Simultaneous beat-to-beat assessment of arterial blood pressure and quality of cardiopulmonary resuscitation in out-of-hospital and in-hospital settings

ObjectiveThe current recommendation for depth and rate of chest compression (CC) during cardiopulmonary resuscitation (CPR) is based on limited hemodynamic data recorded during human CPR. We have evaluated the possible association between CC depth and rate and continuously measured arterial blood pressure during adult CPR.MethodsThis prospective study included data from 104 patients resuscitated inside or outside hospital. Adequate data on continuously measured invasive arterial blood pressure (BP) and the quality of CPR from a defibrillator capable recording CPR quality parameters was successful in 39 patients. We used logistic regression and mixed effects modeling to identify CC depths and rates associated with systolic blood pressure (SBP) ≥85 mmHg and diastolic blood pressure (DBP) ≥30 mmHg.ResultsWe analyzed 41,575 compression-BP pairs. The values for blood pressure varied greatly between the patients. SBP varied from 25 to 225 mmHg and DBP from 2 to 59 mmHg. CC rate 100–120/min and CC depth ≥60 mm (without mattress deflection correction) was associated with DBP ≥30 mmHg in both femoral (OR 1.14; 95% CI 1.03, 1.26; p < 0.05) and radial (OR 4.70; 95% CI 3.92, 5.63; p < 0.001) recordings. For any given subject there was a weak upward trend in blood pressure as CC depth increased.ConclusionDeeper CC does not equal higher BP in every patient. The heterogeneity of patients creates a challenge to find the optimal way to resuscitate patients individually.Clinical Trial Registration: Clinicaltrials.gov NCT00951704.     

Effects of different heel angles in sleep mode on heel interface pressure in the elderly

BackgroundThe heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70 years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined.MethodsTwenty-five females and twenty-six males, 70 years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested.FindingsThe heel of most of the participants is positioned at a 60°–69° or 90°–99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal.InterpretationThe relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores.     

Age-related networks of regional covariance in MRI gray matter: Reproducible multivariate patterns in healthy aging

Healthy aging is associated with brain volume reductions that involve the frontal cortex, but also affect other brain regions. We sought to identify an age-related network pattern of MRI gray matter using a multivariate statistical model of regional covariance, the Scaled Subprofile Model (SSM) with voxel based morphometry (VBM) in 29 healthy adults, 23-84 years of age (Group 1). In addition, we evaluated the reproducibility of the age-related gray matter pattern derived from a prior SSM VBM study of 26 healthy adults, 22-77 years of age (Group 2; Alexander et al., 2006) in relation to the current sample and tested the ability of the network analysis to extract an age-related pattern from both cohorts combined. The SSM VBM analysis of Group 1 identified a regional pattern of gray matter atrophy associated with healthy aging (R² = 0.64, p < 0.000001) that included extensive reductions in bilateral dorsolateral and medial frontal, anterior cingulate, insula/perisylvian, precuneus, parietotemporal, and caudate regions with areas of relative preservation in bilateral cerebellum, thalamus, putamen, mid cingulate, and temporal pole regions. The age-related SSM VBM gray matter pattern, previously reported for Group 2, was highly expressed in Group 1 (R² = 0.52, p < 0.00002). SSM analysis of the combined cohorts extracted a common age-related pattern of gray matter showing reductions involving bilateral medial frontal, insula/perisylvian, anterior cingulate and, to a lesser extent, bilateral dorsolateral prefrontal, lateral temporal, parietal, and caudate brain regions with relative preservation in bilateral cerebellum, temporal pole, and right thalamic regions. The results suggest that healthy aging is associated with a regionally distributed pattern of gray matter atrophy that has reproducible regional features. Whereas the network patterns of atrophy included parietal, temporal, and subcortical regions, involvement of the frontal brain regions showed the most consistently extensive and reliable reductions across samples. Network analysis with SSM VBM can help detect reproducible age-related MRI patterns, assisting efforts in the study of healthy and pathological aging.     

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients

BackgroundForearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution.ObjectivesTo determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity.DesignSingle centre comparison study.SettingAdult Emergency Department, Tertiary Trauma Centre.ParticipantsForty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board.MethodsA random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland–Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg.ResultsThe forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p = 0.002, F-statistic = 11.09). Blood pressure disparity was not associated with participant characteristics.ConclusionsForearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg.     

Alterations of Na+/K+-ATPase,cholinergic and antioxidant enzymes activity by protocatechuic acid in cadmium-induced neurotoxicity and oxidative stress in Wistar rats

BackgroundThis study assessed the possible protective mechanisms of protocatechuic acid (PCA) against cadmium (Cd)-induced oxidative stress and neurotoxicity in rats.MethodsMale wistar strain rats weighing between 150–160 g were purchased and acclimatized for two weeks. The rats were divided into seven groups of seven each; NC group received normal saline, CAD group received 6 mg/kg of Cd-solution, CAD + PSG group received Cd-solution and prostigmine (5 mg/kg), CAD + PCA-10 and CAD + PCA-20 groups received Cd-solution and PCA (10 mg/kg and 20 mg/kg) respectively, PCA-10 and PCA-20 groups received 10 mg/kg and 20 mg/kg PCA each. Animals were administered normal saline, Cd and PCA daily by oral gavage for 21 days. After which the animals were sacrificed, the brain excised, homogenized and centrifuged. The activities of enzymes (Na⁺/K⁺-ATPase, cholinesterases, catalase, glutathione peroxidase, superoxide dismutase) and levels of oxidative stress markers (lipid peroxidation and reduced glutathione) linked to neurodegeneration were subsequently assessed.ResultsSignificant (p < 0.05) alterations in the enzyme activities and levels of oxidative stress markers were observed in CAD group when compared to the NC group. However, the activities of the enzymes were reversed in CAD + PSG and CAD + PCA groups.ConclusionsPCA may protect against cadmium-induced neurotoxicity by altering the activities of Na⁺/K⁺-ATPase, acetylcholinesterase, butyrylcholinesterase and endogenous antioxidant enzymes.     

Non-nutritive sucking,oral breast milk,and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective,randomized controlled trial

BackgroundPreterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous.AimsWe compared the effects of combined sucking+ breast milk, sucking + breast milk + tucking, and routine care on preterm infant pain during and after heel-stick procedures.DesignA prospective, randomized controlled trial.SettingsLevel III neonatal intensive care unit and a neonatal unit at a medical center in Taipei.Participants/subjectsPreterm infants (N = 109, gestational age 29–37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking + breast milk + tucking.MethodsPain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10 min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4–8).ResultsFor infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2–8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values < 0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2–8 (all p-values < 0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care.ConclusionThe combined use of sucking + breast milk +tucking and sucking + breast milk effectively reduced preterm infants’ mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants’ procedural pain.     

Effect of mattress deflection on CPR quality assessment for older children and adolescents

Appropriate chest compression (CC) depth is associated with improved CPR outcome. CCs provided in hospital are often conducted on a compliant mattress. The objective was to quantify the effect of mattress compression on the assessment of CPR quality in children.MethodsA force and deflection sensor (FDS) was used during CPR in the Pediatric Intensive Care Unit and Emergency Department of a children's hospital. The sensor was interposed between the chest of the patient and hands of the rescuer and measured CC depth. Following CPR event, each event was reconstructed with a manikin and an identical mattress/backboard/patient configuration. CCs were performed using FDS on the sternum and a reference accelerometer attached to the spine of the manikin, providing a means to calculate the mattress deflection.ResultsTwelve CPR events with 14,487 CC (11 patients, median age 14.9 years) were recorded and reconstructed: 9 on ICU beds (9296 CC), 3 on stretchers (5191 CC). Measured mean CC depth during CPR was 47 ± 8 mm on ICU beds, and 45 ± 7 mm on stretcher beds with overestimation of 13 ± 4 mm and 4 ± 1 mm, respectively, due to mattress compression. After adjusting for this, the proportion of CC that met the CPR guidelines decreased from 88.4 to 31.8% on ICU beds (p < 0.001), and 86.3 to 64.7% on stretcher (p < 0.001). The proportion of appropriate depth CC was significantly smaller on ICU beds (p < 0.001).ConclusionCC conducted on a non-rigid surface may not be deep enough. FDS may overestimate CC depth by 28% on ICU beds, and 10% on stretcher beds.     

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

BackgroundDiabetes-related medial column foot deformities contribute to high plantar pressure, joint instability, ulceration and amputation. Impaired foot function may be an early indicator of foot structural incompetence and contribute to deformity progression. This study examines the ability of single-limb heel rise multi-segmental kinematics and kinetics to identify midfoot and hindfoot dysfunction in those with diabetes-related medial column foot deformity.MethodsSingle-limb heel rise foot kinematics and kinetics were examined in adults with diabetes mellitus and peripheral neuropathy with and without medial column foot deformity and age-, weight-matched controls.FindingsHindfoot relative to shank plantarflexion, peak and excursion, were reduced in both diabetes groups compared to controls (P < 0.017). Controls ' initial forefoot relative to hindfoot position was plantarflexed 31° and plantarflexed an additional 13° during heel rise. The initial forefoot relative to hindfoot position for the diabetes group without deformity was similarly plantarflexed as controls (34°) while the diabetes deformity group was less plantarflexed (lower arch position: 23°, P < 0.017). During the heel rise task both diabetes groups demonstrated less ability to plantarflex the forefoot relative to the hindfoot compared to controls (2 and 5° respectively, P < 0.017). Ankle plantarflexion power was reduced in the diabetes deformity group compared to controls (P < 0.017).InterpretationThe single-limb heel rise task identified movement dysfunction in those with diabetes mellitus and peripheral neuropathy. Failure to plantarflex the forefoot relative to hindfoot may compromise midfoot joint stability and increase the risk of injury and arch collapse.     

Foot dimensions and morphology in healthy weight,overweight and obese males

BackgroundOverweight and obesity are increasing in prevalence. However, despite reports of poor foot health, the influence of obesity and overweight on adult foot morphology has received limited attention. The objective of this work is to accurately and appropriately quantify the foot morphology of adults who are overweight and obese.MethodsThe foot morphology of 23 healthy weight (BMI = 22.9 kg.m^− 2), overweight (27.5 kg.m^− 2) and obese (32.9 kg.m^− 2) age (60 years) matched males was quantified using a 3D scanner (all size UK 9). Data analysis computed normalised (to foot length) standard anatomical measures, and widths, heights and circumferences of 31 evenly spaced cross-sections of right feet.FindingsAnatomical measures of foot, ball and heel width, ball and heel circumference and ball height were all greater in the obese group than the healthy weight (P < 0.05). Cross-sectional measures were significantly wider than the healthy group for the majority of measures from 14 to 67% (P = 0.025–1.000) of heel-to-toe length. Also, the obese group had significantly higher midfoot regions (P = 0.024–0.025). This increased foot height was not evident from anatomical measures, which were not sensitive enough to detect dimensional differences in this foot region.InterpretationFeet of obese adults differ from healthy and overweight individuals, notably they are wider. Data needs to avoid reliance upon discrete anatomical landmarks to describe foot morphology. In the obese, changes in foot shape do not coincide with traditional anatomical landmarks and more comprehensive foot shape data are required to inform footwear design.     

Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study

PurposeHigh-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model.Materials and methodsThe MetaNeb® System was used to deliver high-frequency pressure pulses to 3.0, 4.0, 6.0 and 8.0 mm ID ETTs connected to a test lung during mechanical ventilation. The experimental setup included a 3D-printed trachea model and imbedded pressure sensors. The pressure attenuation (P_att%) was calculated: P_att% = [(P_proximal–P_distal)/P_proximal]x100. The effect of pulse frequency on P_distal and P_proximal was quantified.ResultsP_att% was inversely and linearly related to ETT ID and (y = − 7.924x + 74.36; R² = 0.9917, P = .0042 for 4.0 Hz pulse frequency and y = − 7.382 + 9.445, R² = 0.9964, P = .0018 for 3.0 Hz pulse frequency). P_att% across the 3.0, 4.0, 6.0 and 8.0 mm I.D. ETTs was 48.88 ± 10.25%, 40.87 ± 5.22%, 27.97 ± 5.29%, and 9.90 ± 1.9% respectively. Selecting the 4.0 Hz frequency mode demonstrated higher P_proximal and P_distal compared to the 3.0 Hz frequency mode (P = .0049 and P = .0065). Observed P_distal was < 30cmH₂O for all experiments.ConclusionsIn an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased.     

Effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in pigs

AimStomach inflation during mask ventilation is frequent, but the effects on haemodynamic and pulmonary function are unclear. We evaluated the effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in a porcine model.MethodsRandomised prospective animal study. After randomisation, in 23 domestic pigs the stomach was inflated every 90 s with 0 L (control; n = 8), 0.5 L (n = 7) or 1 L (n = 8) ambient air.ResultsAfter 22.5 min, i.e. 8.5 L in the 0.5 L and 17 L in the 1 L stomach inflation group, stomach inflation increased central venous pressure (median) (control: 10 mmHg vs. 1 L: 23 mmHg, P < 0.05) and mean pulmonary artery pressure (control: 24 mmHg vs. 1 L: 45 mmHg, P < 0.05). As a result stroke volume index decreased (control: 135 mL/kg vs. 0.5 L: 90 mL/kg, P < 0.05; vs. 1 L: 72 mL/kg, P < 0.05). Stomach inflation also decreased static pulmonary compliance (control: 24 mL/cmH₂O vs. 0.5 L: 8 mL/cmH₂O, P < 0.05; vs. 1 L: 3 mL/cmH₂O, P < 0.05), which increased peak airway pressure (control: 28 cmH₂O vs. 0.5 L: 69 cmH₂O, P < 0.05; vs. 1 L: 73 cmH₂O, P < 0.05). Additionally, arterial oxygen partial pressure (control: 305 mmHg vs. 0.5 L: 140 mmHg, P < 0.05; vs. 1 L: 21 mmHg, P < 0.05) and systemic oxygen delivery (control: 53 mL O₂/min vs. 1 L: 19 mL O₂/min, P < 0.05) decreased. Stomach inflation increased mortality (control: 0/8 vs. 1 L: 5/8, P < 0.05).ConclusionsStomach inflation with 1 L when compared to 0.5 L increments resulted in faster haemodynamic and pulmonary failure and increased mortality. Stomach inflation may cause a hyper-acute abdominal compartment syndrome.     

Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial

BackgroundThe hypertension prevalence rate is increasing but the control rate is unsatisfactory. Nurse-led healthcare may be an effective way to improve outcomes for hypertensive patients but more evidence is required especially at the community level.ObjectiveThis study aims to establish a nurse-led hypertension management model and to test its effectiveness at the community level.DesignA single-blind, randomized controlled trial was performed in an urban community healthcare center in China. Hypertensive patients with uncontrolled blood pressure (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) were randomly allocated into two groups: the study group (n = 67) and the control group (n = 67). The nurse-led hypertension management model included four components (delivery system design, decision support, clinical information system and self-management support). Patients in the control group received usual care. Patients in the study group received a 12-week period of hypertension management. The patient outcomes, which involved blood pressure, self-care behaviors, self-efficacy, quality of life and satisfaction, were assessed at three time points: the baseline, immediately after the intervention and 4 weeks after the intervention.ResultsAfter the intervention, the blood pressure of patients in the study group decreased significantly compared to those in the control group, and the mean reduction of systolic/diastolic blood pressure in the study and control groups was 14.37/7.43 mmHg and 5.10/2.69 mmHg, respectively (p < 0.01). In addition, patients in the study group had significantly greater improvement in self-care behaviors than those in the control group (p < 0.01). The study group had a higher level of satisfaction with hypertensive care than the control group (p < 0.01). No statistically significant difference in self-efficacy and quality of life was detected between the two groups after the intervention.ConclusionsThe nurse-led hypertension management model is feasible and effective in improving the outcomes of patients with uncontrolled blood pressure at the community level.     

Physical activity and inactivity among different body composition phenotypes in individuals with moderate to very severe chronic obstructive pulmonary disease

BackgroundThe phenotype profiling of individuals with chronic obstructive pulmonary disease (COPD) according to impairments in body composition and level of physical activity in daily life (PADL) needs to be determined.ObjectiveTo verify if individuals with COPD classified as physically active/inactive present different characteristics within different body composition phenotypes.MethodsIndividuals with COPD were cross-sectionally stratified into four groups according to fat-free and fat mass indexes: Normal Body Composition (NBC), Obese (Ob), Sarcopenic (Sarc), and Sarcopenic/Obese (Sarc/Ob). Additionally, individuals had their PADL level objectively assessed through activity monitoring during two weekdays for at least 10 h/day, and then were classified as physically active (Act) or inactive (Inact) according to international recommendations. Lung function (spirometry), exercise capacity (6-minute walking test [6MWT]) and peripheral muscle strength (1-repetition maximum [1RM]) were also assessed.Results176 individuals with COPD (mean ± standard deviation age: 67 ± 8 years, body mass index 26 ± 6 kg/m², FEV1 47 ± 16%predicted) were classified as: NBC + Act (17%), NBC + Inact (22%), Ob + Act (6%), Ob + Inact (10%), Sarc + Act (12%), Sarc + Inact (9%), Sarc/Ob + Act (8%) and Sarc/Ob + Inact (16%). The Sarc/Ob + Inact group presented lower 6MWT and 1RM for knee extension compared to NBC + Act, NBC + Inact, and Ob + Act groups (p < 0.05). The Sarc/Ob + Inact group also presented lower FEV1% predicted, 1RM for elbow flexion and elbow extension compared to the NBC + Act and NBC + Inact groups and lower 1RM for elbow extension compared to Ob + Inact group (p < 0.05).ConclusionThe combination of sarcopenia, obesity, and physical inactivity was shown to be detrimental in individuals with COPD. Therefore, this profile is a main therapeutic target for improving PADL level and/or body composition.     

Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest

IntroductionCerebral perfusion is compromised during cardiopulmonary resuscitation (CPR). We hypothesized that beneficial effects of gravity on the venous circulation during CPR performed in the head-up tilt (HUT) position would improve cerebral perfusion compared with supine or head-down tilt (HDT).MethodsTwenty-two pigs were sedated, intubated, anesthetized, paralyzed and placed on a tilt table. After 6 min of untreated ventricular fibrillation (VF) CPR was performed on 14 pigs for 3 min with an automated CPR device called LUCAS (L) plus an impedance threshold device (ITD), followed by 5 min of L-CPR + ITD at 0° supine, 5 min at 30° HUT, and then 5 min at 30° HDT. Microspheres were used to measure organ blood flow in 8 pigs. L-CPR + ITD was performed on 8 additional pigs at 0°, 20°, 30°, 40°, and 50° HUT.ResultsCoronary perfusion pressure was 19 ± 2 mmHg at 0° vs. 30 ± 3 at 30° HUT (p < 0.001) and 10 ± 3 at 30° HDT (p < 0.001). Cerebral perfusion pressure was 19 ± 3 at 0° vs. 35 ± 3 at 30° HUT (p < 0.001) and 4 ± 4 at 30° HDT (p < 0.001). Brain–blood flow was 0.19 ± 0.04 ml min⁻¹ g⁻¹ at 0° vs. 0.27 ± 0.04 at 30° HUT (p = 0.01) and 0.14 ± 0.06 at 30° HDT (p = 0.16). Heart blood flow was not significantly different between interventions. With 0, 10, 20, 30, 40 and 50° HUT, ICP values were 21 ± 2, 16 ± 2, 10 ± 2, 5 ± 2, 0 ± 2, −5 ± 2 respectively, (p < 0.001), CerPP increased linearly (p = 0.001), and CPP remained constant.ConclusionDuring CPR, HDT decreased brain flow whereas HUT significantly lowered ICP and improved cerebral perfusion. Further studies are warranted to explore this new resuscitation concept.     

Bidis — hand-rolled,Indian cigarettes: Induced biochemical changes in plasma and red cell membranes of human male volunteers

ObjectiveTo investigate the effect of bidi smoking on erythrocyte antioxidant status, membrane fluidity.Design and methodsThirty experimental and control subjects (mean age 35 ± 5) were selected for the study. Experimental subjects smoke 22 ± 4 bidis per day for 8–10 years.ResultsIncrease in plasma total cholesterol, LDL-cholesterol, triglycerides, lipid peroxidation, protein carbonyls with a decrease in HDL-cholesterol, thiol groups as well as increased erythrocyte catalase (CAT), superoxide dismutase (SOD), decreased glutathione peroxidase (GPx) activity and reduced glutathione (GSH) content was observed in bidi smokers. Increase in the erythrocyte membrane lipid peroxidation, cholesterol phospholipids (C/P) ratio as well as decrease in protein and Na⁺/K⁺-ATPase activity was observed. Increase in nitrite/nitrate (NOx) levels of plasma, red cell lysate was positively correlated with C/P ratio (r = 0.614) and Na⁺/K⁺-ATPase (r = 0.435) in bidi smokers.ConclusionsBidi smoke alters antioxidant status, red cell membrane fluidity and increases atherogenicity.     

Quantifying loss of CD34+ cells collected by apheresis after processing for freezing and post-thaw

Introduction: CD34⁺ cells collected for autologous bone marrow transplantation (BMT) are usually quantified in the apheresis product after collection, but the necessity to repeat these measures post-thaw is controversial.Methods: We examined the loss of CD34⁺ cells after collection, preparation for freezing and post-thaw in apheresis products collected for BMT.Results: Median number of CD34⁺ cells collected per unit was 1.61 × 10⁶/kg, viability: 97–100%. This number decreased to 1.38 × 10⁶/kg, viability: 96–100% before freezing and was 1.17 × 10⁶/kg post-thaw. Viability decreased to 86–98%. The relative loss of viable PBHPC showed an inverse correlation with the ratio “CD34⁺ cells/total nucleated cells” (r = ?0.45; p = <0.0005). This relative loss was largest in patients with Hodgkin’s lymphoma.Conclusion: Cryopreservation and thawing of PBHPCs in leukapheresis products provokes a small but significant stem cell loss. So, quantification of viable CD34⁺ cells post-thaw is important, especially in poorly mobilizing patients. Besides, the ratio “CD34⁺ cells/total nucleated cells” after leukapheresis is an important parameter for prediction of neutrophil recovery after BMT.     

Plantar pressure differences between cases with symptoms of clinically diagnosed chronic exertional compartment syndrome and asymptomatic controls

BackgroundAnterior chronic exertional compartment syndrome of the leg has been hypothesised to develop due to excessive muscle activity and foot pronation. Plantar pressure variables related to lower limb muscle activity and foot type may therefore provide insight into this condition.Methods70 male cases and 70 asymptomatic controls participated. A clinical diagnosis was established from typical symptoms, with clinical examination excluding other pathologies. Plantar pressure variables during walking, hypothesised to be related to foot type, toe extensor activity or had shown predictive validity for general exercise-related lower leg pain, were extracted.FindingsCases were shorter in height (mean difference 2.4 cm), had greater body mass (mean difference 4.4 kg) and had reduced ankle dorsiflexion range of motion than controls (mean difference 1.5 cm). Plantar pressure variables indicative of foot-type and toe extensor activity did not differ between groups (P > 0.05). The magnitude of medial forefoot loading was the strongest plantar pressure predictor of the presence of chronic exertional compartment syndrome (Odds ratio:0.87, P = 0.005). There was also some evidence of greater lateral heel loading at 5% of stance time (P = 0.049–0.054).InterpretationThe lack of association with foottype-related and toe extensor activity-related plantar pressure variables suggest that these are not risk factors for the development of chronic exertional compartment syndrome, contrary to earlier hypotheses. The greater lateral to medial loading could theoretically represent increased Tibialis anterior muscle activity at heel strike but a subsequent loss of control as the ankle is lowered. Future studies directly investigating muscle activity and function are now required.     

Evaluación del efecto de la terapia de relajación en pacientes con hipertensión arterial

ObjectivesTo evaluate whether the application of a relaxation therapy reduces the blood pressure in hypertensive patients and whether there is improvement in several parameters which can influence blood pressure such as anxiety, quality of life and sleep.MethodsA quasi-experimental study (measures before-after) was performed in 25 Primary Care patients with hypertension poorly controlled by pharmacological treatment. The intervention consisted of relaxation therapy composed of 3 techniques: passive relaxation of Schwartz-Haynes, diaphragmatic breathing and imaginary visualization. A total of 14 group sessions of 30 min each (2/week) were conducted. Systolic and diastolic blood pressure were taken at the beginning and end of the relaxation programme implemented and after each of the programme sessions. The Pittsburgh Sleep Quality, Quality of Life Hypertension, State-Trait Anxiety and Perceived Stress questionnaires were used to measure psychosocial parameters.ResultsAfter intervention, a reduction in systolic blood pressure of 20 mmHg (p < .001) and of 8 mmHg (p < .001) in diastolic blood pressure was observed. Regarding other factors, sleep quality (p < .001), quality of life (p< .001) and state anxiety (p = .004) were significantly improved.ConclusionsRelaxation therapy had positive effects in improving blood pressure parameters, as well as the other factors evaluated. In our opinion, such strategies should be evaluated more thoroughly to consider their inclusion in Primary Care.     

Inertial measurement unit compared to an optical motion capturing system in post-stroke individuals with foot-drop syndrome

BackgroundFunctional electrical stimulation (FES) can be used for compensation of foot-drop for post-stroke individuals by pre-programmed fixed stimulation; however, this stimulation seems no more effective than mechanical ankle foot orthoses.ObjectiveWe evaluated the metrological quality of inertial sensors for movement reconstruction as compared with the gold-standard motion capturing system, to couple FES with inertial sensors to improve dorsiflexion on the paretic side, by using an adaptive stimulation taking into account individuals’ performance post-stroke.MethodsAdults with ischemic or hemorrhagic stroke presenting foot-drop and able to walk 10 m, were included from May 2016 to June 2017. Those with passive ankle dorsiflexion < 0° with the knee stretched were excluded. Synchronous gait was analyzed with the VICON© system as the gold standard and inertial measurement units (IMUs) worn by participants. The main outcome was the dorsiflexion angle at the heel strike and mid-swing phase obtained from IMUs and the VICON system. Secondary outcomes were: stride length, walking speed, maximal ankle dorsiflexion velocity and fatigue detection.ResultsWe included 26 participants [18 males; mean age 58 (range 45–84) years]. During heel strike, the dorsiflexion angle measurements demonstrated a root mean square error (RMSE) of 5.5°; a mean average error (MAE) of 3.9°; Bland-Altman bias of  − 0.1° with limits of agreement  − 10.9° to + 10.7° and good intra-class correlation coefficient (ICC) at 0.87 between the 2 techniques. During the mid-swing phase, the RMSE was 5.6; MAE 3.7°; Bland-Altman bias  − 0.9° with limits of agreement  − 11.7° to + 9.8° and ICC 0.88. Good agreement was demonstrated for secondary outcomes and fatigue detection.ConclusionsIMU-based reconstruction algorithms were effective in measuring ankle dorsiflexion with small biases and good ICCs in adults with ischemic or hemorrhagic stroke presenting foot-drop. The precision obtained is sufficient to observe the fatigue influence on the dorsiflexion and therefore to use IMUs to adapt FES.     

Analytical and pre-analytical performance characteristics of a novel cartridge-type blood gas analyzer for point-of-care and laboratory testing

BackgroundPoint-of-care blood gas test results may benefit therapeutic decision making by their immediate impact on patient care. We evaluated the (pre-)analytical performance of a novel cartridge-type blood gas analyzer, the GEM Premier 5000 (Werfen), for the determination of pH, partial carbon dioxide pressure (pCO₂), partial oxygen pressure (pO₂), sodium (Na⁺), potassium (K⁺), chloride (Cl⁻), ionized calcium (_iCa^2 +), glucose, lactate, and total hemoglobin (tHb).MethodsTotal imprecision was estimated according to the CLSI EP5-A2 protocol. The estimated total error was calculated based on the mean of the range claimed by the manufacturer. Based on the CLSI EP9-A2 evaluation protocol, a method comparison with the Siemens RapidPoint 500 and Abbott i-STAT CG8 + was performed. Obtained data were compared against preset quality specifications. Interference of potential pre-analytical confounders on co-oximetry and electrolyte concentrations were studied.ResultsThe analytical performance was acceptable for all parameters tested. Method comparison demonstrated good agreement to the RapidPoint 500 and i-STAT CG8 +, except for some parameters (RapidPoint 500: pCO₂, K⁺, lactate and tHb; i-STAT CG8 +: pO₂, Na⁺, _iCa^2 + and tHb) for which significant differences between analyzers were recorded. No interference of lipemia or methylene blue on CO-oximetry results was found. On the contrary, significant interference for benzalkonium and hemolysis on electrolyte measurements were found, for which the user is notified by an interferent specific flag.ConclusionIdentification of sample errors from pre-analytical sources, such as interferences and automatic corrective actions, along with the analytical performance, ease of use and low maintenance time of the instrument, makes the evaluated instrument a suitable blood gas analyzer for both POCT and laboratory use.