Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.631
Filtrar
1.
J Cardiothorac Surg ; 16(1): 20, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658041

RESUMO

As a result of the COVID-19 pandemic, most institutions have changed the way patients are assessed or investigated. Using novel non-contact technology, it is possible to continuously monitor the lung function of peri-operative patients undergoing cardiothoracic procedures. Primarily, this results in increased patient surveillance, and therefore, safety. Many centres, globally, are starting to use structured light plethysmography (SLP) technology, providing a non-aerosol generating procedure in place of traditional spirometry. While more evidence is needed, our clinical usage; previous and on-going studies; demonstrate definite potential that SLP is a valuable tool.


Assuntos
/diagnóstico por imagem , Cardiologia/métodos , Pletismografia/métodos , Procedimentos Cirúrgicos Cardíacos , Estudos de Viabilidade , Humanos , Internet , Luz , Pandemias , Satisfação do Paciente , Período Pré-Operatório , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Reprodutibilidade dos Testes , Testes de Função Respiratória , Espirometria
2.
Artigo em Inglês | MEDLINE | ID: mdl-33017917

RESUMO

Prolonged measurement of total body volume variations (deltaVb) with whole-body, flow-based plethysmography (WBP) results in a drift of the signal due to changes in temperature and humidity inside the plethysmograph and to numerical integration of the flow to obtain deltaVb. This drift has been previously corrected with the application of a wavelet- based filter using visual inspection of the signal to select the optimal filter level (Uva et al. Front. Physiol. 6:411, 2016), thus introducing potential operator bias. To exclude the latter we compared this approach with a newly developed automatic method based on (1) correction for actual changes in temperature and humidity inside the plethysmograph (algorithm TH) and (2) automatic selection of the wavelet filter level based on comparison between deltaVb and intra-thoracic and abdominal pressure variations measured simultaneously (algorithm WAV). The Pearson's correlation coefficient between deltaVb and the changes in volume of the chest wall (deltaVcw) simultaneously obtained by optoelectronic plethysmography (OEP) was calculated after correction of deltaVb with TH and WAV applied separately, TH and WAV applied consecutively (TH+WAV), manual selection of a wavelet filter based on visual inspection (MAN) or no correction (CTRL). The correlation between deltaVb and deltaVcw increased marginally with WAV, TH+WAV and MAN compared to CTRL (P <; 0.01). Conversely, TH alone yielded a lower correlation (P <; 0.01). It follows that while the automated wavelet filter level selection method (WAV) represents an effective, operator-independent method for the correction of deltaVb, whether or not it is combined with specific correction for changes in thermodynamic conditions inside the plethysmograph, the manual method (MAN) yields satisfactory results without the constraints of intra-thoracic and abdominal pressure measurement.


Assuntos
Algoritmos , Pletismografia , Pletismografia Total , Temperatura , Termodinâmica
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2642-2645, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018549

RESUMO

Video-based photoplethysmography (vPPG) enables remote and contactless detection of the peripheral pulse of blood flow. This provides a potential mean to extract heart rate (HR) and pulse transit time (PTT) for the purpose of remote health monitoring. The accuracy of average HR and PTT extracted from a two-minute vPPG recording has been investigated at six different lighting conditions among participants with a range of Fitzpatrick skin scores. 12 healthy volunteers (6 females, 27 ± 6 years) were recruited. The video, electrocardiogram and finger PPG were acquired from immobile resting subjects. The vPPG signals from red, green and blue channels, and a combination of those were investigated. The vPPG signals were extracted from two regions of interest (ROIs): one on the forehead and one on the palm of the left hand. The estimated HR error (HR-error) was significantly lower for vPPG from green channels in both ROIs (ROI1 [p<0.001], ROI2 [p<0.05]). The signal from ROI1 demonstrated lower HR-error than ROI2 (p<0.001). HR-error from the darkest lighting conditions (Lumen 1 and 2) were significantly higher than the others (p<0.05). Furthermore, HR-error showed a positive correlation with skin tone scores in every lighting condition. However, at brighter lighting intensity, HR-error was independent of the skin tone score. PTT calculated from vPPG (vPTT) were compared between the 6 levels of lightings and the result was significantly different (p<0.05). In darker lighting conditions, the vPTT increased. Pulse arrival time measured from PPG (PAT-PPG) was calculated, and a positive correlation was found between the ratio of vPTT/PAT-PPG and skin tone score at six different lightings. However, this dependency decreases in brighter lighting intensity. These results suggest that HR-error and the ratio of vPTT/PAT increase with darker skins and at darker backgrounds. However, at brighter lighting conditions, the skin tone score is not a confounder of vPPG accuracy.


Assuntos
Iluminação , Pigmentação da Pele , Feminino , Frequência Cardíaca , Humanos , Pletismografia , Análise de Onda de Pulso
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2699-2702, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018563

RESUMO

We have developed an accelerometric system with a custom-designed patch probe and signal acquisition hardware to acquire the carotid wall displacement from the soft tissue surface for arterial stiffness evaluation. A subject-specific calibration model was developed to estimate the morphology of accurate carotid diameter waveform, using a standard ultrasound B-mode imaging system as the reference. Following the one-time calibration, the accelerometric system continuously acquired a non-invasive carotid lumen diameter waveform. The capability of the accelerometric system to measure the carotid stiffness index (ß) in-vivo was experimentally validated by performing measurements on 8 normotensive subjects in the supine position. The repeatability and reproducibility of the results were investigated and were found to be comparable to those provided by ultrasound imaging systems. Further, the variation of arterial stiffness index measurements on different days was studied to verify the ability of the system to give a stable measure of stiffness. The accuracy of the observed results was confirmed with the state-of-art B-mode ultrasound imaging system. The results were found to be stable over a day, indicating the utility of the system for a reliable measure of non-invasive carotid arterial stiffness.


Assuntos
Rigidez Vascular , Aceleração , Pletismografia , Reprodutibilidade dos Testes , Ultrassonografia
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2711-2714, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018566

RESUMO

Aortic stiffening is a process that is linked to cardiovascular risk factor increase. Then, aortic stiffness evaluation is considered as a good index of the evolution of pathophysiological situations, including myocardial infarction, heart failure, atherosclerosis or stroke. Today, pulse wave velocity (PWV) measurement is considered as the gold standard for evaluation of arterial stiffness. However, most of the current measurement techniques of PWV consider the time for the blood pressure pulse to propagate through a combined length of arteries and give access to arterial PWV. Therefore, none of the available techniques focuses only on the aorta. In the present context of smart clothes development, Inductive Plethsymography (IP) can be an interesting alternative for aortic PWV measure, since it has recently been shown that combination of thoracic and abdominal IP recordings can give cardiac information. We therefore investigate the potential of IP for aortic PWV measurement. In this preliminary study, a comparative analysis of PWV estimated from IP and PWV evaluated from the arm has been carried out on 11 healthy volunteers. Results show a significant linear correlation between both measures (r = 0.86, p<0.001), promising for future investigations on pathological populations.


Assuntos
Análise de Onda de Pulso , Rigidez Vascular , Aorta , Pressão Sanguínea , Humanos , Pletismografia
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4187-4190, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018920

RESUMO

Recently, video plethysmography (VPG) - a heart rate estimation technique using a video camera - has gained significant attention. Most studies of VPG have used a visible RGB camera; only a limited number of studies investigating near-infrared light (wavelength 750-2500 nm), which can be used even in a dark environment, have been performed. The purpose of this study was to investigate the differences between VPG data collected using visible light (VPGVIS) or near-infrared light (VPGNIR) from four facial areas (forehead, right cheek, left cheek, and nose). An experiment was conducted to obtain both VPGVIS and VPGNIR simultaneously by alternately irradiating the face with NIR and VIS lights. Experimental results showed that the root mean squared error of heart rate estimated using VPGNIR was 1 bpm higher than that of VPGVIS. However, contrary to our expectations, the power of the heartbeat-related component included in VPGNIR was not reduced despite the absorbance of hemoglobin in the NIR light range being 1/100 of that in the VIS light range. This result supports the hypothesis that a main factor in the generation of VPG waves was change in the optical properties caused by blood vessels compressing the subcutaneous tissue and the venous bed. Additionally, the accuracy of the heart rate estimation using VPG tended to be high when the nose was set as the ROI. This result was likely associated with the anatomical structure of the nose.


Assuntos
Face , Pletismografia , Testa , Humanos , Raios Infravermelhos , Nariz
7.
PLoS One ; 15(9): e0238402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915810

RESUMO

Infants are at risk for potentially life-threatening postoperative apnea (POA). We developed an Automated Unsupervised Respiratory Event Analysis (AUREA) to classify breathing patterns obtained with dual belt respiratory inductance plethysmography and a reference using Expectation Maximization (EM). This work describes AUREA and evaluates its performance. AUREA computes six metrics and inputs them into a series of four binary k-means classifiers. Breathing patterns were characterized by normalized variance, nonperiodic power, instantaneous frequency and phase. Signals were classified sample by sample into one of 5 patterns: pause (PAU), movement (MVT), synchronous (SYB) and asynchronous (ASB) breathing, and unknown (UNK). MVT and UNK were combined as UNKNOWN. Twenty-one preprocessed records obtained from infants at risk for POA were analyzed. Performance was evaluated with a confusion matrix, overall accuracy, and pattern specific precision, recall, and F-score. Segments of identical patterns were evaluated for fragmentation and pattern matching with the EM reference. PAU exhibited very low normalized variance. MVT had high normalized nonperiodic power and low frequency. SYB and ASB had a median frequency of respectively, 0.76Hz and 0.71Hz, and a mode for phase of 4o and 100o. Overall accuracy was 0.80. AUREA confused patterns most often with UNKNOWN (25.5%). The pattern specific F-score was highest for SYB (0.88) and lowest for PAU (0.60). PAU had high precision (0.78) and low recall (0.49). Fragmentation was evident in pattern events <2s. In 75% of the EM pattern events >2s, 50% of the samples classified by AUREA had identical patterns. Frequency and phase for SYB and ASB were consistent with published values for synchronous and asynchronous breathing in infants. The low normalized variance in PAU, was consistent with published scoring rules for pediatric apnea. These findings support the use of AUREA to classify breathing patterns and warrant a future evaluation of clinically relevant respiratory events.


Assuntos
Pletismografia/estatística & dados numéricos , Mecânica Respiratória/fisiologia , Aprendizado de Máquina não Supervisionado , Apneia/diagnóstico , Apneia/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Pletismografia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Processamento de Sinais Assistido por Computador
8.
Eur J Vasc Endovasc Surg ; 60(5): 739-746, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32778487

RESUMO

OBJECTIVE: Abdominal aortic aneurysm (AAA) is associated with morphological and functional changes in both aneurysmal and non-aneurysmal arteries. However, it remains uncertain whether similar changes also exist in the venous vasculature. The aim of this study was to evaluate global venous function in patients with AAA and controls. METHODS: This experimental study comprised 31 men with AAA (mean ± standard deviation age 70.0 ± 2.8 years) and 29 male controls (aged 70.6 ± 3.4 years). Venous occlusion plethysmography (VOP) was used to evaluate arm venous compliance at venous pressures between 10 and 60 mmHg in steps of 5 mmHg. Compensatory mobilisation of venous capacitance blood (capacitance response) was measured with a volumetric technique during experimental hypovolaemia induced by lower body negative pressure (LBNP). RESULTS: The VOP induced pressure-volume curve was significantly less steep in patients with AAA (interaction, p < .001), indicating lower venous compliance. Accordingly, the corresponding pressure-compliance curves displayed reduced venous compliance at lower venous pressures in patients with AAA vs. controls (interaction, p < .001; AAA vs. control, p = .018). After adjusting for arterial hypertension, diabetes mellitus, hyperlipidaemia, chronic obstructive pulmonary disease, and smoking, VOP detected differences in venous compliance remained significant at low venous pressures, that is, at 10 mmHg (p = .008), 15 mmHg (p = .013), and 20 mmHg (p = .026). Mean venous compliance was negatively correlated with aortic diameter (r = -.332, p = .010). Mobilisation of venous capacitance response during LBNP was reduced by approximately 25% in patients with AAA (p = .030), and the redistribution of venous blood during LBNP was negatively correlated with aortic diameter (r = -.417, p = .007). CONCLUSION: Men with AAA demonstrated reduced venous compliance and, as a result, a lesser capacity to mobilise peripheral venous blood to the central circulation during hypovolaemic stress. These findings imply that the AAA disease may be accompanied by functional changes in the venous vascular wall.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Hipovolemia/fisiopatologia , Veias/fisiopatologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/fisiopatologia , Braço/irrigação sanguínea , Estudos de Casos e Controles , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Masculino , Pletismografia , Ultrassonografia , Pressão Venosa/fisiologia
9.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32796097

RESUMO

OBJECTIVES: To explore the longitudinal association of neonatal adiposity (fat mass percentage) with BMI trajectories and childhood overweight and obesity from ages 2 to 6 years. METHODS: We studied 979 children from the Healthy Start cohort. Air displacement plethysmography was used to estimate fat mass percentage. Child weight and recumbent length or standing height were abstracted from medical records. Overweight and obesity were defined as BMI levels ≥85th percentile for age and sex. Mixed-effects models were used to examine the association between neonatal fat mass percentage and BMI trajectories from age 2 to 6 years. We tested for effect modification by sex, race and/or ethnicity, and breastfeeding duration. We estimated the proportion of children classified as overweight or obese at specific levels of neonatal fat mass percentage (mean ± SD). RESULTS: The mean neonatal adiposity level was 9.1% ± 4.0%. Child BMI levels differed by neonatal adiposity. Each SD increase in neonatal adiposity resulted in a 0.12 higher overall BMI level between ages 2 to 6 years (95% confidence interval: 0.03 to 0.20; P < .01), and this association was not modified by offspring sex, race and/or ethnicity, or breastfeeding duration. Increasing neonatal adiposity was associated with an increasing proportion of childhood overweight and obesity by age 5 years (P = .02). CONCLUSIONS: We provide novel evidence that higher neonatal adiposity is significantly associated with higher overall BMI levels and an increased likelihood of overweight or obesity from ages 2 to 6 years. Because various prenatal exposures may specifically influence offspring fat accretion, neonatal adiposity may be a useful surrogate end point for prenatal interventions aimed at reducing future childhood overweight and obesity.


Assuntos
Adiposidade , Índice de Massa Corporal , Obesidade Pediátrica/etiologia , Adulto , Fatores Etários , Composição Corporal , Tamanho Corporal , Aleitamento Materno , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Sobrepeso/diagnóstico , Sobrepeso/etiologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etnologia , Pletismografia/métodos , Gravidez , Prevalência , Fatores Sexuais
11.
J Vis Exp ; (158)2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32420981

RESUMO

Unrestrained barometric plethysmography (UBP) is a method for quantifying the pattern of breathing in mice, where breathing frequency, tidal volume, and minute ventilation are routinely reported. Moreover, information can be collected regarding the neural output of breathing, including the existence of central apneas and augmented breaths. An important consideration for UBP is obtaining a breathing segment with a minimal impact of anxious or active behaviors, to elucidate the response to breathing challenges. Here, we present a protocol that allows for short, quiet baselines to be obtained in aged mice, comparable to waiting for longer bouts of quiet breathing. The use of shorter time segments is valuable, as some strains of mice may be increasingly excitable or anxious, and longer periods of quiet breathing may not be achieved within a reasonable timeframe. We placed 22 month-old mice in a UBP chamber and compared four 15 s quiet breathing segments between minutes 60-120 to a longer 10 min quiet breathing period that took 2-3 h to acquire. We also obtained counts of central apneas and augmented breaths prior to the quiet breathing segments, following a 30 min familiarization period. We show that 10 min of quiet breathing is comparable to using a much shorter 15 s duration. Additionally, the time leading up to these 15 s quiet breathing segments can be used to gather data regarding apneas of central origin. This protocol allows investigators to collect pattern-of-breathing data in a set amount of time and makes quiet baseline measures feasible for mice that may exhibit increased amounts of excitable behavior. The UBP methodology itself provides a useful and noninvasive way to collect pattern-of-breathing data and allows for mice to be tested over several time points.


Assuntos
Pletismografia/métodos , Respiração/imunologia , Animais , Masculino , Camundongos
12.
Rev Assoc Med Bras (1992) ; 66(2): 180-186, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428153

RESUMO

OBJECTIVE: The current study aimed to examine the body composition of adult male ultra-trail runners (UTR) according to their level of participation (regional UTR-R, vs. national UTR-N). METHODS: The sample was composed of 44 adult male UTR (aged 36.5±7.2 years; UTR-R: n=25; UTR-N: n=19). Body composition was assessed by air displacement plethysmography, bioelectrical impedance, and dual-energy X-ray absorptiometry. In addition, the Food Frequency Questionnaire (FFQ) was applied. A comparison between the groups was performed using independent samples t-test. RESULTS: Significant differences between groups contrasting in the competitive level were found for chronological age (in years; UTR-R: 38.8±8.2 vs. UTR-N: 33.5±4.1); body density (in L.kg-1; UTR-R: 1.062±0.015 vs. UTR-N: 1.074±0.009); and fat mass (in kg; UTR-R: 12.7±6.8 vs. UTR-N: 7.6±2.7). CONCLUSION: UTR-N were younger, presented higher values for body density, and had less fat mass, although no significant differences were found for fat-free mass. The current study evidenced the profile of long-distance runners and the need for weight management programs to regulate body composition.


Assuntos
Composição Corporal/fisiologia , Corrida/fisiologia , Absorciometria de Fóton , Adulto , Antropometria , Atletas , Desempenho Atlético/fisiologia , Impedância Elétrica , Humanos , Masculino , Pletismografia/métodos , Valores de Referência , Inquéritos e Questionários , Fatores de Tempo
13.
Nat Commun ; 11(1): 2411, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415092

RESUMO

Placental insufficiency can cause fetal growth restriction and stillbirth. There are no reliable screening tests for placental insufficiency, especially near-term gestation when the risk of stillbirth rises. Here we show a strong association between low circulating plasma serine peptidase inhibitor Kunitz type-1 (SPINT1) concentrations at 36 weeks' gestation and low birthweight, an indicator of placental insufficiency. We generate a 4-tier risk model based on SPINT1 concentrations, where the highest risk tier has approximately a 2-5 fold risk of birthing neonates with birthweights under the 3rd, 5th, 10th and 20th centiles, whereas the lowest risk tier has a 0-0.3 fold risk. Low SPINT1 is associated with antenatal ultrasound and neonatal anthropomorphic indicators of placental insufficiency. We validate the association between low circulating SPINT1 and placental insufficiency in two other cohorts. Low circulating SPINT1 is a marker of placental insufficiency and may identify pregnancies with an elevated risk of stillbirth.


Assuntos
Biomarcadores/sangue , Retardo do Crescimento Fetal/diagnóstico , Placenta/fisiopatologia , Proteínas Secretadas Inibidoras de Proteinases/sangue , Animais , Antropometria , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Camundongos , Insuficiência Placentária , Pletismografia , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal , Artérias Umbilicais/fisiologia , Artéria Uterina/fisiologia
14.
Am J Cardiol ; 125(11): 1725-1731, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32278465

RESUMO

Hookah (waterpipe) smoking is a growing tobacco epidemic. Though perceived as a safer tobacco alternative, hookah smoke contains, in addition to tobacco combustion products, large amounts of charcoal combustion products-implicated in cardiovascular disease-from the burning charcoal used to heat the flavored tobacco. To date, little is known on the vascular effects of hookah smoking. The aim of this study was to characterize the peripheral circulatory response to acute hookah smoking in cutaneous and muscular beds. In 21 healthy young adult habitual hookah smokers who did not smoke cigarettes (age 24 ± 1 years, mean ± SE), we measured plasma nicotine, exhaled carbon monoxide, skin blood flow (laser Doppler velocimetry) and calf muscle blood flow (strain-gauge plethysmography) before and for up to 60 minutes after ad lib hookah smoking. In nine subjects, nonsmoking time-control studies were performed. Hookah smoking, which increased plasma nicotine by 5.8 ng/ml (from 0.6 ± 0.1 to 6.4 ± 1.3, p <0.001) and exhaled carbon monoxide by 27 ppm (from 2.7 ± 0.2 to 29.5 ± 2.2, p <0.001), decreased skin blood flow by 23% (20.1 ± 2.8 to 14.8 ± 1.9 units, p <0.001) and increased skeletal muscle blood flow by 34% (2.3 ± 0.1 to 2.9 ± 0.2 units, p = 0.010). These responses required more than one hour to recover after smoking cessation. All cardiovascular parameters were unchanged in the nonsmoking time-control studies. Although perceived to be innocuous, hookah smoking produces acute cutaneous vasoconstriction with skeletal muscle vasodilation, a dissociated pattern of peripheral blood flow responses that is characteristic of nicotine and carbon monoxide. In conclusion, these findings provide objective evidence to challenge the perception that hookah smoking is a safer tobacco alternative.


Assuntos
Músculo Esquelético/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Pele/irrigação sanguínea , Fumar Cachimbo de Água/fisiopatologia , Adulto , Testes Respiratórios , Monóxido de Carbono/metabolismo , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , Fluxometria por Laser-Doppler , Masculino , Nicotina/metabolismo , Pletismografia , Fumar Cachimbo de Água/metabolismo , Adulto Jovem
15.
Br J Nutr ; 124(3): 349-360, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32248845

RESUMO

Measurement of body composition is increasingly important in research and clinical settings but is difficult in very young children. Bioelectrical impedance analysis (BIA) and air displacement plethysmography (ADP) are well-established but require specialist equipment so are not always feasible. Our aim was to determine if anthropometry and skinfold thickness measurements can be used as a substitute for BIA or ADP for assessing body composition in very young New Zealand children. We used three multi-ethnic cohorts: 217 children at a mean age of 24·2 months with skinfold and BIA measurements; seventy-nine infants at a mean age of 20·9 weeks and seventy-three infants at a mean age of 16·2 weeks, both with skinfold and ADP measurements. We used Bland-Altman plots to compare fat and fat-free mass calculated using all potentially relevant equations with measurements using BIA or ADP. We also calculated the proportion of children in the same tertile for measured fat or fat-free mass and tertiles (i) calculated using each equation, (ii) each absolute skinfold, and (iii) sum of skinfold thicknesses. We found that even for the best equation for each cohort, the 95 % limits of agreement with standard measures were wide (25-200 % of the mean) and the proportion of children whose standard measures fell in the same tertile as the skinfold estimates was ≤69 %. We conclude that none of the available published skinfold thickness equations provides good prediction of body composition in multi-ethnic cohorts of very young New Zealand children with different birth history and growth patterns.


Assuntos
Antropometria/métodos , Composição Corporal , Impedância Elétrica , Pletismografia/estatística & dados numéricos , Pregas Cutâneas , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Nova Zelândia , Pletismografia/métodos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
16.
Behav Sci Law ; 38(2): 79-99, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32189386

RESUMO

Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribution to the assessment and treatment of adult men with paraphilic interests and men who have committed sex crimes. PPG contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. There is strong support for the utility of PPG within clinical and legal contexts. This article addresses ways in which PPG has been utilized in the courts as part of expert clinical opinion. History of its use, details regarding admissibility in court, and case law are explored within the legal systems of Canada, the UK and the USA. Support for the inclusion of PPG as expert evidence is provided and judicial misunderstandings on the rationale for PPG use and its clinical utility in forensic assessments are discussed.


Assuntos
Direito Penal , Pênis , Pletismografia , Delitos Sexuais/legislação & jurisprudência , Canadá , Literatura Erótica , Prova Pericial , Humanos , Masculino , Reincidência , Reino Unido , Estados Unidos
17.
Anesthesiology ; 133(1): 31-40, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32205547

RESUMO

BACKGROUND: The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery. METHODS: This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient. RESULTS: In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, -0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 µg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively. CONCLUSIONS: Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.


Assuntos
Algoritmos , Hidratação/métodos , Pletismografia/métodos , Medicina de Precisão , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Pressão Arterial , Artroplastia/métodos , Feminino , Humanos , Ácido Láctico/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Renal/epidemiologia , Insuficiência Renal/prevenção & controle , Troponina/sangue
18.
Eur J Vasc Endovasc Surg ; 59(6): 965-971, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32217116

RESUMO

OBJECTIVE: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. METHODS: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. RESULTS: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). CONCLUSION: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.


Assuntos
Determinação da Pressão Arterial/métodos , Isquemia/diagnóstico , Doença Arterial Periférica/complicações , Testes Imediatos , Dedos do Pé/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Dinamarca , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Pletismografia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
Arch Dis Child ; 105(6): 533-538, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32094247

RESUMO

OBJECTIVE: To evaluate if qualitative visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency department (ED). DESIGN: Prospective cohort study. SETTING: Paediatric ED of a tertiary paediatrics hospital in Singapore. PATIENTS: Children managed for moderate to severe wheezing in the resuscitation bay of the ED. INTERVENTIONS: Patients were assessed for the presence of PP based on visual detection of oximeter plethysmograph before and after initial inhaled bronchodilator therapy. MAIN OUTCOME MEASURES: These include the need for adjunct medications such as aminophylline or magnesium sulfate, the need for supplementary ventilation and the need for admission to the high dependency unit (HDU) or intensive care unit (ICU). RESULTS: There were 285 patients included in the study, of whom 78 (27.4%) had PP at ED presentation. There were 40 (14.0%) who had PP after initial management. Children who had PP after initial management had significantly relative risks (RR) of requiring adjunct medications (RR 12.5, 95% CI 4.0 to 38.6), need for supplementary ventilation (RR 5.6, 95% CI 1.2 to 26.5) and admission to the HDU/ICU (RR 5.6, 95% CI 3.0 to 10.4). CONCLUSION: Qualitative detection of PP on pulse oximetry can be used as a potential point-of-care tool to help in the assessment of response to initial treatment in paediatric patients with acute moderate to severe asthma exacerbations. Future studies are needed to assess and validate its role in guiding ED management of acute paediatric asthma.


Assuntos
Asma/fisiopatologia , Pressão Sanguínea/fisiologia , Oximetria , Pletismografia , Índice de Gravidade de Doença , Adolescente , Aminofilina/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/terapia , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Sulfato de Magnésio/uso terapêutico , Masculino , Oxigenoterapia , Admissão do Paciente , Sons Respiratórios/fisiopatologia , Sístole/fisiologia
20.
Medicine (Baltimore) ; 99(6): e19031, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028416

RESUMO

The study was designed to verify if mini-fluid challenge test is more reliable than dynamic fluid variables in predicting stroke volume (SV) and arterial pressure fluid responsiveness during spine surgery in prone position with low-tidal-volume ventilation.Fifty patients undergoing spine surgery in prone position were included. Fluid challenge with 500 mL of colloid over 15 minutes was given. Changes in SV and systolic blood pressure (SBP) after initial 100 mL were compared with SV, pulse pressure variation (PPV), SV variation (SVV), plethysmographic variability index (PVI), and dynamic arterial elastance (Eadyn) in predicting SV or arterial pressure fluid responsiveness (15% increase or greater).An increase in SV of 5% or more after 100 mL predicted SV fluid responsiveness with area under the receiver operating curve (AUROC) of 0.90 (95% confidence interval [CI], 0.82 to 0.99), which was significantly higher than that of PPV (0.71 [95% CI, 0.57 to 0.86]; P = .01), and SVV (0.72 [95% CI, 0.57 to 0.87]; P = .03). A more than 4% increase in SBP after 100 mL predicted arterial pressure fluid responsiveness with AUROC of 0.86 (95% CI, 0.71-1.00), which was significantly higher than that of Eadyn (0.52 [95% CI, 0.33 to 0.71]; P = .01).Changes in SV and SBP after 100 mL of colloid predicted SV and arterial pressure fluid responsiveness, respectively, during spine surgery in prone position with low-tidal-volume ventilation.


Assuntos
Pressão Sanguínea , Monitorização Intraoperatória/métodos , Posicionamento do Paciente , Medula Espinal/cirurgia , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia/métodos , Decúbito Ventral , Estudos Prospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...