Intelligent Wearable Wrist Pulse Detection System Based on Piezoelectric Sensor Array.

The human radial artery pulse carries a rich array of biomedical information. Accurate detection of pulse signal waveform and the identification of the corresponding pulse condition are helpful in understanding the health status of the human body. In the process of pulse detection, there are some problems, such as inaccurate location of radial artery key points, poor signal noise reduction effect and low accuracy of pulse recognition. In this system, the pulse signal waveform is collected by the main control circuit and the new piezoelectric sensor array combined with the wearable wristband, creating the hardware circuit. The key points of radial artery are located by an adaptive pulse finding algorithm. The pulse signal is denoised by wavelet transform, iterative sliding window and prediction reconstruction algorithm. The slippery pulse and the normal pulse are recognized by feature extraction and classification algorithm, so as to analyze the health status of the human body. The system has accurate pulse positioning, good noise reduction effect, and the accuracy of intelligent analysis is up to 98.4%, which can meet the needs of family health care.

Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands.

BACKGROUND: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. METHODS: Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. RESULTS: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function. CONCLUSIONS: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

Pisat's Visual Vasopressor Injection Needle: An Innovative Tool for Increasing Patient Safety in Laparoscopic Myomectomy.

INTRODUCTION: The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intramyometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution. AIMS AND OBJECTIVES: To describe a new design of an injection needle. Pisat's visual vasopressor injection needle (VVIN) can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution. RESULTS: A total of 53 patients who underwent laparoscopic myomectomy at various hospitals in Mumbai, India were studied over a period of two years. Out of these, 23 patients were operated upon using a standard 5 mm laparoscopic injection needle, and 30 patients were operated on by using a VVIN. Out of the 23 patients in whom a regular needle was used, four patients (17.39%) demonstrated a significant (over 20% of pre-injection value), but transient, elevation in pulse and blood pressure readings at one minute post injection. This gradually returned to baseline at 10 minutes after the injection. None of the 30 patients in whom VVIN was used after confirming a negative aspiration demonstrated any significant change in post-injection pulse or blood pressure recordings. CONCLUSIONS: Using a VVIN during a laparoscopic myomectomy enables the surgeon to detect an inadvertent vascular puncture very early, even in a small calibre blood vessel, and with much more sensitivity than a regular needle. This increases patient safety during the intramyometrial injection of a vasoconstrictive agent during myomectomy and reduces the incidence of catastrophic complications.

[A new method to extract time-frequency characteristics of hypertension pathological signal based on pseudo Wigner-Ville distribution].

Hypertension, as one of diseases with the highest incidence in the world at present, is an important cause of stroke, coronary heart disease, renal insufficiency and other serious diseases. Based on pseudo Wigner-Ville distribution, this paper makes an analysis on the relevant pulse characteristics by measuring time range of the energy concentration circle. In view of the present situation, that is, about half of the high-normal blood pressure persons are likely to develop hypertension, we explored the pulse characteristics to find the pathological changes in subjects with prehypertension, in order to solve the problems that there are no obvious clinical significant features in prehypertension. The results showed that the duration of high energy circle in signal with hypertension pathological changes was shorter than the duration of healthy signal. Hence, healthy signal and hypertension pathological signal can be effectively distinguished by this method, and this provides a new basis to identify the lesion signal when blood pressure is in critical period.

Carotid artery examination, an important tool in patient evaluation.

Examination of the arteries is an age old medical tradition. Examination of the carotid artery is of unique importance because it is an easily accessible large artery. Through the methods of inspection, palpation, and auscultation, carotid artery examination gives clinicians important diagnostic clues about the health and disease of the patient. Inspection and palpation of the carotid give insight into left ventricular systolic function and distinguish types of valvular heart disease. Auscultation identifies patients with high-risk atherosclerosis. In most cases carotid examination is neither sensitive nor specific, but in the correct clinical context it offers important evidence leading to specific diagnoses and treatment. In this review, we discuss the examination of the carotid artery under normal conditions and describe how abnormalities in the carotid artery examination are indicators of disease.

Can antihypertensive treatment reverse large-artery stiffening?

In some controlled therapeutic trials for hypertension, a selective reduction of systolic blood pressure has been obtained with long-term treatment. The greatest effects on cardiovascular outcomes stem from a decrease of central blood pressure through a significant reduction of arterial stiffness, wave reflections, or both. Until now, all protocols have used angiotensin II blockade, mainly through angiotensin-converting enzyme inhibition. Cardiovascular outcomes have been significantly improved when compared with controls, but most of them have been treated with beta blockers. Such "de-stiffening" therapies are important to consider and require additional trials.

Cardiovascular assessment in children: assessing pulse and blood pressure.

Cardiovascular assessment is an important nursing skill in the assessment and management of acutely ill children and children with chronic conditions. This article outlines the differences in the cardiovascular systems of infants, children and adults, and explains how to provide circulatory assessment in children, focusing on assessing pulse and blood pressure.

Popliteal artery pseudoaneurysm after arthroscopic cystectomy of a popliteal cyst.

A case of popliteal artery aneurysm after arthroscopic cystectomy of a popliteal cyst is an uncommon complication, and no case has been reported. We present a case of pseudoaneurysm of the popliteal artery after arthroscopic cystectomy of a popliteal cyst 2 months after surgery. Open excision of the pseudoaneurysm and popliteal artery pin-point repair were done. At 30 months' follow-up, both the tibialis posterior and dorsalis pedis pulsations were felt equally on both sides with normal sensations over the limb. Retrospectively reviewing the case, we found that the relation of the popliteal artery and popliteal cyst on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery. It is better not to shave the lateral aspect of the cyst while performing arthroscopic cystectomy when magnetic resonance images show that the popliteal artery is close to the cyst.

[Changes of tongue and pulse parameters in 50 lung cancer patients treated with integrated traditional Chinese and Western medicine].

OBJECTIVE: To observe the changes of tongue and pulse parameters in lung cancer patients after combined treatment with integrated traditional Chinese and Western medicine, and to probe into the application of the tongue and pulse parameters in evaluation of integrated traditional Chinese and Western medicine therapy on lung cancer patients. METHODS: Electropulsograms and tongue pictures of 50 lung cancer patients were examined by TP-I digital electropulsography. The tongue and pulse parameters of the patients, including the indexes of moistness and dryness, thinness and thickness, fissure, swollenness and emaciation, greasiness and likeness of curd, and power spectral ratios (PSRs) 1, 2, 3, 4 and cepstrum spectral ratios (CSRs) 1, 2, 3, 4, were observed after 1-month and 2-month treatment with Yifei Kangliu Oral Liquid (a compound traditional Chinese herbal medicine) plus chemotherapy, respectively. The above parameters of the lung cancer patients were compared before and after the treatment. RESULTS: PSR1 increased, while PSR2 decreased significantly after 1-month and 2-month treatment as compared with before treatment (P < 0.05). PSR1 decreased, while PSR2 increased after 2-month treatment as compared with after 1-month treatment (P < 0.05). PSR4 after 1-month treatment was lower than before treatment (P < 0.05). The tongue parameters including the indexes of moistness and dryness, and greasiness and likeness of curd increased significantly after 1-month and 2-month treatment as compared with before treatment (P < 0.05). The index of thinness and thickness decreased, while the index of fissure increased significantly after 1-month treatment as compared with before treatment (P < 0.05). CONCLUSION: Tongue and pulse parameters can be regarded as one of reference indexes in evaluation of integrated traditional Chinese and Western medicine therapy on lung cancer patients.

[Polidocanol induced cardiotoxicity: a case report and review of the literature]. / Toxicité cardiaque du polidocanol: rapport d'un cas et revue de la littérature.

OBJECTIVE: Polidocanol foam sclerotherapy is a treatment of symptomatic venous disease. This solution is highly valued by clinicians because of its high efficacy and excellent safety profile. Systemic adverse effects are rare. Some life-threatening reactions have been reported. We report a case of respiratory and cardiac arrest, and a literature review on the cardiac toxicity of polidocanol used within and outside their licensed indications. MAIN OUTCOME MEASURES: A 48-year-old woman, with a symptomatic venous disorder, CEAP grade C2, was treated by echosclerotherapy for a great saphenous vein. She developed a malaise and respiratory and cardiac arrest occurred within minutes after a 7 ml foam polidocanol injection. Cardiopulmonary resuscitation was immediately started before restoration of pulses. A literature search was done using the Medline database. RESULTS: Five cases of cardiac toxicity were reported with polidocanol, but four of them were used outside their licensed indications. Because of the very suggestive chronology and the lack of any other obvious etiology, this cardiac arrest was attributed to polidocanol. Initial ST-segment elevation and negativity of anaphylaxis markers suggest a direct myocardial toxicity. CONCLUSIONS: Clinicians should be aware of the possibility of little-known but potentially serious cardiac adverse reaction with polidacanol injection and be prepared to initiate cardiopulmonary resuscitation if needed.

Effectiveness of a multicenter training programme to teach point-of-care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes.

BACKGROUND: The primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD-scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes. METHODS: Five podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1-day), supervised scanning (5-weeks), independent scanning (3-weeks) and a final evaluation of performance (1-day).Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD-scan assessment) were assessed for every supervised scan and again for the final evaluation of performance. RESULTS: A total of 90 PAD-scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9-25.5) vs 9.3 min (IQR 7.3-10.5);p = 0.028) and DUOSATS scores (17.5 (IQR 16.8-21) vs 25 (IQR 24-25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3-5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist. CONCLUSION: A structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD-scan.

An observational study: The utility of perfusion index as a discharge criterion for pain assessment in the postanesthesia care unit.

Acute post-operative pain can remain untreated if patients cannot express themselves. The perfusion index (PI) may decrease when pain activates sympathetic tone and may increase after analgesics are administered. We evaluated if the perfusion index is a feasible indicator for objectively assessing pain relief in the postanesthesia care unit (PACU) and calculated the changes in PI measurements at the time of discharge from the PACU relative to baseline PI measurements to examine if the PI is a useful criterion for discharging patients from the postanesthesia care unit. This retrospective observational study enrolled female patients who were admitted for gynecological or general surgery. The patients received general anesthesia and were admitted to the postanesthesia care unit. The PI, visual analogue scale (VAS) score, heart rate, and blood pressure were recorded before and after administration of intravenous morphine. Changes in these parameters before and after analgesics were administered and the difference of these parameters between age and BMI subgroups were compared. The correlation between the PI and VAS score, ΔPI and ΔVAS, and %ΔPI and %ΔVAS were also evaluated. The percentage change in ΔPI (P9-T0/T0) of the patients at the time of discharge from the postanesthesia care unit relative to baseline PI measurements was calculated. Eighty patients were enrolled, and there were 123 instances during which analgesia was required. Heart rate, PI, and VAS score were significantly different before and after analgesics were administered (p < 0.0001). The difference of parameters between age and BMI subgroups were not significant. The correlation between the PI and VAS score, ΔPI and ΔVAS, and the percentage change in ΔPI and ΔVAS showed weak correlations in age, BMI subgroups, and all measurements. The baseline PI and the PI when arriving at and when being discharged from the postanesthesia care unit were significantly different (p < 0.01). The mean percentage change in Δ PI at the time of discharge from the PACU was 66.2%, and the 99% confidence interval was 12.2%~120.3%. The perfusion index was increased, and the VAS score was decreased significantly after analgesics were administered, but the correlation was weak in each subgroup. The VAS score is a subjective and psychometric parameter. The PI increased when partial pain relief was achieved after morphine was administered but did not reflect pain intensity or changes in the VAS score regardless of age or BMI. A percentage change in ΔPI at the time of discharge from the PACU relative to baseline PI measurements of greater than 12% can be used as a supplemental objective discharge criterion for pain assessment in the postanesthesia care unit.

Pandimensional field pattern changes in healers and healees: experiencing therapeutic touch.

Rogers's Science of Unitary Human Beings framed this study of pandimensional pattern changes in healers and healees paired for an 8-week series of Therapeutic Touch (TT) sessions. Comparison of healee patterns before and after 141 TT sessions supported the hypotheses that healees would manifest decreased pulse and blood pressure, and reduced pain and stress (p < .05). Duration of TT sessions was not preset but determined by healers according to energy cues. TT time was not related to pattern changes, consistent with the clinical practice of TT and the atemporal nature of Rogers's conceptual framework. Healers and healees showed parallel changes after the TT series. Participants manifested greater spirituality (p <.05). Although increases in three of the four dimensions of power were significant (p <.05), changes in power measured as a whole were not. Contrary to expectations, manifestations of diversity were decreased in healers and healees.

When your patient clicks: a loud clicking sound as a key sign to the diagnosis.

A 19-year-old male patient was referred by his general practitioner with a new 'cardiac murmur'. For 1 week, he had been able to provoke a clicking sound, which was in time with his heart beat and originated from his chest. The physical examination and laboratory tests were normal. The sound was initially interpreted as most likely due to a valve condition such as mitral valve prolapse, but a transthoracic echocardiogram was normal. A cardiac CT was obtained, which showed left-sided ventral pneumothorax.The Hamman's sign is a loud precordial pulse synchronous sound, which is often postural. It is pathognomonic for left-sided pneumothorax or pneumomediastinum. Hamman's sign as a presenting symptom is rare, but if present is key to diagnosis. The awareness of rare clinical findings is important and will prevent unnecessary diagnostic tests.

Effect of CPAP on brachial-ankle pulse wave velocity in patients with OSAHS: an open-labelled study.

Pulse wave velocity (PWV) is a good indicator of arterial stiffness and an important predictor of cardiovascular events. Recent studies have revealed that PWV increases in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and it also correlates with its severity. However, the therapeutic effect of continuous positive airway pressure (CPAP) on PWV remains undetermined. To clarify this point, we started CPAP treatment on 17 OSAHS patients. Brachial-ankle PWV was measured before starting CPAP, and at 2 months and 4 months after the start of CPAP. Before the CPAP treatment, mean brachial-ankle PWV of the patients was 15.6+/-0.6 m/s, and mean Epworth sleepiness scale (ESS) score was 8.6+/-1.0. Brachial-ankle PWV was found to positively correlate with heart rate, systolic and diastolic blood pressures, mean blood pressure, and arousal index. During the study period, the CPAP treatment did not have a significant effect on heart rate, blood pressures and serum total cholesterol levels. However, it significantly improved ESS score at 4 months after the start of CPAP (P=0.001), while it effectively decreased brachial-ankle PWV at 2 months and at 4 months after the start of CPAP (P=0.010 and P=0.027, respectively). The CPAP treatment was shown to decrease brachial-ankle PWV without affecting blood pressures in OSAHS patients. Although the precise mechanism for this effect is unclear, our finding suggests a close relationship between OSAHS and arterial stiffness, while also reemphasizing the clinical importance of CPAP treatment.

A non-operative survival case of an 84-year-old patient with type A acute aortic dissection complicated by pulseless tamponade.

An 84-year-old woman was hospitalized in hemodynamic shock due to type A acute aortic dissection (AAD) complicated by pulseless tamponade. She was treated conservatively as her family refused emergency surgery. In spite of warning her family that lack of intervention may possibly lead to an early death, she gradually improved and went home without any further problems. Emergency surgery for octogenarians remains controversial, however. We report the first surviving, non-operative case of an octogenarian with pulseless shock due to aortic dissection.

Pulsed radiofrequency of lumbar nerve roots for treatment of chronic inguinal herniorraphy pain.

BACKGROUND: Inguinal hernia repairs are commonly performed and although not seen in a majority of patients, chronic inguinal pain can be a debilitating state resulting after inguinal hernia repairs. Treatment options exist, including pharmacological and surgical management, but with associated risks and side effects. METHODS: In this case series report, five patients with chronic inguinal pain were selected. After initial positive response to T12, L1 and L2 nerve root blocks, pulse radiofrequency (PRF) was performed. RESULTS: All patients reported 75% to 100% pain relief lasting from six to nine months. DISCUSSION: Several hypotheses have been proposed, including selective delta and c-nerve fiber destruction, upregulation of intermediate early gene expression (IEG) and increase in c-fos protein that modulated pain transmission. CONCLUSION: The mechanism of action of pulsed radiofrequency remains unclear. This case study demonstrates the effectiveness of minimally invasive neurodestruction of T12, L1 and L2 nerve roots utilizing Pulse Radiofrequency fields.