Validation of the auscultatory method for diagnosing peripheral arterial disease

BACKGROUND: The Ankle brachial index (ABI) has been shown to be useful in diagnosing peripheral arterial disease (PAD). Ankle systolic blood pressures are measured by a Doppler device; however, general physicians cannot always use it in daily practice. The ausculutatory method (AUS) is an alternative method and quite easy to perform, but has not yet been validated in diagnosing PAD. OBJECTIVE: To validate AUS for diagnosing PAD based on ABI, compared with Doppler method as gold standard. METHODS: Cross-sectional study. Study subjects were 119 patients aged 50 years and older, who were consecutively admitted to the division of general internal medicine in two community hospitals in Japan. We measured the systolic blood pressures of the brachial and the posterior tibial arteries by two methods. We calculated the ABI from the systolic blood pressure obtained by these two methods. PAD was considered to be present when ABI 0.9. CONCLUSIONS: While AUS is not efficient enough to confirm the presence of PAD based on ABI, it could be clinically useful in excluding PAD when ABI >0.90. When measuring ankle blood pressure by AUS in the daily practice, it is important to realise its strengths and weaknesses.     

Variability and reliability of diastolic blood pressure during adolescence: The Philadelphia blood pressure project

This paper reports results of diastolic blood pressure studies done as part of the Philadelphia Blood Pressure Project (PBPP), a 3-year longitudinal study of black adolescents, initially ages 11–15, who were enrolled originally in the Philadelphia Collaborative Perinatal Project (CPP). Three samples were studied by the PBPP: a representative sample of over 500 black adolescents stratified by age and sex, a smaller sample of adolescents who had blood pressures elevated beyond one standard deviation of the CPP population mean at age 7, and a sample of adolescents born of toxemic pregnancies. We found, for the representative sample, consistent differences in the means of diastolic blood pressure phases IV and V and between diastolic blood pressures taken in supine and seated positions. Supine diastolic blood pressures were more variable at every age and were lower than the comparable seated diastolic blood pressures. In addition, we estimated on a random subsample from all three samples diastolic blood pressure reliability for supine readings taken sequentially by the same (N = 96) and different (N = 55) examiners. We also estimated measurement reliability simultaneously (N = 91 supine, N = 96 seated) using a double-listening stethoscope. We found that although diastolic phase IV blood pressure was more reproducible or less variable over short periods of time (5–15 min) when reliability measures were taken sequentially, two examiners simultaneously could not measure phase IV with significantly greater accuracy than phase V. We concluded that the fourth and fifth Korotkoff sounds should not be used interchangeably during adolescence and that postural position is an important contributor to diastolic blood pressure variance during adolescence. Also, since it has not yet been established which is more statistically predictive of adult blood pressure levels, whenever possible, both phase IV and V should be recorded for adolescents.     

Reproducibility and predictive values of routine blood pressure measurements in children. Comparison with adult values and implications for screening children for elevated blood pressure

A study of the variability of blood pressure was conducted among a total of 780 Massachusetts children, 335 children in East Boston and 445 children in Brookline, ages 8-18 years. All children had their blood pressure measured with a standard mercury sphygmomanometer in a school setting on four visits one week apart with three measurements per visit. In East Boston, repeat measurements were made for the same children for four consecutive years. A nested random effects model was used to estimate between- and within-visit variance components. For children aged 8-12 years, these were, respectively, 33.1, 12.0 in boys and 31.2, 11.1 in girls for systolic blood pressure and 57.7, 21.3 in boys and 56.6, 22.6 in girls for systolic muffling blood pressure (Korotkoff phase 4). For children aged 13-18 years of age, they were, respectively, 41.1, 11.8 in boys and 35.2, 12.2 in girls for blood pressure and 40.6, 15.5 in boys and 36.1, 11.4 in girls for diastolic blood pressure (Korotkoff phase 5). Within-person variability for systolic pressure was comparable to previously published data for 434 white adults ages 30-49 years not on antihypertensive medications; however, within-person variability for diastolic pressure was considerably higher in the children, accounting for over 75% of total variability among 8-12-year-old children, compared with 27% for adults. No meaningful effects of age, sex, or blood pressure level on variability of systolic pressure were found. However, age and level of blood pressure each had a large and independent inverse association with variability of diastolic pressure; variance components for younger children (ages 8-12 years) and children with low diastolic pressure (less than 60 mmHg) were approximately twice as large as for older children (ages 13-18 years) and children with diastolic pressure greater than or equal to 60 mmHg, respectively. Finally, predictive value estimates of blood pressure are provided for particular age-sex groups to enable one to efficiently identify children whose true mean level of blood pressure exceeds the 90th percentile for their age-sex group with minimum misclassification. Because of the substantial variability of diastolic pressure in young children, resulting in relatively low predictive value estimates, systolic pressure (either alone or in combination with diastolic pressure) may be more useful as the primary tool for screening children under age 13 years for high blood pressure.     

踝肱指数、血压节律与颈动脉内-中膜厚度关系研究

目的探讨踝肱指数(Ankle brachial pressure index,ABI)及动态血压节律(ambulatory blood pressure rhythm,ABPR)与颈动脉内-中膜厚度(carotid intima-medial thickness,IMT)的关系。方法入选的92名2型糖尿病合并高血压患者测量ABI,动态血压监测并计算昼夜血压节律,测量颈动脉IMT,进行详细病史采集,检测生化指标,记录研究对象的年龄、身高、体重等。根据动态血压节律将入选患者分成2组:即杓形组与非杓形组,进行各检测指标参数比较。以颈动脉IMT为因变量,将年龄、ABI、体重指数(BMI)、尿微量白蛋白、血清生化指标、病史为自变量作多元逐步回归分析。分别比较血压节律、ABI单项异常,二者异常及二者正常时颈动脉IMT增厚的检出率。结果杓型血压与非杓型血压组各参数比较,ABI低于杓型组,差异有统计学意义,颈动脉IMT与各影响因素进行多、元逐步回归分析,进入回归方程的因素有ABI;血压节律、ABI单项异常较二项联合检查时颈动脉IMT增厚的阳性率低。结论血压节律的异常可以造成血管壁损伤;联合观察ABI和动态血压节律的变化较单独测量对大血管病变有更好的预见性。     

Best reproducibility of the ankle-arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

BACKGROUND AND OBJECTIVE: To investigate which method of ankle-arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility. STUDY DESIGN AND SETTING: In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated. RESULTS: The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap. CONCLUSIONS: To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP.     

The Unusual High Origin Radial Artery in a Black Kenyan Population: A Cadaveric Study

BackgroundThe anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown.MethodsSixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi.ResultsFifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally.ConclusionThe present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount.     

Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci.

OJECTIVE: To measure directly the rate of contamination, during routine patient examination, of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci (VRE). SETTING: A large, academic, tertiary-care hospital. PATIENTS: Between January 1997 and December 1998, 49 patients colonized or infected with VRE were entered in the study. DESIGN: After routine examination, the examiner's glove fingertips, gown (the umbilical region and the cuffs), and stethoscope diaphragm were pressed onto Columbia colistin-nalidixic acid (CNA) agar plates with 5% sheep blood plus vancomycin 6 pg/mL. The stethoscope diaphragm was sampled again after cleaning with a 70% isopropanol wipe. RESULTS: VRE were isolated from at least 1 examiner site (gloves, gowns, or stethoscope) in 33 (67%) of 49 cases. Gloves were contaminated in 63%, gowns in 37%, and stethoscopes in 31%. All three items were positive for VRE in 24%. One case each had stethoscope and gown contamination without glove contamination. Only 1 (2%) of 49 stethoscopes was positive after wiping with an alcohol swab. Contamination at any site was more likely when the patient had a colostomy or ileostomy. Patients identified by rectal-swab culture alone were as likely to contaminate their examiners as were those identified by clinical specimens. CONCLUSIONS: Our study revealed a high rate of examiner contamination with VRE. The similar risk of contamination identified by surveillance and clinical cases reinforces concerns that patients not known to be colonized with VRE could serve as sources for dissemination. Wiping with alcohol is effective in decontaminating stethoscopes.     

Stethoscopes and otoscopes--a potential vector of infection?

OBJECTIVES: We aimed to determine whether stethoscopes and otoscopes used in community paediatric clinics harboured pathogenic micro- organisms, and, if so, which measures could prevent this. METHODS: Fifty-five stethoscopes belonging to paediatric physicians working in 12 community clinics were sampled for bacterial cultures by two methods: (i) direct impression of the diaphragm and bell section of each stethoscope for 5 seconds onto blood agar plates and a mannitol- salt-agar plate; (ii) swabbing the entire surface of the diaphragm of the stethoscope with a sterile cotton-tipped applicator. Forty-two otoscopes from the same physicians were sampled by rubbing the handles of the otoscopes with cotton-tipped swabs. The plates were incubated at 37 degrees C for 48 hours and examined for colony growth at 24 and 48 hours of incubation. Culture results were recorded as mean numbers of colony-forming units (CFUs). Eight additional stethoscope diaphragms were chosen at random at the participating clinics and cultured as described above. They were then wiped with alcohol swabs (isopropyl alcohol 70%), allowed to air dry for approximately 10 minutes and cultured a second time. RESULTS: All the stethoscopes and 90% of the otoscope handles were colonized by microorganisms. Staphylococci were isolated from 85.4% of the stethoscopes and 83.3% of the otoscopes, with 54.5% and 45.2% respectively being S. Aureus. Methicillin- resistant S. aureus were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%). Cleaning with alcohol reduced the colony count by an average of 96.3%. CONCLUSIONS: Fomites can harbour potentially pathogenic bacteria, and with the increasing trend for children with more complex medical problems to be managed in an ambulatory setting, often by physicians who also work in hospitals, there is a real risk of spreading potentially serious infections to such patients. Simple cleansing with alcohol effectively eliminates the bacterial contamination of the fomites, and should be encouraged.      

Factors associated with measured differences between fourth and fifth phase diastolic blood pressure

Data from the Munich Blood Pressure Study I were used to investigate the distributions of fourth (D4) and fifth (D5) phase diastolic blood pressures in a population and to identify factors related to their difference. Muffling (in contrast to change of amplitude) of sounds was taken as the criterion for fourth phase Korotkoff sounds. D4 could not be detected (ie D4 = D5) in 33.7% of the 1032 men and in 42.1% of the 1163 women. The difference D4-D5 (mean +/- SEM) was 3.1 +/- 0.1 mmHg for male and 2.4 +/- 0.1 mmHg for female participants. Only 28.0% of D4-D5 differences were greater than 4 mmHg in men and 20.2% in women. D4-D5 varied considerably between the three measurements of each examination both related to participants and observers. Participant characteristics associated with greater D4-D5 were higher SBP, higher D4, and lower D5. Smoking was more common in men with greater D4-D5. Inter-observer variability was very strong. Non-detection of D4 ranged from 78.8% to 10.2% between observers. To assess the relative importance of participant and observer influence on the magnitude of D4-D5, we fitted a polychotomous logistic regression model. In this model, participant characteristics had only a weak effect on measured D4-D5. This was outweighted by potential observer effects several-fold stronger than the strongest participant effect. We conclude that for reliability reasons D5 should be given preference over D4 when measuring diastolic blood pressure in adults, whether for clinical or for epidemiological purposes.     

支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较

目的 比较支气管堵塞器(BB)与双腔气管导管(DLT)在单肺通气中对呼吸力学和血气的影响.方法 将36例择期行肺叶切除术和食管癌根治术患者按投硬币法随机分为BB组(17例)和DLT组(19例).BB组完成单腔管插管后在纤维支气管镜引导下置入BB,DLT组完成插管后用纤维支气管镜检查确定DLT位置.摆好体位后记录两组双肺通气和单肺通气的气道峰压(Pmax)与肺动态顺应性(CLayn),单肺通气20 min后采动脉血,行动脉血气分析:动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2).结果 两组双肺通气时的Pmax和CLdyn比较差异无统计学意义(P＞0.05).单肺通气时BB组Pmax[(21.00 ±3.59)cm H2O,1 cm H2O=0.098 kPa]明显低于DLT组[(26.89 ±4.21)cm H2O](P＜0.05),CLdyn[(28.10 ±6.24)ml/cm H2O]明显高于DLT组[(24.00±7.13)ml/cm H2O](P＜0.05);两组单肺通气20min后PaO2、PaCO2、SaO2比较差异无统计学意义(P＞0.05).结论 使用BB行单肺通气对呼吸力学参数的影响较使用DLT小,具有很好的临床应用价值.

Abstract：

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.     

踝肱指数在糖尿病足早期预防及护理中的应用

目的：探讨踝肱指数在糖尿病足早期筛查中的应用,并在此基础上进行早期干预,观察干预效果。方法：应用多普勒血流探测仪检测90例糖尿病患者肱动脉、足背动脉、胫后动脉血流波形图以及收缩压计算出踝肱指数（ABI）,并对高危（ABI<0.9）人群进行早期干预。结果：早期护理干预,能预防周围血管病变,可使患者延缓或不发生糖尿病足的发生。结论：通过超声多普勒血流探测仪对糖尿病患者进行筛查踝肱指数（ABI）筛查,能够为糖尿病足高危人群的早期干预提供重要的依据。     

基于PWTT的无创逐拍动脉血压检测的硬件系统设计与实现

目的:设计基于PWTT技术的无创逐拍动脉血压检测的硬件系统.方法:通过采集袖带压力、震荡波、柯氏音等信号,构建基于柯氏音法的单次血压测量系统;通过采集心电、心音、脉搏波、阻抗等多路生理信号,构建PWTT检测.该系统还通过线性放气、同步采集与校正等功能,进一步提高系统性能.结果:各路信号的采样率达到1000点/s,幅值分辨率为12位,时间分辨率为1 ms.单次血压测量系统的放气速率为:2～3 mmHg/s.可以实现单次血压和PWTT的同步采集与校正.结论:间歇式血压测量系统和PWTT逐拍检测系统.两个系统可同时工作,实现收缩压时刻或舒张压时刻同一心动周期内的血压和PWTT的实时校正;确保了逐拍动脉血压测量的准确性.基于该系统,我们将开展检测逐拍动脉血压的深入研究.     

卡托普利对高血压病患者内皮功能和非对称二甲基精氨酸的影响

目的 观察高血压病患者服用卡托普利后肱动脉内皮功能和血浆ADMA的变化.方法 入选35例高血压病患者口服卡托普利25 mg 3次/d,随访3月(高血压组),同时选择32例健康成人作为对照组,观察对照组和高血压病患者治疗前后肱动脉基础内径、充血后内径的变化以及采用HPLC法检测血浆非对称二甲基精氨酸(ADMA)的变化,并观察患者血压变化和药物的不良反应.结果 高血压病患者血压较对照组明显升高(P＜0.05).同对照组相比,高血压病患者肱动脉血流介导的血管舒张功能(FDM)显著降低(5.84±4.72 vs 12.7±3.47%,P＜0.05),血浆ADMA水平显著增加(0.87±0.35vs 0.58±0.36μmol/L,P＜0.05).经卡托普利治疗3月后,高血压病患者的血压下降,肱动脉FDM好转(9.75±3.28 vs 5.84±4.72%,P＜0.01),血浆ADMA水平降低(0.65±0.31 vs 0.87±0.35,μmol/L,P＜0.01).结论 卡托普利不仅可降低高血压病患者血压,同时可显著改善患者的内皮功能.     

Intertester reliability of brachial artery flow-mediated vasodilation using upper and lower arm occlusion in healthy subjects

The assessment of endothelial function as brachial artery flow-mediated vasodilatation is a widely used technique that determines the effect of risk factor intervention and may have the potential to predict the clinical benefit of antiatherogenic therapy. Previous studies suggest that flow-mediated dilation is greater using the upper-arm occlusion technique, but no data are available to compare intertester reliability between technicians. This study was undertaken to compare the amount of hyperemia between upper and lower occlusion techniques and to determine reproducibility between testers. Nineteen healthy adults, ages 25 to 50, were included in the study. Brachial artery vasodilatation was measured 1 and 3 minutes post cuff deflation and was compared with the baseline and expressed as a percent change. There was a tester effect in the percent change in diameter across all measurements. The results of this study reveal inconsistencies between testers when using a blood pressure cuff to induce hyperemia for the assessment of endothelial function through brachial artery flow-mediated vasodilation. However, upper arm as compared to lower arm blood pressure cuff occlusion results in significantly greater hyperemia and vasodilatation, even though there was a difference in measurements between testers.     

Blood pressure, physical activity and anthropometry in adolescents]

The relationship of blood pressure with physical activity and anthropometry was studied in 295 adolescents (mean age, 15.3 years) who entered 1. "formación profesional" (a technological training) in 1990 in Puerto Real, a village of Cádiz, Spain. Systolic and diastolic (fifth-phase Korotkoff) blood pressure, and anthropometrics measurements (weight, height and triceps and subscapular skinfolds thickness) were measured with standardized techniques. Habitual and sports physical activity were assessed by a self-reported questionnaire. The results reported in this study suggest that systolic blood pressure is associated with habitual physical activity in girls, and that the systolic blood pressure is associated weakly with sports activity in girls and in boys. The stronger predictor of blood pressure was Quetelet Index (kg/m2).     

Exposure to glyceryl trinitrate during gun powder production: plasma glyceryl trinitrate concentration, elimination kinetics, and discomfort among production workers.

Plasma glyceryl trinitrate (GTN) concentration was studied in 12 volunteers producing gun powder. Serial blood samples were obtained from the cubital vein before and during work at two sites of production; high concentrations of GTN were detected in the plasma. Control specimens from a femoral vein contained much less GTN, indicating that blood in the cubital vein was enriched by dermally absorbed GTN. In the roll mill area concentrations of GTN in the cubital vein were higher than in the press area, but individual factors were also important since some workers consistently had higher concentration of GTN than others. Differences in absorption were more important than differences in the metabolism of GTN since only a small variation in disappearance rate was found after a sublingual test dose of GTN. Moderate changes in pulse rate and blood pressure were noted during the day. The major discomfort experienced was a headache that increased during working hours, but this was not significantly related to GTN concentrations in the air or in the blood from the cubital vein. The observations imply that major efforts should be made to reduce dermal contact with GTN during production work.     

Exposure to glyceryl trinitrate during gun powder production: plasma glyceryl trinitrate concentration, elimination kinetics, and discomfort among production workers

Plasma glyceryl trinitrate (GTN) concentration was studied in 12 volunteers producing gun powder. Serial blood samples were obtained from the cubital vein before and during work at two sites of production; high concentrations of GTN were detected in the plasma. Control specimens from a femoral vein contained much less GTN, indicating that blood in the cubital vein was enriched by dermally absorbed GTN. In the roll mill area concentrations of GTN in the cubital vein were higher than in the press area, but individual factors were also important since some workers consistently had higher concentration of GTN than others. Differences in absorption were more important than differences in the metabolism of GTN since only a small variation in disappearance rate was found after a sublingual test dose of GTN. Moderate changes in pulse rate and blood pressure were noted during the day. The major discomfort experienced was a headache that increased during working hours, but this was not significantly related to GTN concentrations in the air or in the blood from the cubital vein. The observations imply that major efforts should be made to reduce dermal contact with GTN during production work.     

The Dinamap 1846SX automated blood pressure recorder: comparison with the Hawksley random zero sphygmomanometer under field conditions.

STUDY OBJECTIVE--The aim was to compare the performance of the Dinamap 1846SX automated oscillometric blood pressure recorder with that of the Hawksley random zero sphygmomanometer during use under field study conditions. DESIGN--Two independent within subject measurement comparisons were made, one in adults and one in children, each conducted in three stages over several months while the Dinamap instruments were being used in epidemiological field surveys. SETTING--The studies were done in outpatients clinics (adults) and primary schools (children). PARTICIPANTS--141 adults (20-85 years) and 152 children (5-7 years) took part. MEASUREMENTS AND MAIN RESULTS--In adults a pair of measurements was made with each instrument, the order alternating for consecutive subjects. In children one measurements was made with each instrument, in random order. Measurements with the Dinamap 1846SX were higher than those with the random zero sphygmomanometer both in adults (mean difference 8.1 mm Hg; 95% CI 6.5 to 9.7 mm Hg) and in children (mean difference 8.3 mm Hg; 95% CI 6.9 to 9.7 mm Hg). Diastolic measurements were on average very similar both in adults and in children. The results were consistent at all three stages of both studies. The differences in systolic measurement were independent of blood pressure level. However, the extent of agreement in diastolic pressure depended on the diastolic blood pressure level; in both studies Dinamap diastolic measurements were higher at low diastolic pressures while random zero diastolic measurements were higher at high diastolic pressures. CONCLUSIONS--Systolic measurements made with the Dinamap 1846SX instrument are not directly comparable with those of the Hawksley random zero sphygmomanometer and are unlikely to be comparable with those of earlier Dinamap models. These differences have important implications for clinical practice and for comparisons of blood pressure measurement between epidemiological studies. However, the consistency of measurement by the Dinamap 1846SX over time suggests that the instrument may have a place in standardised blood pressure measurement in the research setting.     

有高血压家族史血压正常的青少年血管内皮功能改变

目的分析有高血压家族史但血压正常的青少年肱动脉内皮功能和血管活性物质的变化。方法对30例有高血压家族史、本人血压正常的青少年（家族史阳性组）和30例无高血压家族史、血压正常青少年（对照组）,以高分辨率超声测定肱动脉血流介导内皮依赖性舒张功能（FMD）,测量身高、体重、体质指数（BMI）、血压、血总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）和一氧化氮（NO）、血浆内皮素（ET-1）。结果与健康对照组相比,家族史阳性但血压正常的青少年的FMD和NO降低（P〈0．05）,ET-1虽升高但两组差异无统计学意义。结论有高血压家族史的青少年即使在血压正常时,已发生内皮依赖性舒张功能降低、血清NO水平下降。     

Comparison of the conical cuff and the standard rectangular cuffs

In this study the applicability of the conical cuff in the measurement of arterial blood pressure in the general population was investigated. A wide range of arm circumferences was used for non-invasive comparative measurements of brachial artery pressures, using the standard rectangular sphygmomanometer cuffs and a recently developed conical cuff. In previous studies the conical cuff proved to reflect arterial blood pressure more accurately in obese patients than the standard rectangular cuffs. With the conical cuff lower systolic and diastolic pressure readings were obtained than with the rectangular cuffs and this proved to be independent of arm circumference. The lower pressure results in obese individuals were probably related to the fact that the conical cuff generally was found to fit better on larger upper arms than the large rectangular cuff. We conclude that in all likelihood blood pressure is more accurately measured in obese people with the use of a conical cuff and therefore warrants further investigation.