基于移动通讯技术的新型院外远程实时心电监测系统的临床研究

目的 评价一种自主研发的基于移动通讯技术的新型院外远程实时心电监测系统数据传输的实时性及对心律失常检测的敏感性.方法 通过测定心电信号传输的延时评估系统的实时性;通过与动态心电图对比评估远程监测对心律失常检测的敏感性.结果 远程监测时心电数据传输的最短延时为9s,最长延时为17s,平均延时为（13.4±4.5）s.在100例受试者中,远程监测和动态心电图分别检测到偶发房性期前收缩62例、57例,频发房性期前收缩22例、25例,心房颤动均为9例,非阵发性室性心动过速16例、12例,差异均无统计学意义（均P ＞0.05）.同时均发现二度Ⅱ型房室传导阻滞5例、三度房室传导阻滞2例.结论 该系统有较好的实时性,对心律失常检出的敏感性与动态心电图相仿.     

互联网远程管理对社区高血压患者治疗依从性影响的研究进展

高血压是严重危害人类健康的慢性病之一，全球范围内有较高的发病率和致死率，且控制率低，尤其在欠发达国家和地区。有效的高血压管理是提高患者治疗依从性和影响血压控制率的关键。随着互联网在全世界的发展，传统基于医生诊室管理高血压患者治疗依从性的模式在发生改变，本文综合探讨了国内外互联网远程管理对高血压患者治疗依从性的影响，分析得出互联网远程管理对高血压患者治疗依从性在健康教育、经济、医患沟通、随访等方面存在优势，但存在使用障碍、数据不准确、研究证据有限、安全性可靠性不能保证等挑战与不足，并提出展望，以期将互联网远程管理更好地应用于社区高血压患者的管理。     

Accelerated ferumoxytol‐enhanced 4D multiphase,steady‐state imaging with contrast enhancement (MUSIC) cardiovascular MRI: validation in pediatric congenital heart disease

The purpose of this work was to validate a parallel imaging (PI) and compressed sensing (CS) combined reconstruction method for a recently proposed 4D non‐breath‐held, multiphase, steady‐state imaging technique (MUSIC) cardiovascular MRI in a cohort of pediatric congenital heart disease patients. We implemented a graphics processing unit accelerated CS‐PI combined reconstruction method and applied it in 13 pediatric patients who underwent cardiovascular MRI after ferumoxytol administration. Conventional breath‐held contrast‐enhanced magnetic resonance angiography (CE‐MRA) was first performed during the first pass of ferumoxytol injection, followed by the original MUSIC and the proposed CS‐PI MUSIC during the steady‐state distribution phase of ferumoxytol. Qualities of acquired images were then evaluated using a four‐point scale. Left ventricular volumes and ejection fractions calculated from the original MUSIC and the CS‐PI MUSIC were also compared with conventional multi‐slice 2D cardiac cine MRI. The proposed CS‐PI MUSIC reduced the imaging time of the MUSIC acquisition to 4.6 ± 0.4 min from 8.9 ± 1.2 min. Computationally intensive image reconstruction was completed within 5 min without interruption of sequential clinical scans. The proposed method (mean 3.3–4.0) provided image quality comparable to that of the original MUSIC (3.2–4.0) (all P ≥ 0.42), and better than conventional breath‐held first‐pass CE‐MRA (1.1–3.3) for 13 anatomical structures (all P ≤ 0.0014) with good inter‐observer agreement (κ > 0.46). The calculated ventricular volumes and ejection fractions from both original MUSIC (r > 0.90) and CS‐PI MUSIC (r > 0.85) correlated well with 2D cine imaging. In conclusion, PI and CS were successfully incorporated into the 4D MUSIC acquisition to further reduce scan time by approximately 50% while maintaining highly comparable image quality in a clinically practical reconstruction time.     

Development of a neonatal incubator with phototherapy,biometric fingerprint reader,remote monitoring,and heart rate control adapted for developing countries hospitals

This paper aims to develop an automatic neonatal incubator equipped with phototherapy, biometric fingerprint reader, remote monitoring and heart rate control modules for developing countries due to the lack of neonatal incubators. The proposed device consists of an acquisition module that senses temperatures (of the enclosure and the baby) and humidity, a biometric fingerprint reader to identify the user, a remote monitoring module in charge of supervising the temperature and the heart rate of the baby, a video surveillance module which allows filming and transmitting the images to the web server in order to give parents and nurses the possibility of being able to visualize whatever their location the newborn baby, a phototherapy module used to treat newborn jaundice by lowering the bilirubin levels in the baby's blood, a digital control module from a pulse width modulation (PWM) signal generated by a microcontroller of Arduino Nano type for system operation monitoring, and a human machine interface module for setting parameters. The equations describing the energy balance and heat transfer for newborn baby (Ostrowski and Rojczyk, 2018) are taken into account for the implementation of power supply and the choice of the heating resistor. The desired temperature of 37 °C was obtained after only a few minutes inside the incubator.     

The efficacy of remote virtual care in comparison to traditional clinical visits for elective orthopaedic patients: A meta-analysis of prospective randomised controlled trials

IntroductionThe Orthopaedic Trauma Association has recommended limitation of in-person encounters to absolute necessity. One method of ensuring standard patient care within these guidelines is through the implementation of telemedicine.AimsTo evaluate the efficacy of telemedicine for elective orthopaedic patients in the recovery and/or rehabilitation period.MethodsA systematic review and meta-analysis of articles in Medline/PubMed and The Cochrane Library databases was performed according to the PRISMA guidelines for prospective randomised controlled trials to compare clinical and symptomatic measures for elective patients managed routinely with remote care compared to those managed with standard in-clinic management. To be included for meta-analysis, parameters must be evaluated in ≥3 studies.ResultsEleven studies were included in the meta-analyses. Both telemedicine and control cohorts were comparable for patient satisfaction (RR, 0.98; 95% CI, 0.90–1.07; I² = 0%; p = 0.52) and patient retention analysis (RR, 1.25; 95% CI, 0.51–3.06; p = 0.54; I² = 0%). Similarly, there was no statistical difference appreciated between cohorts for overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (p = 0.30), Timed Up and Go Test (p = 0.40), and Stair Test (p = 0.18). Significant difference did exist for visual analogue scale (VAS) scores (p = 0.02) in favour of in-clinic management.ConclusionTelemedicine will serve an integral aspect of healthcare delivery throughout the current COVID-19 pandemic and beyond in an effort to deliver safe, efficient and time-sensitive care to the orthopaedic patient population. The results of our meta-analyses indicate that virtual consultations are as effective as traditional in-person consultations for the care of elective orthopaedic patients in the recovery and rehabilitation period. However, further studies are needed to evaluate for initial consultations and certain sub-specialties of orthopaedics.     

Highly accelerated,real‐time phase‐contrast MRI using radial k‐space sampling and GROG‐GRASP reconstruction: a feasibility study in pediatric patients with congenital heart disease

Retrospective electrocardiogram‐gated, 2D phase‐contrast (PC) flow MRI is routinely used in clinical evaluation of valvular/vascular disease in pediatric patients with congenital heart disease (CHD). In patients not requiring general anesthesia, clinical standard PC is conducted with free breathing for several minutes per slice with averaging. In younger patients under general anesthesia, clinical standard PC is conducted with breath‐holding. One approach to overcome this limitation is using either navigator gating or self‐navigation of respiratory motion, at the expense of lengthening scan times. An alternative approach is using highly accelerated, free‐breathing, real‐time PC (rt‐PC) MRI, which to date has not been evaluated in CHD patients. The purpose of this study was to develop a 38.4‐fold accelerated 2D rt‐PC pulse sequence using radial k‐space sampling and compressed sensing with 1.5 × 1.5 × 6.0 mm³ nominal spatial resolution and 40 ms nominal temporal resolution, and evaluate whether it is capable of accurately measuring flow in 17 pediatric patients (aortic valve, pulmonary valve, right and left pulmonary arteries) compared with clinical standard 2D PC (either breath‐hold or free breathing). For clinical translation, we implemented an integrated reconstruction pipeline capable of producing DICOMs of the order of 2 min per time series (46 frames). In terms of association, forward volume, backward volume, regurgitant fraction, and peak velocity at peak systole measured with standard PC and rt‐PC were strongly correlated (R² > 0.76; P < 0.001). Compared with clinical standard PC, in terms of agreement, forward volume (mean difference = 1.4% (3.0% of mean)) and regurgitant fraction (mean difference = ?2.5%) were in good agreement, whereas backward volume (mean difference = ?1.1 mL (28.2% of mean)) and peak‐velocity at peak systole (mean difference = ?21.3 cm/s (17.2% of mean)) were underestimated by rt‐PC. This study demonstrates that the proposed rt‐PC with the said spatial resolution and temporal resolution produces relatively accurate forward volumes and regurgitant fractions but underestimates backward volumes and peak velocities at peak systole in pediatric patients with CHD.     

Role of 5-HT1A and 5-HT3 receptors in serotonergic activation of sensory neurons in relation to itch and pain behavior in the rat

Serotonin (5-hydroxytryptamine, 5-HT) released by platelets, mast cells, and immunocytes is a potent inflammatory mediator which modulates pain and itch sensing in the peripheral nervous system. The serotonergic receptors expressed by primary afferent neurons involved in these sensory functions are not fully identified and appear to be to a large extent species dependent. Moreover, the mechanisms through which 5-HT receptor activation is coupled to changes in neuronal excitability have not been completely revealed. Using a combination of in vitro (calcium and voltage imaging and patch-clamp) and in vivo behavioral methods, we used both male and female Wistar rats to provide evidence for the involvement of two 5-HT receptor subtypes, 5-HT1A and 5-HT3, in mediating the sustained and transient effects, respectively, of 5-HT on rat primary afferent neurons involved in pain and itch processing. In addition, our results are consistent with a model in which sustained serotonergic responses triggered via the 5-HT1A receptor are due to closure of background potassium channels, followed by membrane depolarization and action potentials, during which the activation of voltage-gated calcium channels leads to calcium entry. Our results may provide a better understanding of mammalian serotonergic itch signaling.