Effects of Different Tidal Volumes and PEEPs on Cardiac Output in Pigs Measured by Pulmonary Artery Catheter， Pulse Contour Analysis and Transpulmonary Thermodilution / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of different tidal volumes and positive end expiratory pressures （PEEPs） during mechanical ventilation on the cardiac output of pigs measured by pulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis， and to explore their consistency in cardiac output determination. MethodsTwelve experimental pigs were selected and randomly divided into 3 groups， with 4 pigs in each. Cardiac output was measured by different methods， control group by pulmonary artery catheter， group A by transpulmonary thermodilution and group B by pulse contour analysis. Then we compared the effects of different tidal volumes and PEEPs on the cardiac output of pigs and to explore the consistency. The correlation coefficient between pulse contour analysis and pulmonary artery catheter was r=0.754， and they were positively correlated. The correlation coefficient between transpulmonary thermodilution and pulmonary artery catheter was r=0.771， and they were positively correlated. In determining cardiac output， pulse contour analysis was consistent with pulmonary artery catheter， with a relative error of 13.5% between them； transpulmonary thermodilution was consistent with pulmonary artery catheter， with a relative error of 12.9% between them. The cardiac output decreased significantly along with the increase of tidal volumes or PEEPs and the differences were statistically significant （P<0.05） ConclusionPulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis are well consistent with each other in measuring the cardiac output of pigs. The pigs’cardiac output gradually decreased along with the increase of tidal volumes or PEEPs during mechanical ventilation.

Analysis of the Treatment Strategy of Heart Failure with Preserved Ejection Fraction Based on ZHANG Boli's Theory of “Damp-turbidity and Phlegm-rheum Type of Diseases” / 中医杂志

Professor ZHANG Boli believed that the core pathogenesis of heart failure with preserved ejection fraction （HFpEF） is weak pulse at yang and wiry pulse at yin. By referring to the theory of “damp-turbidity and phlegm-rheum type of diseases”， he proposed that yin pathogens of damp-turbidity and phlegm-rheum may damage yang qi in each stage of HFpEF， thus aggravating the trend of weak pulse at yang and wiry pulse at yin， which played an important role in the deterioration of HFpEF. Therefore， Professor ZHANG Boli advocated that importance should be attached to the elimination of yin pathogen and the protection of yang qi during the various stages of HFpEF in order to delay the aggravation of weak pulse at yang and wiry pulse at yin； he put forward the idea of staged treatment that “yin pathogen should be dispelled and yang qi should be demonstrated”； and he formulated the treatment strategy of treating the disease as early as possible， eliminating pathogens and protecting yang， interrupting the disease trend， using warm-like medicinals， and activating blood circulation， to enrich the theoretical system of traditional Chinese medicine in the treatment of HFpEF.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure / Rigidez vascular e envelhecimento arterial saudável em pacientes idosos com pressão arterial ideal

ABSTRACT Introduction: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). Objective: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. Methods: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). Results: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. Conclusion: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

RESUMO Introdução: A velocidade da onda de pulso é usada para diagnosticar a rigidez arterial central (RAC) e quantificar o envelhecimento vascular saudável (EVS). Objetivo: Avaliar a RAC e o EVS em pacientes idosos com níveis pressóricos sistêmicos classificados como ideais/normais. Métodos: Um total de 102 pacientes sem comorbidades e com pressão sistólica (PS) < 120 mmHg e pressão diastólica (PD) < 80 mmHg foram selecionados do banco de dados EVOPIU (Estudo da Velocidade de Onda de Pulso em Idosos em área Urbana no Brasil). Foram avaliadas a velocidade da onda de pulso carotídeo-femoral (VOPcf) e as pressões central e periférica em todos os pacientes. Os pacientes foram divididos em quatro grupos: G1: (n = 19; com VOPcf < 7,6 m/s; sem medicação), G2 (n = 26; VOPcf ≥ 7,6 m/s; sem medicação), G3 (n = 25; VOPcf < 7,6 m/s com medicação anti-hipertensiva), e G4 (n = 32; VOPcf ≥ 7,6 m/s com medicação anti-hipertensiva). Resultados: Em nossa amostra, 56,7% dos pacientes apresentaram VOPcf ≥ 7,6 m/s. A pressão sistólica central no G1 [99 (10) mmHg] foi inferior à encontrada nos outros três grupos [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0,05)]. Conclusão: Pessoas idosas com pressão arterial ideal não necessariamente têm EVS e podem apresentar valores de VOPcf próximos aos limites estabelecidos para o diagnóstico de RAC.

Sensibilidad y especificidad de la oximetría de pulso para detectarcardiopatías congénitas en recién nacidos / Sensitivity and specificity of pulse oximetry to detect congenital heart disease in newborns

Resumen Objetivo: Determinar la sensibilidad y especificidad de la oximetría de pulso, para detectar cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto. Material y métodos: El estudio es de tipo multicéntrico, prospectivo y transversal, evaluando pacientes del Hospital Regional de Alta Especialidad "Bicentenario 2010" y el Hospital General "Dr. Norberto Treviño Zapata", en ciudad Victoria Tamaulipas, en un periodo que comprendió desde marzo del 2015 a marzo de 2017. Se determinó la oximetría de pulso a recién nacidos sanos antes del egreso hospitalario. Resultados: Se estudiaron 511 recién nacidos. La sensibilidad detectada fue del 88.89 % y una especificidad del 99.80%. Conclusión: Las cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto, se pueden determinar mediante la oximetría de pulso pre y post-ductal.

Abstract Objective: To determine the sensitivity and specificity of pulse oximetry to detect congenital heart disease in healthy newborns in rooming-in. Material and methods: The study is multicenter, prospective and cross-sectional, evaluating patients from the Regional Hospital of High Specialty "Bicentenario 2010" and the General Hospital "Dr. Norberto Treviño Zapata", in the city of Victoria Tamaulipas, in a period from march 2015 to March 2017. Pulse oximetry was determined in healthy newborns before hospital discharge. Results: 511 newborns were studied. The sensitivity detected was 88.89% and a specificity of 99.80%. Conclusion: Congenital heart disease in healthy newborns in rooming-in can be determined by pre- and post-ductal pulse oximetry.

Arterial oxygen saturation in healthy Mexican full-term newborns at different altitudes above sea level / Saturación arterial de oxígeno en recien nacidos mexicanos a término sanos a diferentes altitudes sobre el nivel del mar

Abstract Background: Arterial oxygen saturation (SaO2) values are used to make clinical decisions that might change a patient's prognosis, and it has been proposed as the fifth vital sign. This study aimed to determine the variation of SaO2 at different altitudes above sea level (ASL) in healthy Mexican full-term newborns. Methods: From July 2018 to June 2019, a cross-over study was conducted in six hospitals at different altitudes ASL in Mexico. SaO2 was measured in 4015 newborns after the first 24 h of birth and before leaving the hospital using pulse oximetry. We analyzed three groups: < 250 m ASL (group 1), 1500 m ASL (group 2), and 2250 m ASL (group 3). Results: The mean SaO2 was 97.6 ± 1.8%. For group 1, mean oxygen saturation was 98.2 ± 1.9%; for group 2, 96.7 ± 1.9%, and for group 3, 96.0 ± 2.1%. A statistically significant difference was observed among the groups (p < 0.001), and this difference was higher between groups 1 and 2 (1.5%, p < 0.001). Linear regression analysis showed a decrease in oxygen saturation of 1.01% for every 1000 m ASL. Conclusions: We demonstrated a statistically significant reduction in SaO2 levels at higher altitudes. This observation can be relevant for clinical decision-making based on pulse oximetry such as critical congenital heart disease screening in Mexico, where more than half of the population lives above 1500 m ASL.

Resumen Introducción: Los valores de SaO2 (saturación de oxígeno) se utilizan para la toma de decisiones clínicas que podrían cambiar el pronóstico del paciente. El objetivo de este estudio fue determinar la variación de la SaO2 en recién nacidos mexicanos a término sanos a diferentes altitudes en México. Métodos: Se llevó a cabo un estudio transversal en seis hospitales situados a diferentes altitudes en México. Se determinó la SaO2 usando oximetría de pulso en 4015 recién nacidos después de las primeras 24 horas de vida, pero antes del egreso del hospital de nacimiento. Se formaron tres grupos para el análisis: grupo 1 con altitud < 250 m sobre el nivel del mar (SNM); grupo 2, altitud de 1500 m SNM y grupo 3, altitud de 2250 m SNM. Resultados: El promedio de la SaO2 fue de 97.6 ± 1.8%. Para el grupo 1, la media fue 98.2 ± 1.9%, para el 2, 96.7 ± 1.9% y para el 3, 96.0 ± 2.1%. Se observó una diferencia estadísticamente significativa entre los grupos (p < 0.001), que fue mayor entre los grupos 1 y 2 (1.5%, p < 0.001). El análisis de regresión lineal mostró una reducción de 1.01% en la SaO2 por cada 1000 m SNM. Conclusiones: Se demostró una disminución estadísticamente significativa de los valores de SaO2 conforme aumenta la altitud. Esto puede ser de particular relevancia en la toma de decisions clínicas basadas en la oximetría de pulso, como el tamiz neonatal cardiaco, sobre todo en México donde mas de la mitad de la población vive a una altitud superior a 1500 m SNM.

Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Abstract Background Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness. Objective The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension. Methods This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher's exact test were used. A significance level of 5% was adopted. Results A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group. Conclusion This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

Role of machine learning techniques in classification of peripheral pulse morphology

Recording of peripheral pulse serves as a very important and essential non-invasive tool used widely by doctors for the diagnosis of various diseases. The morphology of pulse is seen to vary as a function of time in a given individual and also from individual to individual. There are many variations in morphological patterns of peripheral pulse in different disease conditions, which lead to difficulty in accurate diagnosis. The peripheral pulse waveforms are extracted from radial arteries as time series data using a peripheral pulse analyzer which is designed on the principle of impedance plethysmography. It was first introduced by Nyober in the mid-nineteen hundreds and ameliorated further by Kubicek. It involves the recording of the instantaneous blood volume by the measurement of electrical impedance as a function of time. Therefore, the study of peripheral pulse morphology has gained much attention in the past few years among researchers. Physiological variability is one of the recent investigations added during the last two decades for the objective assessment of autonomic function and the assessment of prognosis in severe sicknesses namely myocardial infarction, diabetic neuropathy, etc. In addition to heart rate variability studied worldwide, few researchers have studied blood pressure variability and peripheral blood flow variability. In this computer era, artificial intelligence and machine learning techniques have become more important day-by- day, and different types of algorithms were used for the identification of hidden patterns from plethysmographic observations on the radial pulse such as support vector machine as well as crisp and fuzzy clustering. Eight patterns were classified with a yield of 80%–90% and helped with the diagnosis of disorders such as myocardial infarction, pulmonary tuberculosis, coronary artery disorders, cirrhosis of the liver, and bronchial asthma. This paper briefly describes the use of machine learning techniques for the classification of peripheral pulse morphologies.

Estimated continuous cardiac output based on pulse wave transit time in critically ill children: a report of two cases / Débito cardíaco contínuo estimado baseado no tempo de trânsito da onda de pulso em crianças em estado crítico: relato de dois casos

ABSTRACT Cardiac output is an essential determinant of oxygen delivery, although unreliably measured on clinical examination and routine monitoring. Unfortunately, cardiac output monitoring is rarely performed in pediatric critical care medicine, with a limited availability of accurate methods for children. Herein, we report two pediatric cases in which noninvasive pulse-wave transit time-based cardiac output monitoring (esCCO, Nihon Kohden, Tokyo, Japan) was used. The esCCO system calculates cardiac output continuously by using the negative correlation between stroke volume and pulse wave transit time and requires only electrocardiogram monitoring, noninvasive blood pressure, and pulse oximetry signals. Before starting its use, esCCO should be calibrated, which can be done using patient information (gender, age, height, and body weight) or entering cardiac output values obtained by other methods. In both cases, when calibrations were performed using patient information, the agreement between esCCO and echocardiographic measurements was poor. However, after calibration with transthoracic echocardiography, the cardiac output values obtained by both methods remained similar after 2 hours and 18 hours. The results indicate that the esCCO system is suitable for use in children; however, further studies are needed to optimize its algorithm and determine its accuracy, precision, and trend in children.

RESUMO O débito cardíaco é um determinante importante do fornecimento de oxigênio, embora a sua mensuração seja realizada de forma pouco confiável no exame clínico e no monitoramento de rotina. Infelizmente, o monitoramento do débito cardíaco raramente é realizado na medicina intensiva pediátrica, com disponibilidade limitada de métodos precisos para crianças. Relatamos aqui dois casos pediátricos nos quais utilizouse o monitoramento não invasivo do débito cardíaco por meio da análise do tempo de trânsito de ondas de pulso (esCCO, Nihon Kohden, Tóquio, Japão). O sistema esCCO calcula o débito cardíaco continuamente pela correlação negativa entre o volume sistólico e o tempo de trânsito de ondas de pulso e requer apenas o monitoramento por eletrocardiograma, pressão arterial não invasiva e sinais de oximetria de pulso. Antes de iniciar seu uso, o esCCO deve ser calibrado, o que pode ser feito com informações do paciente (sexo, idade, altura e peso corporal) ou informando os valores do débito cardíaco obtidos mediante outros métodos. Em ambos os casos, quando as calibragens foram realizadas com informações do paciente, a concordância entre o débito cardíaco contínuo estimado e as medidas ecocardiográficas foi insatisfatória. Entretanto, após a calibragem com ecocardiografia transtorácica, os valores do débito cardíaco obtidos pelos dois métodos permaneceram semelhantes após 2 horas e 18 horas. Os resultados indicam que o sistema esCCO pode ser útil em crianças; entretanto, são necessários mais estudos para otimizar seu algoritmo e determinar sua exatidão, precisão e tendência em crianças.

Current status and trends in the modernization of pulse diagnosis research: a bibliometric analysis based on CiteSpace and VOSviewer / 数字中医药（英文）

Objective@#To provide ideas for the modernization of pulse diagnosis in traditional Chinese medicine (TCM) by comparing and analyzing the current status and trends of modern research on pulse diagnosis in China and abroad, using bibliometric and visualization software.@*Methods@#Modern research literature on pulse diagnosis was searched in China National Knowledge Infrastructure (CNKI) database from the foundation to May 31, 2023, and in Science Citation Index Expanded (SCIE) from January 1, 2003, to May 31, 2023. After further screening, Microsoft Excel 2019 was used for statistical analysis of publication volume, and CiteSpace (6.1.R6) and VOSviewer (1.6.20) softwares were employed for visual analysis of journals, countries/regions, authors, institutions, keywords, etc.@*Results@#This study included a total of 764 articles in Chinese and 1 459 articles in English. The publication trend of pulse diagnosis research in SCIE database showed an overall fluctuating upward trend, while it exhibited a fluctuating downward trend after 2007 in CNKI database. The volume of English research literature has consistently exceeded that of Chinese literature since 2009. Publications on pulse diagnosis research involved 74 countries/regions. The related journals covered various disciplinary fields, including mathematics, physics, chemistry, and computer science. The most prolific author in CNKI database was WANG Yiqin (Shanghai University of Traditional Chinese Medicine), while the highest number of publications was attributed to ZHANG David (The Hong Kong Polytechnic University) in SCIE database. High-volume institutions in pulse diagnosis research in China and abroad were predominantly TCM research institutions. However, comprehensive universities and other research institutions also made noteworthy contributions. In recent years, hot topics in the modernization of pulse diagnosis research in China included pulse waves, sensors, and artificial intelligence. Foreign research focused on pulse diagnosis systems, sensors, pulse feature extraction, pulse signal analysis, pulse detection, and efficiency of use.@*Conclusion@#Chinese scholars have shown notable participation and emphasis in the modernization research of pulse diagnosis, involving a wide range of disciplinary fields and indicating a characteristic of multidisciplinary cross-fusion development. The hotspots andtrends in the modernization of pulse diagnosis research primarily concentrate on the study of pulse condition and signal acquisition, the integration, development, and optimization of various algorithms with pulse diagnosis equipment, and the practical application research of existing objectified outcomes of pulse diagnosis.

Exploration of the theory of Renying Cunkou pulse method recorded in the Yellow Emperor's Inner Canon / 中国针灸

Renying Cunkou pulse method is one of the classical pulse methods of acupuncture-moxibustion in the Yellow Emperor's Inner Canon, which is also a classical clinical paradigm for diagnosing and treating meridian diseases in the ancient times. Based on comprehensive review of literature and clinical practice, this paper reveals that this method compares the size of the neck Renying pulse with hand Cunkou pulse to determine the change of yin-yang and excess-deficiency identifying the affected meridians. The jing-well, xing-spring, and shu-stream points of the surface and interior meridians of affected meridians are mainly selected to regulate deficiency and excess through reinforcing and reducing methods. The Renying Cunkou pulse method possesses a simple and practical medical theory, easy diagnostic procedure, and clear meridian selection for acupuncture-moxibustion treatment, warranting further exploration of its essence and diagnostic therapeutic principles.

Theory and application of pulse diagnosis at Renying and Cunkou regions / 中国针灸

Renying and Cunkou pulse diagnostic method is one of the important parts of the pulse diagnosis in Huangdi Neijing (Inner Canon of Yellow Emperor) and has been controversial since its proposal. This article takes WANG Shu-he's diagnostic operation as the evidence, and is in reference of the statement, "Cun region (the region ahead of Guan region of Cunkou) determines the human life, that on the left hand refers to Renying, while on the right hand is Qikou". The pulse conditions on the left and right hands represent yin and yang. If Renying pulse on the left is greater, the diseases are in yang meridians, while if Cunkou pulse on the right is bustling, the diseases are in yin meridians. By comparing the pulse condition and strength, as well as the pulse beating (rapid and urgent) between Guan region and region ahead of Guan on the same side, the conditions of three yang and three yin meridians are detected. In treatment, based on the records of Renying and Cunkou pulse diagnosis in Huangdi Neijing, the principles are proposed for reinforcing and reducing methods on hand and foot meridians of yin and yang. Five-shu points and yuan-source points are taken as the main acupoints in acupuncture treatment. During treatment, the changes in pulse conditions should be emphasized specifically and those at Renying and Cunkou regions are the criteria for judging qi arrival and qi regulation.

Effects of acute cycling with electrical muscle stimulation of lower limbs on arterial stiffness / 体力科学

Endurance exercises, such as cycling or running, are useful for reducing arterial stiffness. However, individuals with a low physical fitness level, or patients suffering from leg diseases with pain, are unable to perform such moderate-intensity lower-limb exercises for long periods of time. The aim of this study was to evaluate the effects of acute cycling with Electrical muscle stimulation (EMS) on the brachial to ankle pulse wave velocity (ba-PWV). Ten healthy adult men performed 3 sessions, as follows of 20 min: cycling at 50% VO2max (C), cycling at an intensity of 50%VO2max subtracted from VO2 during EMS (LC), and cycling at the intensity of the LC trial while also being combined with EMS (LC+E). The ba-PWV was measured before and after each exercise. In addition, the femoral artery blood flow (BF) was measured in eight healthy adult men before and after exercise using an ultrasound imaging system. In the C and LC+E trials, the ba-PWV significantly decreased immediately after the exercise session, whereas the ba-PWV did not significantly change following the LC trial in any session. Compared with the baseline, the femoral artery BF values significantly increased after all trials. In the C and LC+E trials, the femoral artery BF was significantly greater than that in the LC trial. Acute endurance low-intensity cycling with EMS results in a reduction in the arterial stiffness which is similar to that with moderate-intensity exercise.

A comprehensive review on photon-counting computed tomography: Principles, technical hurdles and analysis of clinical applications / 生物医学工程学杂志

In recent years, photon-counting computed tomography (PCD-CT) based on photon-counting detectors (PCDs) has become increasingly utilized in clinical practice. Compared with conventional CT, PCD-CT has the potential to achieve micron-level spatial resolution, lower radiation dose, negligible electronic noise, multi-energy imaging, and material identification, etc. This advancement facilitates the promotion of ultra-low dose scans in clinical scenarios, potentially detecting minimal and hidden lesions, thus significantly improving image quality. However, the current state of the art is limited and issues such as charge sharing, pulse pileup, K-escape and count rate drift remain unresolved. These issues could lead to a decrease in image resolution and energy resolution, while an increasing in image noise and ring artifact and so on. This article systematically reviewed the physical principles of PCD-CT, and outlined the structural differences between PCDs and energy integration detectors (EIDs), and the current challenges in the development of PCD-CT. In addition, the advantages and disadvantages of three detector materials were analysed. Then, the clinical benefits of PCD-CT were presented through the clinical application of PCD-CT in the three diseases with the highest mortality rate in China (cardiovascular disease, tumour and respiratory disease). The overall aim of the article is to comprehensively assist medical professionals in understanding the technological innovations and current technical limitations of PCD-CT, while highlighting the urgent problems that PCD-CT needs to address in the coming years.

Research progress on transcranial electrical stimulation for deep brain stimulation / 生物医学工程学杂志

Transcranial electric stimulation (TES) is a non-invasive, economical, and well-tolerated neuromodulation technique. However, traditional TES is a whole-brain stimulation with a small current, which cannot satisfy the need for effectively focused stimulation of deep brain areas in clinical treatment. With the deepening of the clinical application of TES, researchers have constantly investigated new methods for deeper, more intense, and more focused stimulation, especially multi-electrode stimulation represented by high-precision TES and temporal interference stimulation. This paper reviews the stimulation optimization schemes of TES in recent years and further analyzes the characteristics and limitations of existing stimulation methods, aiming to provide a reference for related clinical applications and guide the following research on TES. In addition, this paper proposes the viewpoint of the development direction of TES, especially the direction of optimizing TES for deep brain stimulation, aiming to provide new ideas for subsequent research and application.

Efeito da idade no equilíbrio corporal e nos resultados do vídeo teste do impulso cefálico em pacientes com insuficiência cardíaca / Effect of age on body balance and on the results of the video head impulse test in patients with heart failure

RESUMO Objetivo verificar se existe associação entre a avaliação clínica do equilíbrio e o ganho do reflexo vestíbulo-ocular com o avanço da idade em pacientes com insuficiência cardíaca. Métodos estudo transversal analítico-descritivo, de caráter observacional, que incluiu pacientes com diagnóstico de insuficiência cardíaca, divididos em dois grupos, por idade (G1, menos de 60 anos e G2, 60 anos ou mais). Os pacientes foram avaliados por meio de anamnese, avaliação cardiológica, avaliação clínica do equilíbrio corporal (triagem da função cerebelar e avaliação do equilíbrio estático e dinâmico) e instrumental da função vestibular (Video Head Impulse Test-vHIT). Os achados obtidos foram descritos e comparados por meio de análise estatística inferencial. Resultados foram avaliados 34 pacientes com média de idade de 55 anos e 9 meses, a maioria homens (71,49%). Não houve associação do ganho do reflexo vestíbulo-ocular, simetria dos canais semicirculares e avaliações do equilíbrio corporal com o avanço da idade. Observaram-se associações entre os resultados da prova de Unterberger-Fukuda com o ganho do reflexo vestíbulo-ocular do canal semicircular lateral direito e posterior esquerdo e com os percentuais de simetria dos canais semicirculares anteriores para os pacientes do Grupo 2. Para os indivíduos do Grupo 1, foi observada associação entre os resultados da prova de Unterberger-Fukuda com os valores de simetria dos canais semicirculares anteriores e do ganho de reflexo vestíbulo-ocular dos canais semicirculares anterior esquerdo e posterior direito. Conclusão não houve associação entre os resultados da avaliação clínica do equilíbrio corporal e dos achados do vHIT com o avanço da idade, em pacientes com insuficiência cardíaca. Entretanto, observou-se diferença entre o ganho do reflexo vestíbulo-ocular específico para alguns canais semicirculares, com maiores índices de alteração na prova de equilíbrio dinâmico, em ambos os grupos. Os resultados dos testes aplicados permitiram caracterizar o predomínio da hipofunção vestibular crônica de origem periférica nos pacientes com insuficiência cardíaca, independentemente da faixa etária.

ABSTRACT Purpose to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure. Methods analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis. Results 34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals. Conclusion there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group.

Dexamethasone-cyclophosphamide pulse therapy outcomes comparing pemphigus vulgaris and pemphigus foliaceus groups in a Brazilian cohort study

Abstract Background Dexamethasone-cyclophosphamide pulse (DCP) and dexamethasone pulse (DP) have been successfully used to treat pemphigus, but DCP/DP outcomes comparing pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are scarce. Objective To compare DCP/DP outcomes in a Brazilian cohort of PV and PF patients according to demographic and clinical data. Methods Retrospective analytical cohort study, reviewing medical charts of PV and PF patients (for DCP/DP Phases I‒IV consult Pasricha et al.16‒18). Results 37 PV and 41 PF patients non responsive to usual treatments were included similarly for DCP or DP therapy. Disease duration was longer among PF before DCP/DP prescription (p < 0.001); PF required a higher number of monthly pulses to acquire remission in Phase I (median 10 and 6 pulses, respectively; p = 0.005). DCP/DP outcomes were similar in both groups: remission in 37.8% of PV and 34.1% of PF after completed DCP/DP cycles following a median of 13 months (1-56 months follow-up); failure occurred in 13.5% of PV and 14.6% of PF in Phase I; relapse in 13.5% of PV and 12.2% of PF, and dropout in 27% of PV and 24.4% of PF in Phases II to IV. Mild side effects were documented. Study limitations The severity of PV and PF disease was not assessed by score indexes. Conclusions PV and PF patients presented similar DCP/DP outcomes. DCP/DP should be initiated earlier in PF patients due to the longer duration of their disease in order to decrease the number of pulses and the duration of Phase I to acquire remission.

Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular / Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

Resumo Fundamento Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. Objetivo Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. Métodos Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. Resultados Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. Conclusão O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Abstract Background Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. Objective This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. Methods This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. Results According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. Conclusion The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients / Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Abstract Background Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. Objectives To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. Methods A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. Results A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). Conclusions In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Resumo Contexto O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas. Objetivos Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD. Métodos Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos. Resultados Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04). Conclusões Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.