testar a concordância entre os valores medidos e estimados. O melhor modelo encontrado para predizer o consumo de oxigênio de pico incluiu o 6-min, o IMC e o sexo. Estas variáveis apresentaram um coeficiente de correlação múltipla de 0,77 e um erro padrão de estimativa de 3,99 [(mL/kg)/min]. A acurácia do modelo foi testada aplicando a equação criada no grupo validação no grupo validação cruzada e em toda a amostra. Os resultados do diagrama de Bland-Altman não indicaram erro sistemático e heteroscedasticidade tanto no grupo validação quanto no grupo validação cruzada. Em conclusão, a equação proposta [consumo de oxigênio de pico = 41,946 + 0,022(6-min) ­ 0,875(IMC) + 2.107(sexo) é adequada para predição do consumo de oxigênio de pico em adolescentes de 10 a 14 anos de idade.

Parámetros bioeléctricos in vitro e in vivo, estimados con los analizadores Bodystat®1500-MDD y BioScan®98 / Bioelectrical parameters in vitro and in vivo estimated with analyzers Bodystat®1500-MDD and BioScan®98

Se efectuó un estudio comparativo de 2 analizadores comerciales de bioimpedancia eléctrica corporal (Bodystat® 1500-MDD y BioScan®98) en el Servicio de Oncopediatría del Hospital Infantil Sur de Santiago de Cuba, desde septiembre hasta octubre del 2009, para lo cual se realizó una simulación in vitro con los calibradores de cada equipo y un estudio in vivo de 32 adultos aparentemente sanos y 32 niños con diferentes afecciones. La resistencia eléctrica y la reactancia capacitiva se estimaron con ambos analizadores; además, se calcularon el módulo de impedancia y el ángulo de fase. La prueba t-student de 2 medias para muestras apareadas y el método de Bland-Altman fueron los criterios estadísticos usados. No existieron diferencias significativas entre ambos analizadores al introducir los factores de corrección para la resistencia eléctrica y la reactancia capacitiva; por tanto, es posible usarlos indistintamente para caracterizar bioeléctricamente a los individuos aparentemente sanos y pacientes con diferentes enfermedades.

A controlled trial with 2 body electrical impedance commercial analyzers was carried out (Bodystat® 1500-MDD and BioScan®98) at the Pediatric Oncology Department of the Southern Children Hospital in Santiago de Cuba, from September to October 2009, for which an in vitro simulation with gauges of each device and an in vivo study in 32 apparently healthy adults and 32 children with different conditions were conducted. Electrical resistance and capacitive reactance were estimated with both analyzers, and impedance module and phase angle were also calculated. The two-means Student's t test for paired samples and the Bland-Altman method were used as statistical criteria. There were not significant differences between the two analyzers by introducing correction factors for electrical resistance and capacitive reactance; therefore, it is possible to use either to characterize bioelectrically apparently healthy individuals and patients with different conditions.