Destete guiado por ecografía / Ultrasound-Guided Extubation

Introducción: La observación del diafragma con el ultrasonido ha sido posible desde hace más de cuatro décadas; recientemente se le ha dado importancia a la valoración ultrasonográfica del diafragma en el proceso de destete del paciente ventilado. Objetivo: Describir la utilización de la ecografía diafragmática en la evaluación del proceso de destete en dos pacientes. Presentación de caso: Se presentan dos casos, el primer caso paciente femenino de 79 años con diagnóstico de infarto cerebral, coma y bronconeumonía; que precisó ventilación mecánica invasiva y previa prueba de ventilación espontánea. Se le realizó ultrasonido de diafragma donde se comprobó alta probabilidad de falla en la extubación, por lo que se modificó el esquema de destete para corregir las causas. El segundo paciente masculino de 68 años con diagnóstico de neumonitis aspirativa por queroseno que necesitó soporte ventilatorio invasivo; cuando presentó mejoría del cuadro inicial y parámetros de oxigenación, se le evaluó la función diafragmática mediante ultrasonografía se comprobó alta probabilidad de éxito en la extubación, se logró sin complicaciones. Conclusiones: Se utilizó la ultrasonografía diafragmática, emerge como una herramienta de fácil acceso y bajo costo, en la evaluación del proceso de destete en los pacientes ventilados, permitió la exploración de la función del diafragma en directo y en pie de cama. La valoración de la excursión diafragmática y la fracción de engrosamiento diafragmático proporcionó una escala predictiva valiosa, para prever que pacientes tendrán una extubación exitosa o no(AU)

Introduction: The observation of the diaphragm with ultrasound has been possible for more than four decades; but only recently has importance been given to the ultra-sonographic assessment of the diaphragm in the weaning process of the ventilated patient. Objective: To describe the use of diaphragmatic ultrasound in the evaluation of the weaning process in two patients. Case presentation: Two cases are presented, the first case is a 79-year-old female patient with a diagnosis of cerebral infarction, coma and bronchopneumonia; that she required invasive mechanical ventilation and after a spontaneous ventilation test, an ultrasound of the diaphragm was performed, where a high probability of failure in extubation was verified, for which the weaning scheme was modified to correct the causes. The second 68-year-old male patient diagnosed with kerosene aspiration pneumonitis that required invasive ventilator support; that when he presented improvement of the initial symptoms and oxygenation parameters, his diaphragmatic function was evaluated by ultrasonography, verifying a high probability of success in extubation, achieved without complications. Conclusions: Diaphragmatic ultrasonography emerges as a tool of easy access and low cost, in the evaluation of the weaning process in ventilated patients, allowing the exploration of the function of the diaphragm in direct and at the foot of the bed. The evaluation of the diaphragmatic excursion and the fraction of diaphragmatic thickening provide us with a valuable predictive scale, to anticipate which patients will have a successful extubation or not(AU)

Índice de respiración rápida superficial diafragmática como predictor weaning de la ventilación mecánica / Rate of rapid superficial diaphragmatic breathing as a weaning predictor of mechanical ventilation

El destete de la ventilación mecánica (VM) es un paso clave para los pacientes sometidos a VM invasiva en la unidad de cuidados intensivos (UCI). Entre las diversas herramientas destinadas a ayudar a predecir el fracaso sucesor del destete, encontramos el índice rápido de respiración superficial (RSBI por sus siglas en inglés), es decir, la relación entre la frecuencia respiratoria y el volumen corriente (Fr/Vt) medido durante una prueba de respiración espontánea (SBT por sus siglas en inglés). Objetivo: Describir el índice de respiración superficial diagramática como predictor Weaning de la ventilación mecánica. Materiales y métodos: Estudio de revisión, de tipo monográfico. Apoyado en artículos científicos, publicados en diferentes revistas indexzada en índices reconocidos. Resultado: Durante un SBT, el valor de RSBI parece ser paralelo a la evolución de la fatiga de los músculos respiratorios. Por lo tanto, se considera que el RSBI refleja la carga inspiratoria, siendo la disminución del volumen tidal junto con el aumento de frecuencia respiratoria indicativo de posible debilidad o fatiga de los músculos inspiratorios, u otros efectos fisiológicos. Conclusión: Entre los pacientes ventilados en la UCI, una alteración multifactorial del diafragma es común y puede resultar en falla del destete y prolongación de la VM invasiva; por lo tanto, evaluar la función del diafragma es un medio útil para evaluar la capacidad del paciente para tolerar la respiración espontánea(AU)

Weaning from mechanical ventilation (MV) is a key step for patients undergoing invasive MV in the intensive care unit (ICU). Among the various tools intended to help predict successor failure weaning, we found the rapid shallow breathing index (RSBI for its acronym in English), that is, the relationship between the respiratory rate and the volume current (Fr/Vt) measured during a spontaneous breathing test (SBT by its acronym in English). Objective: To describe the rate of shallow breathing Diagrammatic as a Weaning predictor of mechanical ventilation. Materials and methods: Review study, monographic type. supported by articles scientific, published in different magazines indexed in recognized indices. Result: During an SBT, the RSBI value appears to be parallel to the evolution of respiratory muscle fatigue. Therefore, it is considered that the RSBI reflects the inspiratory load, being the decrease in tidal volume together with the increased respiratory rate indicative of possible weakness or fatigue of the inspiratory muscles, or other physiological effects. Conclusion: Among the patients ventilated in the ICU, a multifactorial alteration of the diaphragm is common and can result in weaning failure and prolongation of invasive MV; by Therefore, assessing diaphragm function is a useful means of assessing the patient's ability to tolerate spontaneous breathing(AU)

Study on establishing the reference range of atrial septal excursion index and foramen ovale membrane angle in normal fetuses aged 16-40 weeks / 中华超声影像学杂志

Objective:To establish the normal reference range of atrial septal excursion index (ASEI) and foramen ovale membrane angle in normal fetuses aged 16-40 weeks, and to analyze the correlation between ASEI and foramen ovale membrane angle in normal fetuses.Methods:A total of 378 normal singletons with gestational ages of 16-40 weeks undergoing by fetal echocardiography were selected in the Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, from January to June 2021, and 349 fetuses successfully finished all measurements. After all fetuses completed the systematic fetal echocardiography, fetal foramen ovale diameter and foramen ovale membrane angle were measured on the four chamber view. The maximum distance of foramen ovale valve from the base of atrial septum to the free wall of left atrium and the transverse diameter of left atrium were measured, and ASEI was calculated. The differences of ASEI, foramen ovale membrane angle and foramen ovale diameter of the groups with different gestational weeks were compared. The correlations among ASEI, foramen ovale membrane angle and foramen ovale diameter were analyzed by Pearson correlation analysis.Results:All 349 fetuses were divided into 6 groups according to their gestational weeks, including 17 cases at 16-20 weeks, 46 cases at 21-24 weeks, 114 cases at 25-28 weeks, 105 cases at 29-32 weeks, 31 cases at 33-36 weeks and 36 cases at 37-40 weeks. The ± s of ASEI was 0.492 7±0.059 7, 95% CI was 0.486 4-0.499 0, 95% normal reference value range was 0.375 7-0.609 8. Significant differences were found in ASEI among different groups( P<0.05). The ± s of foramen ovale membrane angle was (44.03±5.48)°, 95% CI was 43.46-44.61°, 95% normal reference value range was 33.29-54.78°. Significant differences were found in the foramen ovale membrane angle among different groups( P<0.05). The ± s of foramen ovale diameter was (4.32±1.30)mm, 95% CI was 4.18-4.45 mm, the differences among different groups were significant( P<0.05) and foramen ovale diameter was found increased with the increase of gestational weeks. There was a significant positive correlation between ASEI and foramen ovale membrane angle ( r=0.558, P<0.05). There was no correlation between foramen ovale diameter and ASEI and foramen ovale membrane angle ( r=-0.166, -0.084; all P>0.05). Conclusions:The normal reference ranges of ASEI and foramen ovale valve angle of normal fetuses aged 16-40 weeks was successfully established. These parameters may be useful for evaluating diastolic cardiac function by assessing foramen ovale.

Application of fetal atrial septal excursion index and comprehensive Z-scores of cardiovascular structures in fetuses with redundancy foramen ovale flap / 中华超声影像学杂志

Objective:To investigate the application of fetal atria septal excursion index (ASEI) combining cardiovascular structure Z-scores in fetuses with redundancy foramen ovale flap (RFOF).Methods:Twenty-two fetuses with RFOF diagnosed by fetal echocardiography in Sir Run Run Shaw Hospital from December 2019 to September 2021 were selected as the RFOF group and 62 normal fetuses as the control group. The movement of the foramen ovale valve was observed in the four chamber view, and the maximum distance of the foramen ovale valve bulging, the total length of the atrial septum, the foramen ovale diameter, the diameters of the aortic valve, the pulmonary valve, the ascending aorta, the aortic isthmus, the descending aorta and the left and right ventricular areas were measured. ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, aortic valvular annular diameter Z-score(AOV Z-score), pulmonary valvular annular diameter Z-score(PV Z-score), ascending aorta diameter Z-score(AOA Z-score), ascending aorta diameter Z-score (AOA Z-score), aortic isthmus Z-score (AOI Z-score), descending aorta diameter Z-score (AOD Z-score), diastolic right ventricular area Z-score (RV area Z-score) and diastolic left ventricular area Z-score(LV area Z-score) were compared between the two groups. RFOF fetuses were followed up to observe the prognosis.Results:There were significant differences in fetal ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, AOV Z-score, PV Z-score, AOA Z-score, AOI Z-score, AOD Z-score and LV area Z-score between RFOF group and control group (all P<0.05), but there was no significant difference in RV area Z-score ( P>0.05). Postnatal follow-up outcomes in RFOF group indicated that 17 of 22 cases (77.3%) had live birth, five cases (22.7%) were lost at follow-up. Twelve of 17 live birth cases (70.5%) showed structurally normal heart by postnatal echocardiography, 3 cases (17.6%) showed mild coarctation of the aorta with nonsignificant hemodynamics under clinical follow-up, 2 cases (11.8%) were diagnosed with coarctation of the aorta, pulmonary artery dilation and atrial septal defect, and died after operation, of which one case died of infections pneumonia after operation. Another case was born prematurely at 36 + 4 weeks with a birth weight of 2 650 g, and neotal echocardiography showed ventricular septal defect, atrial septal defect and patent ductus arteriosus. Conclusions:ASEI can quantitatively evaluate the behavior of foramen ovale valve mobility and in combination with Z-scores of cardiovascular structures can be used to assess the morphological changes of fetal hearts. Although some fetuses with RFOF demonstrate left and right ventricular disproportion and coarctation of the aorta in fetal echocardiography, most fetuses have a good prognosis.

The relationship between sarcopenia and the maximum diaphragmatic excursion on ultrasound in the elderly / 中华老年医学杂志

Objective:To investigate the relationship between sarcopenia and the maximum diaphragm excursion(Dmax)observed on ultrasound in the elderly.Methods:Elderly volunteers(age≥60 years)were recruited from family members of patients at Guangdong Provincial People's Hospital.Their Dmax during forced inhalation was measured via ultrasound.The parameters for the diagnosis of sarcopenia included the appendicular skeletal muscle mass index(ASMI), handgrip strength and usual gait speed.We compared the differences in physical characteristics, pulmonary ventilation, physical performance and Dmax between patients with and without sarcopenia, and evaluated the relationship between sarcopenia and DEmax in the elderly via linear regression.Results:A total of 145 elderly volunteers[age(69.47±5.15)years]were included, and 28(19.31%)were diagnosed with sarcopenia.Body weight, ASMI, maximum inspiratory pressure(Pinmax), maximal power output(Wmax)and Dmax of patients with sarcopenia were significantly lower than those of patients without sarcopenia(all P<0.05).Dmax in the elderly was correlated with sex, height, ASMI, handgrip strength, usual gait speed, Pinmax and Wmax( r=0.181, 0.130, 0.322, 0.373, 0.401, 0.134, and 0.388, P=0.012, 0.037, 0.009, 0.002, 0.022, 0.009, and 0.002, respectively).After adjusting for sex, age, height and forced vital capacity(FVC), there was still a negative correlation between sarcopenia and Dmax in the elderly( β=-0.310, P=0.021). Conclusions:Dmax is related to Pinmax and physical performance in the elderly, and sarcopenia increases the risk of decline in the maximum diaphragm excursion in the elderly as observed on ultrasound.

Do the Different Types of Pulmonary Hypertension Cause the Same Effect on Right Heart and Serum Asymmetrical Dimethylarginine Levels in Female Patients?

ABSTRACT Objective: Right-heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. This study aimed to evaluate if different types of pulmonary hypertension (PH) would cause the same effect on right-heart functions and serum ADMA levels in female patients. Methods: This study included patients with PAH as group I, patients with PVH due to mitral stenosis (mitral valve area ≤ 1.5 cm2, without any additional valve or left-heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II, and healthy control subjects as group III. Transthorasic echocardiographic evaluations for right-heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected, and the serum ADMA concentrations were obtained with the ELISA kit (DRG® International Inc., Springfield, NJ, USA). Results: Patients in groups I and II had higher ADMA levels than healthy control subjects. Right-atrium area and dimensions, right-ventricular (RV) volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure, RV wall thickness, and RV outflow tract diameters were significantly higher in group I patients than in group II patients. Right-ventricular myocardial performance index was lower, and RV fractional area change and tricuspid valve systolic tissue Doppler velocity were higher in group II patients than in group I patients. Conclusion: This study demonstrated that both PAH and PVH caused increase in right-heart dimensions and impairment in right-heart functions.

Validity and Reliability of Star Excursion Balance Test for Dynamic Balance Assessment in Stroke Patients / 中国康复理论与实践

Objective:To apply Star Excursion Balance Test (SEBT) in evaluating dynamic balance function in stroke patients. Methods:From September, 2018 to November, 2019, 38 stroke hemiplegic patients of Brunnstrom IV and above who could walk independently were included. They completed SEBT by two testers; the anterior, posteromedial and posterolateral extension standardized distance of the affected leg support were recorded. One of the testers measured SEBT again the day after the next day. The intraclass correlation coefficient (ICC) was calculated. The limits of stability on different directions were measured with active balancer EAB-100 (EAB) and tested with Timed 'Up & Go' Test (TUGT) by the third tester. The correlation of SEBT to EAB and TUGT was analyzed with Pearson correlation coefficient. Results:ICCs of three directions was 0.892 to 0.951 between testers, and 0.888 to 0.963 of test-retest. The standardized distance of three directions of SEBT correlated with the anterior and lateral stability limits of EAB (r = 0.479 to 0.671, P < 0.05), as well as TUGT (r = -0.557~-0.633， P < 0.05). Conclusion:SEBT is valid and reliable for evaluation of the dynamic balance for stroke patients of Brunnstrom IV and above who can walk independently.

Carga respiratória em obesos e jovens asmáticos: um estudo da cinética diafragmática / Respiratory burden in obese and young asthmatics: a study of diaphragmatic kinetics

RESUMO Objetivo O objetivo deste estudo foi avaliar a cinética diafragmática, a função respiratória e a dosagem sérica de leptina e citocinas inflamatórias (IL-6 e TNF-α) em três grupos clínicos: obeso, asmático e saudável. Métodos Estudo clínico-exploratório realizado com 73 jovens (12-24 anos, sendo 42,5% do sexo masculino) alocados em três grupos: obesidade (GO, n = 33), índice de massa corporal (IMC z-score) ≥ + 2 e asmáticos leves controlados (GA, n = 26), classificados pela GINA, e grupo controle saudável (GC, n = 14). Os participantes foram submetidos à ultrassonografia diafragmática, espirometria, pressão respiratória máxima, níveis séricos de leptina e níveis de IL-6 e TNF-α em hemocultura total. Resultados A espessura do diafragma foi maior no GO em comparação ao GA e GC (2,0 ± 0,4 vs 1,7 ± 0,5 e 1,6 ± 0,2, respectivamente, com p < 0,05). A ventilação voluntária máxima (VVM) foi significativamente menor no GO e GA em relação ao GC (82,8 ± 21,4 e 72,5 ± 21,2 vs 102,8 ± 27,3, respectivamente, com p < 0,05). O GO tem a maior taxa de leptina entre todos os grupos (com os outros dois grupos, p < 0,05). Os três grupos tinham níveis semelhantes de TNF-α e IL-6. Conclusão A hipertrofia muscular encontrada no diafragma de indivíduos obesos pode ser justificada pelo aumento do trabalho respiratório imposto pela condição crônica da doença. Esse aumento de espessura não ocorreu em asmáticos leves controlados. Os marcadores IL-6 e TNF-α não detectaram evidências de inflamação muscular, embora fosse esperado que a leptina estivesse alterada em indivíduos obesos. Pacientes obesos e asmáticos apresentaram menor resistência pulmonar do que os saudáveis.

ABSTRACT Objective The aim of this study was to assess the diaphragm kinetics, respiratory function, and serum dosage of leptin and inflammatory cytokines (IL-6 and TNF-α) in three clinical groups: obese, asthmatic, and healthy. Methods This is a clinical exploratory study performed on 73 youths (12-24 years of age, 42.5% male) allocated into three groups: obesity (OG, n=33), body mass index (BMIz-score) ≥ +2, asthmatic (AG, n=26) controlled mild asthmatics, classified by GINA, and Healthy Control Group (CG, n=14). The participants were subjected to diaphragmatic ultrasound, spirometry, maximal respiratory pressure, serum leptin levels, and IL-6 and TNF-α whole blood cell culture levels. Results Diaphragm thickness was higher in OG in comparison to AG and CG (2.0±0.4 vs 1.7±0.5 and 1.6±0.2, both with p<0.05). Maximal voluntary ventilation (MVV) was significantly lower in OG and AG in relation to the CG (82.8±21.4 and 72.5±21.2 vs 102.8±27.3, both with p<0.05). OG has the highest leptin rate among the groups (with the other two groups had p<0.05). All groups had similar TNF-α and IL-6 levels. Conclusion The muscular hypertrophy found in the diaphragm of the obese individuals can be justified by the increase in respiratory work imposed by the chronic condition of the disease. Such increase in thickness did not occur in controlled mild asthmatics. The IL-6 and TNF-α markers detected no evidence of muscle inflammation, even though leptin was expected to be altered in obese individuals. Both obese and asthmatic patients had lower pulmonary resistance than the healthy ones.

Excursión diafragmática como predictor de éxito para el retiro de la ventilación mecánica en el paciente obeso / Diaphragmatic excursion as a predictor of success in the removal of mechanical ventilation in obese patient / Mobilidade diafragmática como preditor de sucesso na remoção da ventilação mecânica no paciente obeso

Resumen: Introducción: El soporte respiratorio es una de las principales indicaciones para los pacientes que ingresan a la Unidad de Cuidados Intensivos (UCI). La liberación de la ventilación mecánica invasiva (VMI) representa hasta 40% del tiempo en la VMI; comorbilidades como obesidad son más frecuentes en la UCI; existen recomendaciones en la liberación de la VMI en este grupo de pacientes, sin embargo, no existen predictores de éxito que esté ajustado para la población mexicana. Objetivo: Evaluar la excursión diafragmática (ED) como predictor de éxito para el retiro de la VMI en pacientes obesos. Material y métodos: Se realizó un estudio transversal, prospectivo, comparativo y analítico, en pacientes obesos ingresados a las UCI con VMI por más de 48 horas. Se analizaron variables demográficas, índice de ventilación de respiración superficial (IVRS) y ED. El punto de desenlace fue el éxito en la liberación de la VMI. Resultados: La distribución por género fue 42% de mujeres y 58% de hombres; la edad fue de 41.3 ± 12.8 años; estancia hospitalaria de 9.6 ± 4.6 días; el tiempo de VMI: 8.8 ± 4.8 días, e índice de masa corporal (IMC): 33.3 ± 2.7 kg/cm2; representados en grado I: 76%, grado II: 2%, grado III: 22%, IVRS: 59 ± 9.4; ED: 1.55 ± 0.11. El área bajo la curva (ABC) para IRS fue 0.60 y ED de 0.77. Adicionalmente, el mejor punto de corte para éxito fue IVRS < 44 con sensibilidad y especificidad de 100%, y la ED > 1.9 cm con sensibilidad y especificidad de 100%. Conclusión: El mejor predictor de éxito fue la ED con respecto al IVRS. Se proponen nuevos puntos de corte para IVRS y ED.

Abstract: Introduction: Respiratory support is an indication of admission to Intensive Care Units (ICU). The release of invasive mechanical ventilation (VMI), represents up to 40% of the time in VMI; comorbidities such as obesity are more frequent in the ICU; there are recommendations on the release of the VMI (LVMI) in this group of patients, however, there are no adjusted predictors of success for the Mexican population. Objective: To evaluate the diaphragmatic excursion (ED) as a predictor of success in the removal of IMV in obese patients (PO). Material and methods: A cross-sectional, prospective, comparative and analytical study was conducted in POs admitted to ICUs with IMV for more than 48 hours, demographic variables, surface respiration index (RSBI), ED were analyzed, the outcome was the success in LVMI. Results: The distribution by gender was women 42% and men 58%; age: 41.3 ± 12.8 years; hospital stay: 9.6 ± 4.6 days; VMI time: 8.8 ± 4.8 days, l body mass index (BMI): 33.3 ± 2.7; represented in grade I: 76%, grade II: 2%, grade III: 22%, RSBI: 59 ± 9.4; ED: 1.55 ± 0.11. The area under the curve (ABC) for RSBI was 0.60 and ED 0.77. Additionally, the best cut-off point for success was: RSBI < 44 with 100% sensitivity and specificity, and ED > 1.9 cm with 100% sensitivity and specificity. Conclusion: The best predictor of success was the ED with respect to the RSBI, new cut-off points for RSBI and ED are proposed.

Resumo: Introdução: O suporte respiratório é uma indicação de admissão em Unidades de Terapia Intensiva (UTI), a liberação de ventilação mecânica invasiva (VMI) representa até 40% do tempo na VMI; comorbidades como obesidade são mais frequentes na UTI; existem recomendações sobre a liberação do VMI (LVMI) nesse grupo de pacientes, no entanto, não há preditores ajustados de sucesso para a população mexicana. Objetivo: Avaliar a mobilidade diafragmática (MD) como preditor de sucesso na remoção de VMI em pacientes obesos (PO). Material e métodos: Foi realizado um estudo transversal, prospectivo, comparativo e analítico em PO admitidos em UTI com VMI por mais de 48 horas, foram analisadas variáveis demográficas, índice de ventilação da respiração superficial (IVRS), MD. O resultado foi bem-sucedido em LVMI. Resultados: A distribuição por gênero foi de mulheres 42%, homens 58%; idade 41.3 ± 12.8 anos internação 9.6 ± 4.6 dias, tempo de VMI: 8.8 ± 4.8 dias, índice de massa corporal (IMC) 33.3 ± 2.7; representado em Grau I 76%, Grau II 2%, Grau III 22%, IRS 59 ± 9.4; MD 1.55 ± 0.11. A área sob a curva (ABC) para IRS foi de 0.60 e MD 0.77. Além disso, o melhor ponto de corte para o sucesso foi: IVRS < 44 com 100% de sensibilidade e especificidade e ED > 1.9 cm com sensibilidade e especificidade de 100%. Conclusão: O melhor preditor de sucesso foi o MD em relação ao IVRS, novos pontos de corte para IVRS e MD são propostos.

To Evaluate And Compare Dynamic Balance Between Cricketers And Non-Cricketers Using Star Excursion Balance Test

Background: Exercise and sports are considered important for quality life. In athletes, high level of lower limb strength and balance are important prerequisites for the independent and successful performance during sports. To move efficiently, one requires control of the body’s postural alignment. In other words, a strong balance is needed to move efficiently. Impaired balance is one of the several risk factor that have been associated with increased risk of lower extremity injuries Method: Total 50 subjects were included in the study. 25 Cricketers from Teerthanker Mahaveer University Cricket Academy and 25 non-cricketers from different colleges of Teerthanker Mahaveer University, Moradabad, U.P. Age of the subject range from 18-24 years. The informed consent was taken and Star Excursion Balance Test were performed. The data obtained was analyzed using independent t- test. Result: Our result indicates that there is significant difference between the reach distance of cricketers and non-cricketers of both dominant and non-dominant legs. Conclusion: The result of the study showed better dynamic balance in cricketers than non-cricketers in dominant leg and non-dominant leg. It is recommended to incorporate star excursion balance test in cricketers training program for measuring dynamic balance.

Temperature integrity and exposure to freezing temperature during vaccine transfer under the universal immunization program in Three States of India

Temperature excursion and exposure to sub-zero temperatures may reduce the potency of the freeze-sensitive vaccines. This study assessed temperature during vaccine transfers at various levels under the Universal Immunization Program. This cross-sectional study undertaken in 21 districts of three states of India – Bihar (n = 8), Kerala (n = 8), and Gujarat (n = 5). We documented temperature inside the cold boxes and vaccine carriers using LogTag-Trix8 data loggers. In total, 110 vaccine transportation episodes were observed; 55 inter-facility transfers and 55 outreach sessions. Sizable proportions of inter-facility (9% to 35%) and outreach vaccine transfers (18%) were exposed to sub-zero temperature. The proportions of exposure to temperature to >8°C were in the range of 0.8%–11.3% for inter-facility transfers and 2.3% for outreach sessions. The vaccines were exposed to freezing temperatures for significant durations during transportation across the cold chain. Rigorous monitoring of temperature integrity is essential to ensure the delivery of potent vaccines and to avoid vaccine failure.

Explore Regulation Mechanism of “Spleen Qi to Dispersing Essence” on Blood Glucose Homeostasis from Microcirculation of Pancreatic Islet / 中国实验方剂学杂志

Reducing glycemic excursion is of great importance to the successful practice for diabetes intervention and complication prevention. This is also an advantage of traditional Chinese medicine (TCM) in the treatment of diabetes. More and more studies have shown that the dysfunction of islet microcirculation is the key pathological link for glycemic excursion caused by decrease of islet function. The over-activation of local renin-angiotensin system (RAS) in islet microcirculation is a key ring to the islet decompensation, intimately related to the functionality of islet endocrine cells, and has gradually become the focus in the study of islet functionality. In TCM, it is believed that glycemic excursion in diabetes mellitus is closely related to the incapability of "spleen Qi to dispersing essence". If spleen fails to disperse essence, the essence will be accumulated in the body and become harmful stuffs. The stuffs further break the blood glucose homeostasis, acting as the key pathogenesis of diabetes. By supplementing the "spleen" Qi and promoting the dispersion of nutrient substance (hormone) in "pancreas", the balance between sugar-regulated hormones can be restored and therefore glycemic excursion can be reduced. However, the regulation mechanism of "spleen Qi to dispersing essence" on glycemic excursion remains unclear at present. Based on the previous clinical and scientific work, the following ideas were proposed by the authors:the effects of "spleen Qi to dispersing essence" on the improvement of islet function and the regulation of glycemic excursion may be achieved by promoting islet microcirculation, and its mechanism may be related to inhibiting the activation status of local RAS in islet microcirculation. It is important to note that the mutual antagonistic relationship between the signal pathways of RAS in islet microcirculation is similar to the antagonistic relationship between "spleen Qi to dispersing essence" and spermatozoa in TCM. Thus, the mechanism of "spleen Qi to dispersing essence" on the regulation mechanism of blood glucose fluctuations needs to be further explored from the perspective of the overall regulation of RAS in islet microcirculation, so as to reveal the scientific connotation of TCM on regulating the body's environmental homeostasis and reducing glycemic excursion in diabetic patients.

Study on the characteristics of mitral annular displacement in middle and late pregnancy fetuses based on speckle tracking imaging / 中华超声影像学杂志

Objective@#To assess the longitudinal mitral annular plane systolic excursion (MAPSE) of different directions in normal fetuses during mid-late pregnancy based on two-dimensional speckle tracking imaging (STI).@*Methods@#Seventy-six normal fetuses during middle and late pregnancy were selected at 26-32 weeks of gestation. The peak MAPSE was measured by free angle M-mode echocardiography (FAM) perpendicular to the lateral annulus in the mitral annular plane. The time-displacement curves of interventricular septal mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of interventricular septal mitral annulus (SEPT-MAPSE-A, SEPT-MAPSE-B, SEPT-MAPSE-C) in three different directions including points A, B and C and the time to peak (TTP: SEPT-TTP-A, SEPT-TTP-B, SEPT-TTP-C) were recorded respectively. The time-displacement curves of lateral mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of lateral mitral annulus (LAT-MAPSE-A, LAT-MAPSE-B, LAT-MAPSE-C) in three different directions including points A, B and C, the time to peak(LAT-TTP-A, LAT-TTP-B, LAT-TTP-C) were recorded respectively. Finally, the data were analyzed statistically.@*Results@#The peak MAPSE of the lateral mitral annulus in 3 different directions including points A, B and C[LAT-MAPSE-A (3.62±1.01)mm, LAT-MAPSE-B (3.95±1.04)mm, LAT-MAPSE-C (4.45±1.05)mm] were greater than those of the interventricular septum mitral annulus[SEPT-MAPSE-A (3.41±0.63)mm, SEPT-MAPSE-B (3.07±0.50)mm, SEPT-MAPSE-C (2.82±0.51)mm]. LAT-MAPSE-C and SEPT-MAPSE-A were the largest longitudinal excursions of mitral annulus. The differences were statistically significant in points B and C (P<0.05). There was no significant difference in point A (P>0.05). LAT-MAPSE-C was less than FAM-MAPSE[(6.06±1.35)mm]. There was a significant difference between them(P<0.05). Strong correlation was found between them(r=0.896, P<0.05). There were no significant differences in the time to peak of interventricular septal mitral annulus [SEPT-TTP-A (0.210±0.008)s, SEPT-TTP-B (0.213±0.008)s, SEPT-TTP-C (0.210±0.005)s] in directions including points A, B, C(P>0.05). There were no significant differences in time to peak of lateral mitral annulus[LAT-TTP-A(0.210±0.008)s, LAT-TTP-B(0.213±0.006)s, LAT-TTP-C(0.210±0.007)s] in directions inclucling points A, B, C(P>0.05).@*Conclusions@#Longitudinal systolic motion of fetal left ventricular wall during mid-late pregnancy has good synchronization. Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement, with the movement perpendicular to the annulus as the maximum displacement direction. The displacement parameters of mitral annulus measured by STI can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses.

Impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction and type 2 diabetes / 中国综合临床

Objective To assess the impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction (STEMI) and type 2 diabetes.Methods Three hundred and three patients with type 2 diabetes and first STEMI between May 2014 and December 2016 in Beijing Anzhen Hospital,Capital Medical University were seclected continuously.All participants' continuous glucose monitoring system (CGMS) parameters,echocardiogram and biochemical characteristics were measured at baseline.According to the level of mean amplitude of glycemic excursion (MAGE) which is the gold indicator to present glycemic variability patients were classified into low MAGE group (n=182) and high MAGE group (n =117).Impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction and type 2 diabetes were analysed.Results (1) Cardiac function evaluation:The level of left ventricular ejection fraction (LVEF) were significantly lower in high MAGE group than in low MAGE group ((43.8± 7.2) vs.(52.3± 8.5) ％,t =4.912,P＜ 0.001).There were significant differences between the two groups in Killip classification (x2 =49.931,P＜ 0.001).(2) Pearson correlation analysis shows that LVEF negatively correlated with the levels of MAGE(r=-0.367,P＜0.001),postprandial glucose excursion (PPGE) (r=-0.274,P=0.003),Hemoglobin A1c(HbA1c) (r=-0.238,P =0.010),serum highsensitive C-reactive protein (hs-CRP) via logarithmic transformation (r =-0.245,P =0.008) and fasting plasma glucose (FPG) (r =-0.229,P =0.021).Killip classification positively correlated with the levels of MAGE (r =0.301,P ＜ 0.001),PPGE (r =0.228,P =0.022),hs-CRP via logarithmic transformation (r =0.234,P =0.019),H bA 1 c (r =0.195,P =0.041) and FPG (r =0.193,P =0.045).(3) Multiple stepwise regression analysis and multivariate Logistic regression analysis indicated that the level of MAGE was independent risk factor of LVEF (t =-2.279,P =0.005,95％ CI(-3.160 -0.219)) and the level of MAGE was an independent risk factor of Killip classification (Waldx2 =5.673,OR=1.665,95％CI(1.095-2.534),P=0.017).Conclusion Glycemic variability is associated with the presence and severity of left ventricular function in patients with STEMI and type 2 diabetes.

Cultural Tradition of School Excursion and Collective Trauma of the Motor Vessel Sewol Accident

The Motor Vessel Sewol accident was a horrible accident, and it had complex ripple effects in various areas such as politics, economy, and culture. In particular, the psychological impact of each individual in Korean society was great, and various explanations for the causes of such psychological mass trauma would be possible. One of these important causes is the historical memory about common cultural custom. Therefore, the historical and cultural memory of the school trips shared by members of Korean society may be one of the causes of the psychological trauma. This paper aims to explain the cultural and social functions of school trips in East Asian societies from a historical point of view. In addition, we will also analyse the reasons why shared cultural memories contributed to the formation of collective trauma of the accident from a cultural, anthropological and psychiatric point of view.

The effects of electromyographic biofeedback on the swallowing function of stroke survivors with dysphagia / 中华物理医学与康复杂志

Objective To evaluate the effect of intensive electromyographic biofeedback ( EMGBF ) on swallowing and the velocity of hyolaryngeal excursion among stroke survivors with dysphagia. Methods Forty-two stroke survivors with dysphagia were randomly divided into a conventional rehabilitation group ( group A, n=15) , an EMGBF group (group B, n=14) and an intensive EMGBF group (group C, n=13).In addition to routine medica-tions and motor function rehabilitation training, all received 30 minutes of conventional swallowing training once a day, 5 days per week for 4 weeks. Group B additionally received 15 minutes of EMGBF once daily and group C twice daily. Videofluoroscopy was conducted to measure the superior and anterior excursion distances and the movement time of the hyoid bone when swallowing semi-liquid food, and the velocity was calculated. The swallowing dysfunction evaluation and a penetration-aspiration scale ( PAS) were also employed to evaluate the subjects'swallowing function before and after the treatment. Results There were no significant differences among the 3 groups in any of the measurements before the treatment. After the 4 weeks of treatment the average swallowing dysfunction evaluation and PAS scores of all three groups had improved significantly, as had the superior and anterior excursion velocity of the hyoid bone. Compared with group A, the average swallowing dysfunction evaluation and PAS scores of groups B and C had improved significantly more. The average swallowing dysfunction evaluation scores of groups B and C were not sig-nificantly different, but the average anterior and superior excursion velocity of the hyoid bone in group C was signifi-cantly higher than in group B. Conclusion EMGBF therapy has advantages over routine rehabilitation training in improving swallowing function after a stroke and speeding the velocity of the hyoid bone's excursions.

Study on the characteristics of mitral annular displacement in middle and late pregnancy fetuses based on speckle tracking imaging / 中华超声影像学杂志

Objective To assess the longitudinal mitral annular plane systolic excursion ( M APSE) of different directions in normal fetuses during mid‐late pregnancy based on two‐dimensional speckle tracking imaging ( ST I) . Methods Seventy‐six normal fetuses during middle and late pregnancy were selected at 26－32 weeks of gestation . T he peak M APSE was measured by free angle M‐mode echocardiography ( FAM ) perpendicular to the lateral annulus in the mitral annular plane . The time‐displacement curves of interventricular septal mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of interventricular septal mitral annulus ( SEPT‐M APSE‐A ,SEPT‐M APSE‐B ,SEPT‐M APSE‐C) in three different directions including points A ,B and C and the time to peak ( T T P :SEPT‐T T P‐A ,SEPT‐T T P‐B ,SEPT‐T T P‐C) were recorded respectively . T he time‐displacement curves of lateral mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of lateral mitral annulus ( LAT‐M APSE‐A ,LAT‐MAPSE‐B ,LAT‐MAPSE‐C) in three different directions including points A ,B and C ,the time to peak( LA T‐T T P‐A ,LA T‐T T P‐B ,LA T‐T T P‐C) were recorded respectively . Finally ,the data were analyzed statistically . Results T he peak M APSE of the lateral mitral annulus in 3 different directions including points A ,B and C[ LA T‐M APSE‐A ( 3 .62 ± 1 .01) mm ,LA T‐M APSE‐B ( 3 .95 ± 1 .04) mm ,LAT‐M APSE‐C ( 4 .45 ± 1 .05) mm ] were greater than those of the interventricular septum mitral annulus[ SEPT‐MAPSE‐A (3 .41 ± 0 .63)mm ,SEPT‐MAPSE‐B (3 .07 ± 0 .50) mm ,SEPT‐MAPSE‐C (2 .82 ± 0 .51) mm] . LAT‐M APSE‐C and SEPT‐M APSE‐A were the largest longitudinal excursions of mitral annulus . T he differences were statistically significant in points B and C ( P ＜0 .05) . T here was no significant difference in point A ( P ＞0 .05) . LA T‐M APSE‐C was less than FAM‐M APSE [ ( 6 .06 ± 1 .35 ) mm ] . T here was a significant difference between them ( P ＜0 .05 ) . Strong correlation was found between them ( r ＝0 .896 , P＜0 .05) . T here were no significant differences in the time to peak of interventricular septal mitral annulus [ SEPT‐T T P‐A ( 0 .210 ± 0 .008 ) s ,SEPT‐T T P‐B ( 0 .213 ± 0 .008 ) s ,SEPT‐T T P‐C ( 0 .210 ± 0 .005 ) s] in directions including points A ,B ,C ( P＞ 0 .05 ) . T here were no significant differences in time to peak of lateral mitral annulus [ LAT‐T T P‐A ( 0 .210 ± 0 .008 ) s , LAT‐T T P‐B ( 0 .213 ± 0 .006 ) s , LAT‐T T P‐C ( 0 .210 ± 0 .007) s] in directions inclucling points A ,B ,C ( P ＞0 .05) . Conclusions Longitudinal systolic motion of fetal left ventricular wall during mid‐late pregnancy has good synchronization . Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement ,with the movement perpendicular to the annulus as the maximum displacement direction . T he displacement parameters of mitral annulus measured by ST I can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses .

Validity of the Star Excursion Balance Test as an assessment of the balance ability for community-dwelling elderly people / 体力科学

The purpose of this study was to consider the validity of measuring the Star Excursion Balance Test (SEBT), which has been used as a measure of balance ability in athletes, for community-dwelling elderly people. To achieve this purpose, we examined the relationship between the existing balance ability measures, leg strength, and the SEBT. The subjects were 36 elderly people (mean age: 71.1 years). We used the SEBT, functional reach test (FRT), timed up-and-go test (TUG), and Mini-BESTest to evaluate balance ability and the 30-second chair-stand test (CS-30) to assess leg strength; we also assessed the 10-m walk time. The correlation coefficient with the SEBT was calculated. The significant level was 5%. A significant positive correlation was observed between the total score of Mini-BESTest and the SEBT reach distance in the anterior direction (r = 0.364, p < 0.05) and the posteromedial direction (r = 0.407, p < 0.05). A significant positive correlation was observed between anticipatory postural control and the SEBT reach distance in the anterior directions (r = 0.403, p < 0.05), and postural responses and SEBT reach distance in the posterolateral direction (r = 0.360, p < 0.05), which were subsystem category of Mini-BESTest. No significant correlation was found in the other items. The correlation with Mini-BESTest indicates that SEBT might be a valid tool to evaluate the dynamic balance ability of community-dwelling elderly people. However, their correlation coefficient is not high, suggesting that SEBT can evaluate elements different from Mini-BESTest.

Value of mitral annular plane systolic excursion in the assessment of contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization

Background Mitral annular plane systolic excursion (MAPSE) is an M-mode derived echocardiographic marker of left ventricular longitudinal function, the aim of this study is to evaluate the value of MAPSE in assessment of contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization. Methods The study included 50 patients with ischemic cardiomyopathy with ejection fraction (EF) ≤35%, the patients presented to echocardiography laboratory for dobutamine stress echocardiography (DSE) to assess viability and contractile reserve before revascularization, patients with primary valvular disease, and those with significant mitral annular calcifications were excluded from the study. A low dose DSE was done to all patients using standardized incremental infusions of 5, 10, and 20 μg/kg/min and the following parameters were measured at both baseline and peak dose, (EF, wall motion score index(WMSI) and MAPSE). Contractile reserve was measured as the difference between the low dose and baseline values of the EF and WMSI. Results The study included 50 patients aged 55.08 ± 7.15 years, 94% were males, the DSE protocol was complete in all patients without serious side effects. A total of eight hundred segments were analyzed, at baseline 65% were dysfunctional including 31.2% hypokinetic, 28.8% were akinetic, and 5% were dyskinetic. At low dose study 70% of the dysfunctional myocardium showed viability, EF increased significantly from 30.84 ± 4.56 to 42.24 ± 8.15%, p < 0.001, the WMSI reduced significantly from 1.92 ± 0.33 to 1.47 ± 0.39, and MAPSE increased significantly from 1.02 ± 0.23 to 1.30 ± 0.30 mm. MAPSE showed a significant positive correlation with EF at both baseline and low dose study (r = 0.283, p = 0.046 & r = 0.348, p = 0.013) respectively and a significant negative correlation with WMSI at both baseline and low dose study (r = −0.3, p = 0.034 & r = −0.409, p = 0.003), respectively. By ROC curve analysis we found that Δ MAPSE ≥2 mm can predict contractile reserve at Δ EF >10% (AUC = 0.6, sensitivity 67.86, specificity 59.09), and Δ MAPSE ≥1.8 mm can predict contractile reserve at ΔWMSI ≤0.20 (AUC = 0.61, sensitivity 65.5, specificity 75.6). Conclusions MAPSE is a rapid simple quantitative echocardiographic method that can asses contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization.

Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success

BACKGROUND/AIMS: Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubation success. METHODS: This study included patients subjected to extubation trial in the medical or surgical intensive care unit of a university-affiliated hospital from May 2015 through February 2016. Diaphragm excursion and percent of thickening change (Δtdi%) were measured using US within 24 hours before extubation. RESULTS: Sixty patients were included, and 78.3% (47/60) of these patients were successfully extubated, whereas 21.7% (13/60) were not. The median degree of excursion was greater in patients with extubation success than in those with extubation failure (1.65 cm vs. 0.8 cm, p < 0.001). Patients with extubation success had a greater Δtdi% than those with extubation failure (42.1% vs. 22.5%, p = 0.03). The areas under the receiver operating curve for excursion and Δtdi% were 0.836 (95% confidence interval [CI], 0.717 to 0.919) and 0.698 (95% CI, 0.566 to 0.810), respectively (p = 0.017). CONCLUSIONS: Diaphragm excursion seems more accurate than a change in the diaphragm thickness to predict extubation success.