Effects of weight loss on myocardial energetics and diastolic function in obesity

A reduced myocardial phosphocreatine/adenosine triphosphate (PCr/ATP) ratio is linked to both diastolic dysfunction and heart failure. Although obesity is well known to cause diastolic dysfunction a link to impaired cardiac energetics has only recently been established. We assessed whether or not long-term weight loss in obesity, which is known to reduce mortality, is accompanied by both improved cardiac energetics and diastolic function. Normal weight (BMI 22 ± 2; n = 18) and obese subjects (BMI 34 ± 4; n = 13) underwent cine-MRI (1.5 Tesla) to determine left ventricular diastolic function using volume-time curve analysis, and ³¹P-MR spectroscopy (3 Tesla) to assess cardiac energetics (PCr/ATP ratio). Obese subjects (n = 13) underwent repeat assessment after 1 year of supervised weight loss. Obesity, in the absence of identifiable cardiovascular risk factors, was associated with significantly impaired myocardial high energy phosphate metabolism (PCr/ATP ratio, normal; 2.03 ± 0.27 vs. obese; 1.58 ± 0.47, p = 0.002) and significantly lower peak diastolic filling rate (normal; 4.8 ± 0.8 vs. obese; 3.8 ± 0.7 EDV/s, p = 0.01). Weight loss (on average 9 kg, 55 % excess weight) over 1 year resulted in a 24 % increase in PCr/ATP ratio (p = 0.01) and an 18 % improvement in peak diastolic filling rate (p = 0.01). Myocardial PCr/ATP ratio remained positively correlated with peak diastolic filling rate after weight loss (r = 0.63, p = 0.02). In obesity, weight loss improves impaired cardiac energetics and myocardial relaxation. Improved myocardial energetics appear to play a key role in diastolic functional recovery accompanying weight loss.     

Non-invasive measurement of cardiac output in obese children and adolescents: comparison of electrical cardiometry and transthoracic Doppler echocardiography

The objective of this study was to evaluate the reliability and accuracy of electrical cardiometry (EC) for the noninvasive determination of cardiac output (CO) in obese children and adolescents. We compared these results with those obtained by transthoracic echocardiography. Sixty-four participants underwent simultaneous measurement of CO. Cardiac output was measured by EC using the ICON^® device. Simultaneously CO was determined by using transthoracic Doppler echocardiography from parasternal long-axis and apical view. The median age was 12.52 years (range 7.9–17.6 years) and 36 (56 %) were female. A strongly significant correlation was found between the CO_EC and CO_Echo measurements (p < 0.0001, r = 0.91). Significant correlations were also found between CO and age (r = 0.37, p = 0.002), weight (r = 0.57, p < 0.0001), height (0.60, p < 0.0001) and BMI (r = 0.42, p = 0.001). The mean difference between the two methods (CO_EC ? CO_Echo) was 0.015 l min^?1. According to the Bland and Altman method, the upper and lower limits of agreement, defined as mean difference ±2 SD, were +1.21 and ?0.91 l min^?1, respectively. Compared to the transthoracic Doppler echocardiography, Electrical Cardiometry provides accurate and reliable CO measurements in obese children and adolescents.     

Think Yourself Thin: Concern for Appropriateness Mediates the Link Between Hypnotizability and Disordered Eating

There has been no research examining why people with disordered eating tend to be highly hypnotizable. The authors examine the hypothesis that concern for appropriateness mediates the association between hypnotizability and disordered eating. Fifty participants aged 15 to 30 completed the Eating Attitudes Test–26 (EAT–26) and the Concern for Appropriateness Scale (CAS) and were administered the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C). EAT–26 scores predicted CAS scores (β = 0.24, p < .001), CAS scores predicted SHSS:C scores (β = 0.38, p < .001), and the mediation model was significant (Sobel Test; R² = .24, z = 2.54, p < .01). Individuals with problematic eating attitudes may tend to be more hypnotizable than those with normal eating attitudes at least in part because they are highly influenced by interpersonal messages.     

Incentive spirometry and positive expiratory pressure improve ventilation and recruitment in postoperative recovery: A randomized crossover study

Introduction: Impairment of global and regional pulmonary ventilations is a well-known consequence of general anesthesia. Positive expiratory pressure (PEP) or incentive spirometry (IS) is commonly prescribed, albeit their efficacy is poorly demonstrated. The aim of this study was to assess the effects of PEP and IS on lung ventilation and recruitment in patients after surgery involving anesthesia using electrical impedance tomography (EIT). Method: Ten male subjects (age = 61.2 ± 16.3 years; BMI = 25.3 ± 3.8 kg/m²), free of pulmonary disease before being anesthetized, were recruited. Two series of manoeuvers (PEP and volume-oriented IS) were randomly performed with quiet breathing interposed between these phases. Pulmonary ventilation (ΔEELVVT (i ? e)) and recruitment (ΔEELI) were evaluated continuously in a semi-seated position during all phases by EIT. Comparisons between rest and treatment were performed by Wilcoxon signed rank test. Rest phases were compared by a mixed ANOVA. Bonferroni method was used for post-hoc comparisons. Results: ΔEELVVT (i ? e) and ΔEELI were significantly increased by both techniques (+422% [p < 0.001]; +138% [p = 0.040] and +296% [p < 0.001]; +638% [p < 0.001] for PEP and IS, respectively). No difference was observed between both manoeuvers neither on ventilation nor on recruitment. This positive effect disappeared during the quiet breathing phases. Conclusion: IS and PEP improved ventilation and recruitment instantaneously without remnant effect after stopping the exercise.     

Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography

To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVA_MDCT) and by the continuity equation with TTE (AVA_TTE). To generate a reference AVA (AVA_REF) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVA_REF was used as the reference to compare both measures against, since it bypasses the assumption of LVOT being circular in the continuity equation and the potential placement error of PW Doppler in the LVOT. The mean (±SD) age of the patients was 71 (±9) years, 113 (67 %) were males. Mean AVA_TTE was 0.93 (±0.33) cm², mean AVA_MDCT was 0.99 (±0.36) cm² and mean AVA_REF was 1.00 (±0.39) cm². The mean difference between AVA_TTE and AVA_MDCT was ?0.06 cm², p = 0.001, mean difference between AVA_TTE and AVA_REF was ?0.06 cm², p < 0.001, and mean difference between AVA_MDCT and AVA_REF was ?0.01 cm², p = 0.60. Calcification of the aortic valve quantified by Agatston score, significantly decreased the correlation between AVA_MDCT and AVA_REF, (r low Agatston = 0.90, r high Agatston = 0.57). MDCT measured AVA is slightly larger than AVA measured by TTE (0.06 cm²). The accuracy and precision errors on AVA measurements are comparable for MDCT and TTE. Valvular calcification may primarily affect the accuracy of AVA_MDCT.     

Modeling the Impact of Extraction Conditions on Functional Properties of Gelatin from Scales of Blackspotted Croaker (Protonibea diacanthus)

Utilization of waste from fish processing industry for value added products is gaining considerable attention as it addresses environmental pollution issues and adds economic returns to the industry. Scales of Blackspotted croaker were utilized for the extraction of gelatin and response surface methodology (RSM) with central composite design was employed to determine the optimal conditions of three independent variables namely concentration of sodium hydroxide (X₁), extraction temperature (X₂) and extraction time (X₃) on yield (%), gel strength (g), viscosity (cP) and melting point (°C). The models obtained by RSM produced a satisfactory fit to the data with respect to gelatin yield (R ² = 0.931, p < 0.01), gel strength (R ² = 0.957, p < 0.001), viscosity (R ² = 0.847, p < 0.05) and melting point (R ² = 0.876, p < 0.05). The maximum values of the responses were obtained at a combined condition of sodium hydroxide concentration, extraction temperature and extraction time of 0.4 %, 80 °C and 3 h respectively. The predicted maximum response values obtained from the models (7.82 % yield, 248.4 g gel strength, 10.11cP viscosity and 21.4 °C melting point) were experimentally verified. Results from the present study clearly revealed that the mathematical models derived from RSM help in extracting gelatin from fish scales with the desirable functional properties.     

Ability of Hypnosis to Facilitate Movement Through Stages of Change for Smoking Cessation

On the basis of the transtheoretical model of change, we hypothesized that hypnosis would facilitate significantly greater movement through the stages of change toward smoking cessation in contrast to psychoeducation. Thirty participants were pretested for hypnotizability using the Elkins Hypnotizability Scale (EHS). Participants’ readiness for change was assessed using the University of Rhode Island Change Assessment scale (URICA). The EHS relaxation induction was used to induce hypnosis. Hypnotic suggestions addressed motivation and ambivalence. The URICA was administered following the intervention and at a 10-day follow-up. Two-factor split-plot ANOVAs showed significant changes within groups on the contemplation subscale (p = .002), action subscale (p = .00007), and the number of cigarettes smoked per day (p = .003).     

Influencing Factors and Consequences of Workplace Bullying among Nurses: A Structural Equation Modeling

Purpose

The purpose of this study was to build and test a model outlining the factors related to workplace bullying among nurses. The hypothesized model included authentic leadership and a relationship-oriented organizational culture as influencing factors, symptom experience and turnover intention as consequences, and positive psychological capital as a mediator of workplace bullying among nurses.

The evaluation of a multifaceted intervention to promote “speaking up” and strengthen interprofessional teamwork climate perceptions

ABSTRACT

Communication failure is a leading cause of error and is often due to inhibition of individuals to speak up in interprofessional healthcare environments. The present study sought to evaluate the impact of a multifaceted intervention designed to promote speaking up on teamwork climate in one clinical department of a large community hospital based in Canada. The multifaceted intervention included a role-playing simulation workshop, teamwork climate data feedback and facilitated discussion with the interprofessional team (discussion briefings), and other department-led initiatives to promote trust, teamwork, and speaking up among interprofessional team members. A quasi-experiment (pretest–posttest control group design, using two posttests several months apart) was used to evaluate the impact of the complete intervention on individual teamwork climate perceptions. The intervention was implemented with an intact interprofessional team (the Emergency Department—ED) in 2014. The intensive care unit (ICU) was used as the control unit. Survey response rates were the highest at time 1 (83/102 = 81% for the ED and 29/31 = 94% for the ICU) and the lowest at time 3 (38/105 = 36% for the ED and 14/30 = 47% for the ICU). The results obtained from paired and unpaired analyses suggest that this type of multifaceted approach can improve staff perceptions of teamwork climate. The teamwork climate score in the ED was significantly higher at follow-up (Mt2 = 3.42, SD = 0.66) compared to baseline (Mt1 = 3.13, SD = 0.72), (F(1, 34) = 12.2, p = .001, eta²p = .263), while baseline and follow-up scores were not significantly different between baseline and follow-up for the ICU group (Mt1 = 4.12, SD = 0.60; Mt2 = 4.15, SD = 0.56; F(1, 34) = 0.06, p = .806, eta²p = .002). Sustaining high levels of participation in interprofessional initiatives and engaging physicians remain challenging when interventions are used in context. Improving team communication is a broad and challenging area that continues to require attention.     

Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve

In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB?, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB? patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m², p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m², p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m², p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m², p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB? groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = ?0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.     

Effects of Kinesio tape in individuals with lateral epicondylitis: A deceptive crossover trial

Objectives: To determine the true and immediate effect of applying Kinesio tape (KT) on the pain intensity, pain-free grip strength, maximal grip strength, and electromyographic activity with facilitatory KT, inhibitory KT, sham KT, and untaped condition in patients with lateral epicondylitis (LE) who were ignorant about KT. Design: Deceptive crossover trial. Participants: Thirty-three patients with unilateral chronic LE who were ignorant about KT, 30 of them were successfully deceived in this study. Interventions: Patients were randomly allocated into different sequences of four taping conditions: facilitatory KT, inhibitory KT, sham KT, and untaped condition. Outcome Measures: Pain intensity, pain-free grip strength, maximal grip strength, and electromyographic activity of wrist extensor muscles were assessed immediately after each tape application. Results: No significant differences in the pain intensity (p = 0.321, η² = 0.04); pain-free grip strength (p = 0.312, η ² = 0.04); maximal grip strength (p = 0.499, η² = 0.03); and electromyographic activity (maximal grip: p = 0.774, η² = 0.01; and pain-free grip: p = 0.618, η² = 0.02) were recorded among various taping conditions. Conclusions: Neither facilitatory nor inhibitory effects were observed between different application techniques of KT in patients with LE. Hence, alternative intervention should be used to manage LE.     

Subgrouping children with cerebral palsy from a broader perspective using two methods

The purpose was to develop two versions of a body function index in cerebral palsy (BFI-CP I and BFI-CP II) using two methods to explore the relationship and differences among them and the Gross Motor Function Classification System (GMFCS) and to explore the differences among subsets of the classifications that do not correspond to the ordinal levels of the GMFCS. Data on various measures from 405 children with CP between 18 months and 5 years of age were extracted from the Move & PLAY Study. The BFI-CP I was developed using a summing technique and the BFI-CP II was developed using cluster analysis. There was a strong correlation between the BFI-CP I and the GMFCS (r = 0.92), between the BFI-CP II and the GMFCS (r = 0.93), and between the BFI-CP I and II (r = 0.92) all (p < 0.001). There was also a significant difference between the BFI-CP I and the GMFCS (χ² = 670.49, df = 16, p < 0.001) and between the BFI-CP II and the GMFCS (χ² = 685.57, df = 16, p < 0.001). The findings of this study indicate that the two versions of the BFI-CP could be used as complementary methods in describing children with CP.     

Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension

We tested the hypothesis that the addition of right atrial (RA) remodeling to right ventricular (RV) function enhances the capability of the latter to predict long-term outcome for pulmonary hypertension (PH) patients. We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free ≤19.4 % and RA area of >18 cm², respectively. Long-term unfavorable outcome events were tracked for 2.0 years. RA area correlated with mean RA pressure (r = 0.62, p < 0.001), as well as with tricuspid E/E’ (r = 0.38, p = 0.001). Moreover, RA area in patients with RV restrictive filling was significantly larger than that in patients with others (all p < 0.05). Kaplan–Meier analysis revealed that patients with RV-free ≤19.4 % had worse long-term outcomes than those with RV-free >19.4 % (log-rank p = 0.01), as did patients with RA area >18 cm² compared with those with RA area ≤18 cm² (log-rank p < 0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 = 3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 = 9.24; p < 0.05), and RV-free (χ2 = 17.11; p = 0.005), and further improved by addition of RA area (χ2 = 21.36, p < 0.05). In conclusion, the combined assessment of RV function and RA area results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.     

Capturing interprofessional collaboration between physicians and nurses in an acute care setting. A validation study of the revised German version of the Collaborative Practice Scales

ABSTRACT

The relevance of interprofessional collaboration (IPC) is widely acknowledged. Given the lack of a fully validated instrument in the German language for measuring the level of IPC, we built upon the current, albeit psychometrically weak, German-language version of the instrument to devise a new version with improved wording and for subsequent psychometric testing. In a tertiary hospital in German-speaking Switzerland, 160 physicians and 374 nurses completed the revised Collaborative Practice Scales in German (CPS-G) and additional scales regarding positive and negative activation at work and regarding job demands and job resources. A confirmatory factor analysis of the CPS-G was performed, and internal consistency estimates were computed. Partial correlations between the CPS-G and the additional scales were examined for criterion validity. The model fit of the CPS-G was good for physicians (χ²/df = 2.38, p?<?.001; CFI = .923; RMSEA = .051, 90%-CI (0.037–0.065)) and moderate for nurses (χ²/df = 5, p?<?.001; CFI = .919; RMSEA = .087, 90%-CI (0.072–0.102)) supporting the two-factor structure of the original English version. Reliability was acceptable in all sub-scales for physicians (inclusion, α = 0.79; consensus, α = 0.80) and nurses (assertiveness, α = 0.77; understanding α = 0.82). As expected, the CPS-G physicians’ subscales correlated positively with positive activation and job resources and negatively with negative activation and job demands, albeit not always statistically significantly. Similar correlations were found with the CPS-G nurses’ subscales other than in one instance. The CPS-G showed good construct and criterion validity and acceptable internal consistency. It consequently represents a valid instrument ready for application to measure the level of interprofessional collaboration between nurses and physicians in acute care settings.     

Progression of diffuse myocardial fibrosis assessed by cardiac magnetic resonance T1 mapping

To evaluate long-term changes in diffuse myocardial fibrosis using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and T₁ mapping. Patients with chronic stable cardiomyopathy and stable clinical status (n = 52) underwent repeat CMR at a 6 month or greater follow up interval and had LGE and left ventricular (LV) T₁ mapping CMR. Diffuse myocardial fibrosis (excluding areas of focal myocardial scar) was assessed by post gadolinium myocardial T₁ times. Mean baseline age of 52 patients (66 % male) was 35 ± 19 years with a mean interval between CMR examinations of 2.0 ± 0.8 years. CMR parameters, including LV mass and ejection fraction, showed no change at follow-up CMR (p > 0.05). LVT₁ times (excluding focal scar) decreased over the study interval (from 468 ± 106 to 434 ± 82 ms, p = 0.049). 38 Patients had no visual LGE?, while 14 were LGE+. For LGE? patients, greater change in LV mass and end systolic volume index were associated with change in T₁ time (β = ?2.03 ms/g/m², p = 0.035 and β = 2.1 ms/mL/m², p = 0.029, respectively). For LGE+ patients, scar size was stable between CMR1 and CMR2 (10.7 ± 13.8 and 11.5 ± 13.9 g, respectively, p = 0.32). These results suggest that diffuse myocardial fibrosis, as assessed by T₁ mapping, progresses over time in patients with chronic stable cardiomyopathy.     

Efficacy and tolerability of buccal buprenorphine in opioid-naive patients with moderate to severe chronic low back pain

Objectives: Buprenorphine HCl buccal film has been developed for treating chronic pain utilizing BioErodible MucoAdhesive (BEMA^®) delivery technology. Buccal buprenorphine (BBUP; Belbuca^TM, Endo Pharmaceuticals) was evaluated for the management of moderate to severe chronic low back pain (CLBP) requiring around-the-clock analgesia in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal study in opioid-naive patients.

Methods: Patients (n = 749) were titrated to a dose of BBUP (range, 150–450 µg every 12 h) that was generally well tolerated and provided adequate analgesia for ≥14 days, and then randomized to BBUP (n = 229) or placebo (n = 232), respectively. The primary efficacy variable was the change from baseline to week 12 of double-blind treatment in the mean of daily average pain intensity scores (numeric rating scale from 0 [no pain] to 10 [worst pain imaginable]).

Results: Patients were experiencing moderate to severe pain at study entry: mean (SD) = 7.15 (1.05). Following titration, pain was reduced to the mild range; 2.81 (1.07). After randomization, mean (SD) pain scores increased from baseline to week 12 more with placebo (1.59 [2.04]) versus BBUP: (0.94 [1.85]) with a significant between-group difference (?0.67 [95% CI: ?1.07 to ?0.26]; p = 0.0012). A significantly larger percentage of patients receiving BBUP versus placebo had ≥30% pain reduction (63% vs 47%; p = 0.0012). During double-blind treatment, the most frequent adverse events (AEs) with BBUP were nausea (10%), constipation (4%) and vomiting (4%). The most common AEs with placebo were nausea (7%), upper respiratory tract infection (4%), headache (3%) and diarrhea (3%).

Conclusions: These findings demonstrate the efficacy and tolerability of BBUP among opioid-naive patients requiring around-the-clock opioid treatment for CLBP.     

The relationship of CD34+ dosage and platelet recovery following high dose chemotherapy and autologous CD34+ reinfusion in multiple myeloma

Autologous hematopoietic stem cell transplantation (ASCT) is an established treatment for multiple myeloma (MM), yet the impact of transplanted CD34+ cell dose remains unresolved, especially in patients over the age of 65 years. Data was collected from 207 consecutive ASCT patients to determine the relationship between CD34+ infusion count and short-term and long-term platelet recovery. For MM patients under the age of 65 years (n = 155), CD34+ dosage correlates with time to platelet engraftment (p < 0.001) and platelet count at 30 days (p = 0.003), but not with long-term platelet counts at 180 or 360 days from the CD34+ reinfusion. For MM patients aged 65 years or older (n = 46), CD34+ dosage did not correlate with time to platelet engraftment, but did correlate with both short-term and long-term platelet counts at 30 (p < 0.001), 180 (p = 0.021), and 360 days (p = 0.005). Exploratory regression analysis was done to explore platelet stability following the current minimum CD34+ dosage reinfusion. For MM patients under the age of 65 years, the minimum standard CD34+ dosage of 2 × 10⁶ cells/kg was sufficient for a timing to platelet engraftment of <21 days and short-term platelets count ≥150 × 10⁹/L at 30 days. Alternatively, for MM patients aged 65 years or older, the CD34+ dosage of 2 × 10⁶ cells/kg was insufficient for platelet counts ≥150 × 10⁹/L at 30 and only marginally attainable at 360 days suggesting that in elderly MM patients a higher CD34+ dosage may be required for platelet recovery and possibly long-term platelet stability.     

Ability and efficiency of an automatic analysis software to measure microvascular parameters

Analysis of the microcirculation is currently performed offline, is time consuming and operator dependent. The aim of this study was to assess the ability and efficiency of the automatic analysis software CytoCamTools 1.7.12 (CC) to measure microvascular parameters in comparison with Automated Vascular Analysis (AVA) software 3.2. 22 patients admitted to the cardiothoracic intensive care unit following cardiac surgery were prospectively enrolled. Sublingual microcirculatory videos were analysed using AVA and CC software. The total vessel density (TVD) for small vessels, perfused vessel density (PVD) and proportion of perfused vessels (PPV) were calculated. Blood flow was assessed using the microvascular flow index (MFI) for AVA software and the averaged perfused speed indicator (APSI) for the CC software. The duration of the analysis was also recorded. Eighty-four videos from 22 patients were analysed. The bias between TVD-CC and TVD-AVA was 2.20 mm/mm² (95 % CI 1.37–3.03) with limits of agreement (LOA) of ?4.39 (95 % CI ?5.66 to ?3.16) and 8.79 (95 % CI 7.50–10.01) mm/mm². The percentage error (PE) for TVD was ±32.2 %. TVD was positively correlated between CC and AVA (r = 0.74, p < 0.001). The bias between PVD-CC and PVD-AVA was 6.54 mm/mm² (95 % CI 5.60–7.48) with LOA of ?4.25 (95 % CI ?8.48 to ?0.02) and 17.34 (95 % CI 13.11–21.57) mm/mm². The PE for PVD was ±61.2 %. PVD was positively correlated between CC and AVA (r = 0.66, p < 0.001). The median PPV-AVA was significantly higher than the median PPV-CC [97.39 % (95.25, 100 %) vs. 81.65 % (61.97, 88.99), p < 0.0001]. MFI categories cannot estimate or predict APSI values (p = 0.45). The time required for the analysis was shorter with CC than with AVA system [2′42″ (2′12″, 3′31″) vs. 16′12″ (13′38″, 17′57″), p < 0.001]. TVD is comparable between the two softwares, although faster with CC software. The values for PVD and PPV are not interchangeable given the different approach to assess microcirculatory flow.