Determining factors of pulse oximetry accuracy: A literature review.

OBJECTIVE: Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry. METHODS: We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results. RESULTS: 23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO2, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal. CONCLUSIONS: The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO2, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.

Análisis de la fotopletismografía para determinación de variaciones en el tono vascular y la presión arterial: Estudio basado en redes neuronales / Photoplethys mography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks

Antecedentes y objetivo: El propósito del presente estudio fue evaluar si una red neuronal superficial (RN-S) puede detectar y clasificar los cambios en la presión arterial (PA), dependientes del tono vascular mediante un análisis del contorno de la onda de fotopletismografía (FPG). Material y métodos: Las señales de FPG y PA invasivas fueron simultáneamente registradas en 26 pacientes programados para cirugía general. Se estudió la aparición de episodios de hipertensión (presión arterial sistólica (PAS) > 140 mmHg), normotensión e hipotensión (PAS < 90 mmHg). El tono vascular fue clasificado según la FPG en dos formas: 1) Mediante inspección visual de los cambios en la amplitud de la onda de FPG y en la posición de la incisura dícrota; donde las clases I-II representan vasoconstricción (incisura dícrota ubicada a > 50% de la amplitud de FPG en ondas de pequeña amplitud), tono vascular normal de clase III (incisura dícrota ubicada entre 20-50% de la amplitud de FPG en ondas normales) y vasodilatación de clases IV-V-VI (incisura dícrota a < 20% de la amplitud FPG en ondas grandes). 2) Mediante un análisis automatizado basado en RN-S que combina siete parámetros derivados de la onda de FPG. Resultados: La evaluación visual fue precisa en la detección de hipotensión (sensibilidad 91%, especificidad 86% y precisión 88%) e hipertensión (sensibilidad 93%, especificidad 88% y precisión 90%). La normotensión se presentó como clase visual III (III-III) (mediana y 1°- 3° cuartiles), hipotensión como clase V (IV-VI) e hipertensión como clase II (I-III); todos con significancia estadística (p < 0,0001). La RN-S funcionó bien en la clasificación de las condiciones de PA. El porcentaje de datos con clasificación correcta por la RN-S fue del 83% para normotensión, 94% para hipotensión y 90% para hipertensión. Conclusiones: Los cambios en la PA inducidos por alteraciones en el tono vascular fueron clasificados correctamente de forma automática con una RN-S con base en...(AU)

Background: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. Methods: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) > 140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed > 50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch < 20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. Results: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < 0.0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. Conclusions: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.(AU)

Photoplethysmography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks.

BACKGROUND: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. METHODS: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. RESULTS: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < .0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. CONCLUSIONS: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.

Early cardiovascular sympathetic reflex activation is independent of occlusion time during reactive hyperemia / La activación temprana del reflejo simpático cardiovascular es independiente del tiempo de oclusión durante la hiperemia reactiva / A ativação precoce do reflexo simpático cardiovascular é independente do tempo de oclusão durante a hiperemia reativa

Purpose: The aim of the present study was to investigate the role of occlusion time in dynamic changes of autonomic activation during reactive hyperemia. Methods: Healthy subjects (n = 30) in the age range of 18­25 years participated in this study. Vascular reactivity was assessed by measuring the dynamic changes in finger pulse volume amplitude (PVA) and  pulse transit time relative to the RR intervals in the test (occluded arm) and control arm (contralateral non-occluded arm) during 1, 3 and 5 minute of occlusion using two separate Photoplethysmographic sensors. Heart Rate Variability was computed from a simultaneously acquired ECG signal to monitor the dynamic changes in cardiac autonomic nervous activity. Time-varying analysis of all signals were shown every 1 second in average response graphs. Results: Time-varying analysis of vascular and autonomic response during reactive hyperemia demonstrated the presence of a characteristic response pattern with an increase in the Sympathetic index and a decrease in Parasympathetic index at 8 to 10 seconds, an increase in heart rate at 20 seconds and a progressive increase in PVA during the first 60 seconds after occlusion regardless of the time spent in the procedure. Moreover, a decrease in pulse transits time relative to RR intervals,  followed by an increase regardless of the occlusion time was evidenced.  Conclusions: Early cardiovascular sympathetic activation is independent of occlusion time during reactive hyperemia, which suggests this is a vascular autonomic reflex response involved in the generation of the physiological phenomenon of reactive hyperemia.

Objetivo: El objetivo del presente estudio fue investigar el papel del tiempo de oclusión en los cambios dinámicos de la activación autónoma durante la hiperemia reactiva.Métodos: Participaron en este estudio sujetos sanos (n = 30) en el rango de edad de 18 a 25 años. La reactividad vascular se evaluó midiendo los cambios dinámicos en la amplitud del volumen del pulso del dedo (PVA) y el tiempo de tránsito del pulso en relación con los intervalos RR en la prueba (brazo ocluido) y el brazo de control (brazo contralateral no ocluido) durante 1, 3 y 5 minutos. de oclusión utilizando dos sensores fotopletismográficos separados. La variabilidad de la frecuencia cardíaca se calculó a partir de una señal de ECG adquirida simultáneamente para controlar los cambios dinámicos en la actividad nerviosa autónoma cardíaca. El análisis variable en el tiempo de todas las señales se mostró cada segundo en gráficos de respuesta promedio.Resultados: El análisis variable en el tiempo de la respuesta vascular y autonómica durante la hiperemia reactiva demostró la presencia de un patrón de respuesta característico con un aumento en el índice simpático y una disminución en el índice parasimpático a los 8 a 10 segundos, un aumento en la frecuencia cardíaca a los 20 segundos y un aumento progresivo de PVA durante los primeros 60 segundos después de la oclusión independientemente del tiempo transcurrido en el procedimiento. Además, se evidenció una disminución en el tiempo de tránsitos del pulso en relación con los intervalos RR, seguido de un aumento independientemente del tiempo de oclusión.Conclusiones: La activación simpática cardiovascular temprana es independiente del tiempo de oclusión durante la hiperemia reactiva, lo que sugiere que se trata de una respuesta refleja autonómica vascular involucrada en la generación del fenómeno fisiológico de hiperemia reactiva.

Objetivo: O objetivo do presente estudo foi investigar o papel do tempo de oclusão nas mudanças dinâmicas da ativação autonômica durante a hiperemia reativa.Métodos: Participaram deste estudo indivíduos saudáveis ​​(n = 30) na faixa etária de 18 a 25 anos. A reatividade vascular foi avaliada medindo as mudanças dinâmicas na amplitude do volume do pulso do dedo (PVA) e tempo de trânsito do pulso em relação aos intervalos RR no teste (braço ocluído) e braço controle (braço não ocluído contralateral) durante 1, 3 e 5 minutos de oclusão usando dois sensores fotopletismográficos separados. A variabilidade da frequência cardíaca foi calculada a partir de um sinal de ECG adquirido simultaneamente para monitorar as mudanças dinâmicas na atividade nervosa autonômica cardíaca. A análise variável no tempo de todos os sinais foi mostrada a cada 1 segundo em gráficos de resposta média.Resultados: A análise variável no tempo da resposta vascular e autonômica durante a hiperemia reativa demonstrou a presença de um padrão de resposta característico com um aumento no índice simpático e uma diminuição no índice parassimpático em 8 a 10 segundos, um aumento na frequência cardíaca em 20 segundos e aumento progressivo do PVA durante os primeiros 60 segundos após a oclusão, independentemente do tempo despendido no procedimento. Além disso, foi evidenciada uma diminuição no tempo de trânsito de pulso em relação aos intervalos RR, seguida de um aumento independente do tempo de oclusão.Conclusões: A ativação simpática cardiovascular precoce independe do tempo de oclusão durante a hiperemia reativa, o que sugere que se trata de uma resposta reflexa autonômica vascular envolvida na geração do fenômeno fisiológico de hiperemia reativa.

The RITHMI study: diagnostic ability of a heart rhythm monitor for automatic detection of atrial fibrillation.

INTRODUCTION AND OBJECTIVES: Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection. METHODS: RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram. RESULTS: The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98). CONCLUSIONS: This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.

Comparação do índice tornozelo-braquial com parâmetros de rigidez e resistência arterial periférica avaliados por fotopletismografia em idosos / Comparison of the ankle-brachial index with parameters of stiffness and peripheral arterial resistance assessed by photoplethysmography in elderly patients

O índice tornozelo-braquial (ITB) utiliza a razão entre a pressão arterial sistólica do tornozelo e do braço para diagnosticar de forma não invasiva a doença arterial periférica (DAP). A fotopletismografia (photoplethysmography, PPG) faz a medição e o registro das modificações de volume sanguíneo do corpo humano por meio de técnicas ópticas. Objetivos O objetivo deste estudo foi comparar o ITB com parâmetros de rigidez arterial e resistência periférica avaliados pela PPG em idosos e propor um modelo de predição para o ITB. Métodos Foi realizado um estudo transversal quantitativo. A amostra foi composta por idosos atendidos no ambulatório médico de especialidades da Universidade do Sul de Santa Catarina (UNISUL). Foram verificados: idade, sexo, índice de massa corporal (IMC), presença de comorbidades, tabagismo e atividade física. Para comparação das variáveis obtidas com a PPG com o ITB, foi realizada regressão linear bivariada e multivariada, considerando erro α = 0,05. Resultados Foram avaliados 93 idosos, sendo 63,4% mulheres. Em 98,9% dos casos, o ITB apresentou-se dentro da normalidade. Na comparação do ITB e variáveis derivadas da PPG em relação à idade, foram demonstradas associações significativas. Contudo, não foram observadas associações significativas entre ITB e PPG. O modelo multivariado indicou que apenas idade, sexo e tabagismo foram associados ao ITB. Conclusões Como conclusão, o ITB e a PPG demonstraram associação com o envelhecimento arterial, tendo em vista sua correlação com a idade; contudo, o ITB foi relacionado apenas com idade, sexo e tabagismo. Mais estudos são necessários para avaliar o potencial uso da PPG como rastreio de doenças vasculares em rotinas ambulatórias

The ankle-brachial index (ABI) uses the ratio between systolic blood pressures at the ankle and the arm to diagnose peripheral arterial disease (PAD) noninvasively. Photoplethysmography (PPG) measures and records changes to the blood volume in the human body using optical techniques. Objectives The objective of this study was to compare ABI with arterial stiffness and peripheral resistance parameters assessed using PPG in elderly patients and to propose a model for prediction of ABI. Methods A cross-sectional, quantitative study was conducted. The sample comprised elderly patients seen at a medical specialties clinic at the Universidade do Sul de Santa Catarina (UNISUL), Brazil. Age, sex, body mass index (BMI), comorbidities, smoking, and physical activity were recorded. The variables obtained using PPG and ABI were compared using bivariate and multivariate linear regression, with an α error of 0.05. Results A total of 93 elderly patients were assessed, 63.4% of whom were women. In 98.9% of cases, ABI was within normal limits. Comparison of ABI with variables acquired by PPG revealed significant associations with age. However, no significant associations were observed between ABI and PPG. The multivariate model indicated that only age, sex, and smoking were associated with ABI. Conclusions In conclusion, ABI and PPG exhibited associations with arterial aging, considering its correlation with age. However, ABI was only related to age, sex, and smoking. More studies are needed to evaluate the potential uses of PPG for screening for vascular diseases in ambulatory settings

Validity and reliability of a set of sexual stimuli in a sample of Colombian heterosexual young women / Validez y fiabilidad de un set de estímulos sexuales en una muestra de jóvenes mujeres heterosexuales colombianas

Vaginal photoplethysmography is a method for physiological evaluation of sexual arousal in women. This paper undertook to obtain the validity and reliability of a set of sexual stimuli in young heterosexual women. Six six-minute video clips were selected. A total of 34 women aged 18-30 years(M = 22.38, SD = 2.52) participated in this study. Objective Sexual Arousal, Subjective Sexual Arousal, emotional activation, emotional valence and socio-psycho-sexual information were evaluated. Three of the six sexual stimuli were selected from the scores obtained after the experimental phase. It was observed that the aforementioned video clips produced the most arousal-activation-pleasure, with internally consistent measures. As expected, good indicators of external validity were observed, with statistically significant differences. According to the data obtained, the pooled use of the three stimuli increases the like lihoodof obtainingan objective arousal response in healthy young women, there by minimizing the possibilities of displeasure.

La fotopletismografía vaginal es un método para evaluar fisiológicamente la excitación sexual objetiva en mujeres. El objetivo del presente estudio es obtener la validez y fiabilidad de un set de estímulos sexuales en mujeres jóvenes heterosexuales. Se seleccionaron seis videos sexuales de 6 minutos de duración. Un total de 34 mujeres entre los 18 y 30 años (M = 22.38; SD = 2.52) participaron en este estudio. Se evaluó la Excitación Sexual Objetiva, Subjetiva, la activación y valencia emocional e información sociopsicosexual. Tres de los seis estímulos sexuales se seleccionaron a partir de las puntuaciones obtenidas luego de la fase experimental. Se observó que estos fueron los que mayor excitación-activación-agrado produjeron con medidas internamente consistentes. Se observaron buenos indicadores de validez externa con diferencias estadísticamente significativas, como era de esperarse. Según los datos obtenidos, el uso agrupado de los tres estímulos aumentan la probabilidad de obtener unarespuesta de excitación objetiva en mujeres jóvenes saludables y minimizan las posibilidades de desagrado.

Alteraciones de la microcirculación en pacientes con anemia drepanocítica según técnicas fotopletismográficas / Changes of microcirculation in patients with sickle-cell anemia according to photoplethysmographical techniques

Se realizó un estudio observacional, descriptivo y transversal, de serie de casos, de 74 individuos (24 con anemia drepanocítica y 50 aparentemente sanos portadores de hemoglobinopatía SS), quienes asistieron a la Consulta de Hematología Especial del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el periodo 2013-2014, con vistas a identificar las alteraciones de la microcirculación según variabilidad de los parámetros fotopletismográficos. Se realizaron estudios con el Angiodin PD 3000, a partir del registro basal de la onda de volumen de pulso y el test de hiperemia reactiva. La fotopletismografía en estado basal de miembros inferiores mostró que los pacientes con anemia drepanocítica presentaron alteraciones en el sistema circulatorio, en tanto, las macroangiopatías tuvieron mayor frecuencia en la hiperemia reactiva. Los resultados obtenidos revelaron la utilidad de estas pruebas en la detección de trastornos funcionales circulatorios(AU)

An observational, descriptive and cross-sectional cases series study, of 74 individuals (24 with sickel-cell anemia and 50 apparently healthy with hemoglobinopathies SS) who attended the Special Hematology Department from Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out during the period 2013-2014, with the aim of identifying the changes of the microcirculation according to variability of the photopletismographical parameters. Studies with the Angiodin PD 3000 were carried out, from the basal register of the pulse volume wave and the reactive hyperemia test. The photoplethysmography in basal state of lower members showed that patients with sickle-cell anemia presented changes in the circulatory system, while, the macroangiopathies had higher frequency in the reactive hyperemia. The obtained results revealed the usefulness of these tests in the detection of circulatory functional disorders(AU)

Alteraciones de la microcirculación en pacientes con anemia drepanocítica según técnicas fotopletismográficas / Changes of microcirculation in patients with sickle-cell anemia according to photoplethysmographical techniques

Se realizó un estudio observacional, descriptivo y transversal, de serie de casos, de 74 individuos (24 con anemia drepanocítica y 50 aparentemente sanos portadores de hemoglobinopatía SS), quienes asistieron a la Consulta de Hematología Especial del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el periodo 2013-2014, con vistas a identificar las alteraciones de la microcirculación según variabilidad de los parámetros fotopletismográficos. Se realizaron estudios con el Angiodin PD 3000, a partir del registro basal de la onda de volumen de pulso y el test de hiperemia reactiva. La fotopletismografía en estado basal de miembros inferiores mostró que los pacientes con anemia drepanocítica presentaron alteraciones en el sistema circulatorio, en tanto, las macroangiopatías tuvieron mayor frecuencia en la hiperemia reactiva. Los resultados obtenidos revelaron la utilidad de estas pruebas en la detección de trastornos funcionales circulatorios.

An observational, descriptive and cross-sectional cases series study, of 74 individuals (24 with sickel-cell anemia and 50 apparently healthy with hemoglobinopathies SS) who attended the Special Hematology Department from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the period 2013-2014, with the aim of identifying the changes of the microcirculation according to variability of the photopletismographical parameters. Studies with the Angiodin PD 3000 were carried out, from the basal register of the pulse volume wave and the reactive hyperemia test. The photoplethysmography in basal state of lower members showed that patients with sickle-cell anemia presented changes in the circulatory system, while, the macroangiopathies had higher frequency in the reactive hyperemia. The obtained results revealed the usefulness of these tests in the detection of circulatory functional disorders.

Evaluation of quality of life and photoplethysmography in patients with chronic venous insufficiency treated with foam sclerotherapy

BACKGROUND: Ultrasound-guided foam sclerotherapy plays a major role in treatment of chronic venous insufficiency, providing clinical and hemodynamic improvement to patients undergoing treatment.OBJECTIVES: To examine the relationships between venous refilling time and impact of venous disease on quality of life and between changes in venous refilling time and improvement of symptoms after ultrasound-guided foam sclerotherapy for chronic venous insufficiency. METHODS: Thirty-two patients classified as C4, C5 or C6 answered a questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy.RESULTS: Statistically significant improvements were observed in quality of life scores and in venous filling time and in the following symptoms: aching, heavy legs, restless legs, swelling, burning sensations, and throbbing (p<0.0001). A similar improvement was also seen in the work and social domains of quality of life (p<0.0001).CONCLUSIONS: As confirmed by questionnaire scores and venous refilling times, ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels and low rates of major complications.

CONTEXTO: A escleroterapia com espuma guiada por ultrassom (EGUS) ocupa lugar de destaque no tratamento da insuficiência venosa crônica (IVC), proporcionando melhora clínica e hemodinâmica aos pacientes submetidos ao tratamento.OBJETIVOS: Verificar a correlação entre dados obtidos por questionário de qualidade de vida e de sintomas com dados obtidos por fotopletismografia (FPG), antes e depois do tratamento por escleroterapia com espuma guiada por ultrassom (EGUS) da insuficiência venosa crônica (IVC). MÉTODOS: Um grupo de 32 pacientes, classificados como C4, C5 e C6, foi submetido à aplicação de questionário de qualidade de vida e sintomas, sendo aferido o tempo de enchimento venoso (TEV) por FPG antes e 45 dias depois do tratamento da IVC através de EGUS. O teste do sinal foi utilizado para análise estatística da melhora dos escores dos questionários e do TEV. O teste de McNemar foi utilizado para avaliação da melhora nos sintomas e do impacto do tratamento nas atividades laborais e sociais dos pacientes.RESULTADOS: Houve melhora nos escores dos questionários de qualidade de vida e no TEV, com significância estatística (p<0,0001). Houve melhora estatisticamente significativa nos sintomas: dor, cansaço, edema, queimação, pernas inquietas e latejamento (p<0,0001). Incremento na qualidade laboral e social após o tratamento apresentou melhora estatisticamente significativa (p<0,0001). Não ocorreram complicações maiores ou efeitos adversos nesta série.CONCLUSÕES: A EGUS mostrou-se eficaz, com alto índice de satisfação e baixas taxas de complicacões maiores, ratificada pelos escores dos questionários e pelos TEVs aferidos pela FPG.

Avaliação quantitativa da insuficiência da veia safena magna nos pacientes portadores de varizes primárias de membros inferiores pelo mapeamento dúplex e fotopletismografia / Quantitative evaluation of the insufficiency of the great saphenous vein of patients with primary varicose veins of the lower limbs by means of duplex scanning and photoplethysmography

INTRODUÇÃO: A doença venosa crônica (DVC) é uma doença comum com conseqüências sócio-econômicas importantes. O refluxo é uma das principais causas da DVC. Detectar e quantificar o refluxo são medidas importantes no diagnóstico de insuficiência venosa crônica. A avaliação quantitativa da DVC pode ser realizada por meio de métodos invasivos e não invasivos. Os métodos não invasivos, quantitativos, são: fotopletismografia (FPG), pletismografia a ar e o mapeamento dúplex. O MD, padrão-ouro, permite a detecção e quantificação acurada do refluxo em veias individuais, pela medida da duração do refluxo ou tempo de fechamento da válvula, além de proporcionar informações anatômicas e funcionais relevantes para direcionar o tratamento de veias varicosas. Nos pacientes com varizes primárias dos membros inferiores a veia safena magna (VSM) é freqüentemente acometida, especialmente por refluxo na junção safeno-femoral (JSF), por insuficiência da válvula ostial. A avaliação da VSM é importante porque a sua preservação traz vantagens, pois a mesma tem sido utilizada como substituto arterial em doenças degenerativas, como a doença arterial obstrutiva crônica dos membros inferiores, na revascularização miocárdica e nos traumas vasculares de extremidades...

INTRODUCTION: The chronic venous disease (CVD) is a common disease with socio-economic consequences. Reflux is one of the main causes of CVD. Detecting and quantifying the reflux are important steps in the diagnosis of chronic venous insufficiency. The quantitative evaluation of CVD may be performed by means of invasive and non-invasive methods. Non-invasive quantitative methods are: photoplethysmography (FPG), air plethysmography and duplex scan. The DS, gold standard, allows the detection and quantification accurate measurement of the vein reflux individual, by the measure of length of reflux or time of valve closure, in addition to providing functional and relevant anatomical information to guide the treatment of varicose veins. In patients with primary varicose veins of the lower limbs the great saphenous vein (GSV) is frequently affected, especially by reflux in the saphenofemoral junction (SFJ), because of the failure of the ostial valve. The evaluation of the GSV is important because its preservation brings advantages so that it has been used as a replacing arterial in degenerative diseases such as chronic obstructive arterial disease of the lower limbs, in myocardial revascularization and in vascular trauma of the extremities...

Série fracionada da extensão de joelho proporciona maiores respostas cardiovasculares que séries contínuas / Discontinuous sets of knee extensions induce higher cardiovascular responses in comparison to continuous ones

FUNDAMENTO: O exercício de força pode proporcionar significativas respostas cardiovasculares durante sua execução, sendo interessante traçar estratégias para reduzí-las sem comprometer a produção de força. OBJETIVO: Comparar as respostas cardiovasculares agudas de pressão arterial sistólica (PAS), diastólica (PAD), freqüência cardíaca (FC) e duplo-produto (DP) durante a extensão unilateral de joelho (quatro séries de oito repetições máximas) realizada de forma contínua ou fracionada. Ambos os protocolos envolveram 2 minutos (min) de intervalo entre as séries, e no protocolo fracionado foi adicionada uma pausa de 2 segundos (s) entre a 4ª e a 5ª repetições. MÉTODOS: Oito homens saudáveis e treinados em força muscular (26± 6 anos) participaram da coleta de dados, aleatoriamente divididos em dois dias não-consecutivos. As respostas cardiovasculares foram medidas por fotopletismografia (Finapres) em repouso, ao término de cada série e 2 min após a execução de cada protocolo. RESULTADOS: A série fracionada acusou valores significativamente mais elevados que o protocolo de série contínua para: PAS (mmHg) na 2ª (173,1± 5,4 vs 152,0± 4,0; p=0,001), 3ª (188,9± 8,6 vs 162,4± 6,0; p=0,000) e 4ª série (193,1± 8,1 vs 161,6± 5,9; p=0,000); PAD (mmHg) na 3ª (103,8± 4,1 vs 86,1± 3,3; p=0,000) e 4ª série (104,1± 2,7 vs 83,4± 3,3; p=0,000); DP (mmHg.bpm) na 2ª (17.907,5± 1.350,7 vs 14.541,9± 1.848,0; p=0,03), 3ª (19.687,3± 1.444,3 vs 15.612,1± 1.180,3; p=0,008) e 4ª série (21.271,0± 1.794,2 vs 15.992,0± 1.093,4; p=0,001). CONCLUSÃO: O protocolo fracionado proporcionou maior elevação das respostas pressóricas que o protocolo contínuo. No entanto, pelas características do delineamento adotado, são necessários outros estudos para confrontar esses achados.

BACKGROUND: The strength training can promote significant cardiovascular responses during its performance and it is interesting to devise strategies to reduce them, without compromising the strength production. OBJECTIVE: To compare the acute cardiovascular responses of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR) and double product (DP) during the unilateral knee extension (four series of 8 maximum repetitions) performed continuously or discontinuously. Both protocols involved a 2-minute interval between the series and the discontinuous protocol had an extra interval of 2 seconds between the 4th and the 5th repetitions. METHODS: Eight healthy men trained in muscular strength (aged 26± 6 years) participated in the data collection and were randomly divided in two non-consecutive days. The cardiovascular responses were measured by photoplethysmography (Finapres, Ohmeda, Louisville, CO, USA) at rest, at the end of each series and 2 minutes after the performance of each protocol. RESULTS: The discontinuous series showed significantly higher values when compared to the protocol of the continuous series for: SAP (mmHg) at the 2nd (173.1± 5.4 vs 152.0± 4.0; p=0.001), 3rd (188.9± 8.6 vs 162.4± 6.0; p=0.000) and 4th series (193.1± 8.1 vs 161.6± 5.9; p=0.000); DAP (mmHg) at the 3rd (103.8± 4.1 vs 86.1± 3.3; p=0.000) and 4th series (104.1± 2.7 vs 83.4± 3.3; p=0.000); DP (mmHg.bpm) at the 2nd (17,907.5± 1,350.7 vs 14,541.9± 1,848.0; p=0.03), 3rd (19,687.3± 1,444.3 vs 15,612.1± 1,180.3; p=0.008) and 4th series (21,271.0± 1,794.2 vs 15,992.0± 1,093.4; p=0.001). CONCLUSION: The discontinuous protocol promoted higher increase in pressure responses when compared to the continuous one. However, due to the characteristics of the study design, further studies are necessary to support these findings.