Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis.

BACKGROUND: Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU). METHODS: We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration's Revman 5.3 software. RESULTS: A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU. CONCLUSION: This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.

Recommendation to Use Wearable-Based mHealth in Closed-Loop Management of Acute Cardiovascular Disease Patients During the COVID-19 Pandemic.

Because of the rapid and serious nature of acute cardiovascular disease (CVD) especially ST segment elevation myocardial infarction (STEMI), a leading cause of death worldwide, prompt diagnosis and treatment is of crucial importance to reduce both mortality and morbidity. During a pandemic such as coronavirus disease-2019 (COVID-19), it is critical to balance cardiovascular emergencies with infectious risk. In this work, we recommend using wearable device based mobile health (mHealth) as an early screening and real-time monitoring tool to address this balance and facilitate remote monitoring to tackle this unprecedented challenge. This recommendation may help to improve the efficiency and effectiveness of acute CVD patient management while reducing infection risk.

Daily self-care practices influence exit-site condition in patients having peritoneal dialysis: A multicenter cross-sectional survey.

AIMS: To investigate practice patterns in exit-site care and identify the risk factors for exit-site infection. DESIGN: A quantitative cross-sectional design. METHODS: Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit-site care practice patterns and exit-site status of patients receiving PD were assessed through interviews and questionnaires. RESULTS/FINDINGS: Most of the 1,204 patients adhered with the protocols about main aspects of exit-site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty-four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter-related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES. CONCLUSIONS: The adherence levels on different aspects of exit-site care were varied in patients having PD. Their self-care behaviours did correlate with the exit-site status. IMPACT: The adherence level of patients' exit-site care practice needs attention of medical staff. Further studies about the optimal procedure in exit-site care were warranted.

Multi-Wavelength Photoplethysmography Enabling Continuous Blood Pressure Measurement With Compact Wearable Electronics.

OBJECTIVE: To fight the "silent killer" hypertension, continuous blood pressure (BP) monitoring has been one of the most desired functions in wearable electronics. However, current BP measuring principles and protocols either involve a vessel occlusion process with a cuff or require multiple sensing nodes on the body, which makes it difficult to implement them in compact wearable electronics like smartwatches and wristbands with long-term wearability. METHODS: In this work, we proposed a highly compact multi-wavelength photoplethysmography (MWPPG) module and a depth-resolved MWPPG approach for continuous monitoring of BP and systemic vascular resistance (SVR). By associating the wavelength-dependent light penetration depth in the skin with skin vasculatures, our method exploited the pulse transit time (PTT) on skin arterioles for tracking SVR (n = 20). Then, we developed an arteriolar PTT-based method for beat-to-beat BP measurement. The BP estimation accuracy of the proposed arteriolar PTT method was validated against Finometer (n = 20) and the arterial line (n = 4). RESULTS: The correlation between arteriolar PTT and SVR was theoretically deduced and experimentally validated on 20 human subjects performing various maneuvers. The proposed arteriolar PTT-based method outperformed the traditional arterial PTT-based method with better BP estimation accuracy and simpler measurement setup, i.e., with a single sensing node. CONCLUSION: The proposed depth-resolved MWPPG method can provide accurate measurements of SVR and BP, which are traditionally difficult to measure in a noninvasive or continuous fashion. SIGNIFICANCE: This MWPPG work provides the wearable healthcare electronics of compact size with a low-cost and physiology-based solution for continuous measurement of BP and SVR.

A Novel Continuous Blood Pressure Estimation Approach Based on Data Mining Techniques.

Continuous blood pressure (BP) estimation using pulse transit time (PTT) is a promising method for unobtrusive BP measurement. However, the accuracy of this approach must be improved for it to be viable for a wide range of applications. This study proposes a novel continuous BP estimation approach that combines data mining techniques with a traditional mechanism-driven model. First, 14 features derived from simultaneous electrocardiogram and photoplethysmogram signals were extracted for beat-to-beat BP estimation. A genetic algorithm-based feature selection method was then used to select BP indicators for each subject. Multivariate linear regression and support vector regression were employed to develop the BP model. The accuracy and robustness of the proposed approach were validated for static, dynamic, and follow-up performance. Experimental results based on 73 subjects showed that the proposed approach exhibited excellent accuracy in static BP estimation, with a correlation coefficient and mean error of 0.852 and -0.001 ± 3.102 mmHg for systolic BP, and 0.790 and -0.004 ± 2.199 mmHg for diastolic BP. Similar performance was observed for dynamic BP estimation. The robustness results indicated that the estimation accuracy was lower by a certain degree one day after model construction but was relatively stable from one day to six months after construction. The proposed approach is superior to the state-of-the-art PTT-based model for an approximately 2-mmHg reduction in the standard derivation at different time intervals, thus providing potentially novel insights for cuffless BP estimation.

Multi-wavelength photoplethysmography method for skin arterial pulse extraction.

In this work, we present a multi-wavelength (MW) PPG method exploiting the wavelength dependence of light penetration in skin tissue to provide depth resolution of skin blood pulsation. The MW PPG system requires two to three light sources in different wavelengths and extracts the arterial blood pulsation through a multi-wavelength multi-layer light-skin interaction model, which removes the capillary pulsation (determined from the short-wavelength PPG signal) from the long-wavelength PPG signal using absorption weighting factors that are quasi-analytically calibrated. The extracted pulsations are used to calculate blood pressure (BP) through pulse transit time (PTT), and the results are compared with those obtained from the single wavelength PPG method. The comparative study is clinically performed on 20 subjects including 10 patients diagnosed with cardiovascular diseases and 10 healthy subjects. The result demonstrates that the MW PPG method significantly improves the measurement accuracy of systolic BP (SBP), reducing the mean absolute difference between the reference and the estimated SBP values from 5.7 mmHg (for single-wavelength PPG) to 2.9 mmHg (for three-wavelength PPG).

Continuous Blood Pressure Measurement From Invasive to Unobtrusive: Celebration of 200th Birth Anniversary of Carl Ludwig.

The year 2016 marks the 200th birth anniversary of Carl Friedrich Wilhelm Ludwig (1816-1895). As one of the most remarkable scientists, Ludwig invented the kymograph, which for the first time enabled the recording of continuous blood pressure (BP), opening the door to the modern study of physiology. Almost a century later, intraarterial BP monitoring through an arterial line has been used clinically. Subsequently, arterial tonometry and volume clamp method were developed and applied in continuous BP measurement in a noninvasive way. In the last two decades, additional efforts have been made to transform the method of unobtrusive continuous BP monitoring without the use of a cuff. This review summarizes the key milestones in continuous BP measurement; that is, kymograph, intraarterial BP monitoring, arterial tonometry, volume clamp method, and cuffless BP technologies. Our emphasis is on recent studies of unobtrusive BP measurements as well as on challenges and future directions.

Continuous Cuffless Blood Pressure Estimation Using Pulse Transit Time and Photoplethysmogram Intensity Ratio.

Pulse transit time (PTT) has attracted much interest for cuffless blood pressure (BP) measurement. However, its limited accuracy is one of the main problems preventing its widespread acceptance. Arterial BP oscillates mainly at high frequency (HF) because of respiratory activity, and at low frequency (LF) because of vasomotor tone. Prior studies suggested that PTT can track BP variation in HF range, but was inadequate to follow the LF variation, which is probably the main reason for its unsatisfactory accuracy. This paper presents a new indicator, the photoplethysmogram intensity ratio (PIR), which can be affected by changes in the arterial diameter, and, thus, trace the LF variation of BP. Spectral analysis of BP, PTT, PIR, and respiratory signal confirmed that PTT was related to BP in HF at the respiratory frequency, while PIR was associated with BP in LF range. We, therefore, develop a novel BP estimation algorithm by using both PTT and PIR. The proposed algorithm was validated on 27 healthy subjects with continuous Finapres BP as reference. The results showed that the mean ± standard deviation (SD) for the estimated systolic, diastolic, and mean BP with the proposed method against reference were -0.37 ±5.21, -0.08 ±4.06, -0.18 ±4.13 mmHg, and mean absolute difference (MAD) were 4.09, 3.18, 3.18 mmHg, respectively. Furthermore, the proposed method outperformed the two most cited PTT algorithms for about 2 mmHg in SD and MAD. These results demonstrated that the proposed BP model using PIR and PTT can estimate continuous BP with improved accuracy.

Photoplethysmogram intensity ratio: A potential indicator for improving the accuracy of PTT-based cuffless blood pressure estimation.

The most commonly used method for cuffless blood pressure (BP) measurement is using pulse transit time (PTT), which is based on Moens-Korteweg (M-K) equation underlying the assumption that arterial geometries such as the arterial diameter keep unchanged. However, the arterial diameter is dynamic which varies over the cardiac cycle, and it is regulated through the contraction or relaxation of the vascular smooth muscle innervated primarily by the sympathetic nervous system. This may be one of the main reasons that impair the BP estimation accuracy. In this paper, we propose a novel indicator, the photoplethysmogram (PPG) intensity ratio (PIR), to evaluate the arterial diameter change. The deep breathing (DB) maneuver and Valsalva maneuver (VM) were performed on five healthy subjects for assessing parasympathetic and sympathetic nervous activities, respectively. Heart rate (HR), PTT, PIR and BP were measured from the simultaneously recorded electrocardiogram (ECG), PPG, and continuous BP. It was found that PIR increased significantly from inspiration to expiration during DB, whilst BP dipped correspondingly. Nevertheless, PIR changed positively with BP during VM. In addition, the spectral analysis revealed that the dominant frequency component of PIR, HR and SBP, shifted significantly from high frequency (HF) to low frequency (LF), but not obvious in that of PTT. These results demonstrated that PIR can be potentially used to evaluate the smooth muscle tone which modulates arterial BP in the LF range. The PTT-based BP measurement that take into account the PIR could therefore improve its estimation accuracy.

Effects of cuff inflation and deflation on pulse transit time measured from ECG and multi-wavelength PPG.

Pulse transit time (PTT), which refers to the time it takes a pulse wave to travel between two arterial sites is a promising index for cuff-less blood pressure (BP) estimation, as well as non-invasive assessment of arterial functions. However, it has not been investigated whether PTTs measured from ECG and different wavelength PPG are equally affected by the arterial status. Furthermore, comparison between the changes of different PTTs can provide enlightenment on the hardware implementation of the PTT-based BP estimation method. This work mainly studied the changes of PTTs calculated from electrocardiogram (ECG) and multi-wavelength photoplethysmogram (PPG) after exerting cuff pressure on the upper arm. A four-channel PPG acquisition system was developed to collect the multi-wavelength PPG signals of red, yellow, green and blue light at the fingertip simultaneously. Ten subjects participated in the experiment and their PTTs measured from different PPG and ECG signals before and after exerting cuff pressure were compared. This study found that within one minute after the four-minute cuff inflation and deflation process, the PTT measured from ECG and yellow PPG experienced a significant increase (p<;0.05) while the PTT from ECG and blue PPG had no statistical difference (p>0.9) compared with that before exerting cuff pressure. This indicates that PTTs calculated from different wavelength PPG have different recoverability from smooth muscle relaxation. Another interesting finding is that the PTT calculated from ECG and yellow PPG had a strong correlation (|r|>0.7) with the time difference between yellow PPG and other PPG signals, which implies the potential of the time difference between yellow PPG and other PPGs as a complementary to PTT-based model for blood pressure estimation.

Unobtrusive sensing and wearable devices for health informatics.

The aging population, prevalence of chronic diseases, and outbreaks of infectious diseases are some of the major challenges of our present-day society. To address these unmet healthcare needs, especially for the early prediction and treatment of major diseases, health informatics, which deals with the acquisition, transmission, processing, storage, retrieval, and use of health information, has emerged as an active area of interdisciplinary research. In particular, acquisition of health-related information by unobtrusive sensing and wearable technologies is considered as a cornerstone in health informatics. Sensors can be weaved or integrated into clothing, accessories, and the living environment, such that health information can be acquired seamlessly and pervasively in daily living. Sensors can even be designed as stick-on electronic tattoos or directly printed onto human skin to enable long-term health monitoring. This paper aims to provide an overview of four emerging unobtrusive and wearable technologies, which are essential to the realization of pervasive health information acquisition, including: (1) unobtrusive sensing methods, (2) smart textile technology, (3) flexible-stretchable-printable electronics, and (4) sensor fusion, and then to identify some future directions of research.

Serum low-density lipoprotein and heart rate related to the effectiveness in the treatment of angina pectoris with two similar Chinese medicine herbal formulae.

OBJECTIVE: To explore the effectiveness related indicators which might help identify the indications of Tongxinluo Capsule () and Kangxin Capsule () targeting on qi deficiency and blood stasis pattern in Chinese medicine (CM) in the treatment of angina pectoris. METHODS: The data from a multicenter, randomized and double-blinded study conducted at 5 centers in China were obtained for the analysis. A total of 239 patients with angina pectoris and CM syndrome of qi deficiency and blood stasis were randomly assigned in a 1:1 ratio to Tongxinluo Capsule group (119 cases) and Kangxin Capsule group (120 cases). Angina effectiveness and electrocardiogram (ECG) improvement were selected as the therapeutic outcomes. RESULTS: After a 4-week treatment, the effective rates of Tongxinluo Capsule and Kangxin Capsule were 43.70% and 25.00%, respectively (P <0.05). Serum low-density lipoprotein (LDL) level was found to influence the effectiveness of Tongxinluo Capsule which had higher effective rate in the patients with lower level of LDL. Heart rate was found to influence the effectiveness in the patients treated with Kangxin Capsule which had higher effective rate in the patients with heart rate [Symbol: see text]80 beats/min. CONCLUSION: LDL level and heart rate were the indicators which help indentify the indications of Tongxinluo Capsule and Kangxin Capsule, respectively, in the treatment of angina pectoris with CM syndrome of qi deficiency and blood stasis.

Methodology of pharmacodynamic evaluation on Chinese herbal medicine based on syndrome differentiation.

The clinical application of Chinese herbal medicine should be based on syndrome differentiation in traditional Chinese medicine (TCM), and the pharmacological evaluation of herbal medicine in new drug discovery should be also based on the TCM syndrome differentiation. To clarify the Chinese herbal characteristics and mechanisms of action through pharmacological experiments is not only the inevitable requirement for Chinese herb modernization and internationalization, but also the key way to direct the clinical rational administration. Thus how to characterize the syndrome type in commonly used animal disease models becomes the key issue in pharmacological evaluation. Following the development of biomedicine, one important way to clarify the syndrome characteristics of animal disease model in the pharmacological evaluation is to compare the differences between the responsive and non-responsive animals, and to find out the responsiveness-related biocharacteristics. An important approach to set up the Chinese herbal pharmacological evaluation which is suitable for Chinese medicine differentiation is to utilize the method of surveying syndrome type with Chinese herb formula and select the responsive animal model to reflect certain syndrome type, and furthermore to clear up the syndrome characteristics of the animal model by investigating its modern biological basis and establishing the correct indications of special TCM syndrome type. This pharmacological evaluation way based on finding out the responsiveness-related biocharacteristics of herbal medicine could become more effective in evaluating drug effects, further improving the new drug discovery, and developing Chinese herbal medicine.

Effects of acupuncture on expressions of the transcription factors NF-E2, YB-1, LRG47 in the SAMP10 mice.

OBJECTIVE: To explore the mechanism of acupuncture for delaying aging. METHODS: Using the senescence accelerated mouse pattern SAMP10 and the normal aging mice SAMR1 as models and applying RT-PCR and digoxin (DIG)-labeled Northern blot technique to observe expressions of NF-E2, YB-1, LRG47 genes in the forebrain, cortex and hippocampus in a 8-month old SAMR1 control group, a 8-month old SAMP10 control group, a 8-month old SAMP10 acupuncture group and a 8-month old SAMP10 non-point stimulation group. RESULTS: In the SAMP10 control group, the expressions of NF-E2, YB-1 and LRG47 were down-regulated in the forebrain, cortex and hippocampus, and after acupuncture they were up-regulated and tended to normal. CONCLUSION: The brain aging of the SAMP10 mice is related with abnormal expressions of NF-E2, YB-1 and LRG47 genes; and acupuncture can regulate the expressions of NF-E2, YB-1 and LRG47 genes, strengthening the functions of erythrocyte series, increasing the proliferation of cells and enhancing the cellular immune function in anti-bacteria, hence delaying aging.

Current situation and progress in integrative medicine in China.

In the past 50 years, integration of traditional Chinese medicine and Western medicine, known as the Chinese version of integrative medicine (IM), has achieved significant developments. In this article, the present situation and progress in IM development in China are summarized from the aspects of IM application, policy making, scientific research, education, academic exchanges, and its future development. With continuous support from the Chinese government and successful scientific achievements in the past 50 years, the authors believe that IM will be moving forwards to a full globalization.

[Effects of acupuncture on expressions of transcription factors NF-E2, YB-1, LRG47 in the SAMP10 mouse].

OBJECTIVE: To explore the mechanism of acupuncture in delaying aging. METHODS: Using SAMP10 mice and normal control SAMR1 as model and applying RT-PCR and DIG probed Northern blot techniques to observe expression of NF-E2, YB-1, LRG47 genes in whole brain, cortex and hippocampus in the 8-month SAMR1 control group, 8-month SAMP10 control group, 8-month SAMP10 acupuncture group and 8-month SAMP10 non-point acupuncture group. RESULTS: In the SAMP10 control group, the expression of NF-E2, YB-1 and LRG47 were down-regulated in the whole brain, cortex and hippocampus, and after acupuncture they were up-regulated and tended to normal. CONCLUSION: Aging of the SAMP10 mouse brain is related with expression of NF-E2, YB-1 and LRG47 genes, and acupuncture can regulate the expression of NF-E2, YB-1 and LRG47 genes, improving the functions of erythrocyte series, increasing proliferation of cells and immune function of cells in anti-bacteria, hence anti-aging.

[Study on expression of brain aging-relative genes HSP86 and HSP84 and effects of acupuncture in the SAMP10 mouse].

OBJECTIVE: To probe the mechanism of acupuncture for anti-aging. METHODS: In the senescence accelerated mouse the SAMP10 and the SAMR1, by using RT-PCR and DIG-labeled Northern blot technique, the expression differences of HSP84 and HSP86 genes in whole brain, cortex and hippocampus in the 4 groups,8-month SAMR1 control group, 8-month SAMP10 control group, 8-month SAMP10 acupuncture group and 8-month SAMP10 non-point acupuncture group were investigated. RESULTS: In the SAMP10 control group, the expression of HSP84 and HSP86 were down-regulated in the whole brain, the cortex and the hippocampus, and they were up-regulated after acupuncture, tending to the normal group. CONCLUSION: Brain aging of the SAMP10 mouse is related with abnormal expression of HSP84 and HSP86 genes, and acupuncture can strengthen the protection of cells, inhibit apoptosis and anti-oxidative stress through regulating expression of HSP84 and HSP86, hence anti-aging.