Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 73.318
Filtrar
1.
Sensors (Basel) ; 24(11)2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38894099

RESUMO

Cochlear implants are crucial for addressing severe-to-profound hearing loss, with the success of the procedure requiring careful electrode placement. This scoping review synthesizes the findings from 125 studies examining the factors influencing insertion forces (IFs) and intracochlear pressure (IP), which are crucial for optimizing implantation techniques and enhancing patient outcomes. The review highlights the impact of variables, including insertion depth, speed, and the use of robotic assistance on IFs and IP. Results indicate that higher insertion speeds generally increase IFs and IP in artificial models, a pattern not consistently observed in cadaveric studies due to variations in methodology and sample size. The study also explores the observed minimal impact of robotic assistance on reducing IFs compared to manual methods. Importantly, this review underscores the need for a standardized approach in cochlear implant research to address inconsistencies and improve clinical practices aimed at preserving hearing during implantation.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Implante Coclear/métodos , Pressão , Cóclea/cirurgia , Cóclea/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/métodos , Perda Auditiva/cirurgia , Perda Auditiva/fisiopatologia
2.
Sensors (Basel) ; 24(11)2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38894317

RESUMO

Over the past two decades, there has been extensive research into surveillance methods for the post-endovascular repair of abdominal aortic aneurysms, highlighting the importance of these technologies in supplementing or even replacing conventional image-screening modalities. This review aims to provide an overview of the current status of alternative surveillance solutions for endovascular aneurysm repair, while also identifying potential aneurysm features that could be used to develop novel monitoring technologies. It offers a comprehensive review of these recent clinical advances, comparing new and standard clinical practices. After introducing the clinical understanding of abdominal aortic aneurysms and exploring current treatment procedures, the paper discusses the current surveillance methods for endovascular repair, contrasting them with recent pressure-sensing technologies. The literature on three commercial pressure-sensing devices for post-endovascular repair surveillance is analyzed. Various pre-clinical and clinical studies assessing the safety and efficacy of these devices are reviewed, providing a comparative summary of their outcomes. The review of the results from pre-clinical and clinical studies suggests a consistent trend of decreased blood pressure in the excluded aneurysm sac post-repair. However, despite successful pressure readings from the aneurysm sac, no strong link has been established to translate these measurements into the presence or absence of endoleaks. Furthermore, the results do not allow for a conclusive determination of ongoing aneurysm sac growth. Consequently, a strong clinical need persists for monitoring endoleaks and aneurysm growth following endovascular repair.


Assuntos
Aneurisma da Aorta Abdominal , Procedimentos Endovasculares , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/instrumentação , Pressão Sanguínea/fisiologia , Pressão , Próteses e Implantes , Correção Endovascular de Aneurisma
3.
Ulus Travma Acil Cerrahi Derg ; 30(6): 430-436, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38863292

RESUMO

BACKGROUND: This study aims to compare the effects of 8 mmHg and 12 mmHg pneumoperitoneum (PNP) pressures on operative, postoperative, and anesthesiological parameters in robot-assisted laparoscopic radical prostatectomy (RARP). METHODS: In this prospective study, 43 patients undergoing RARP performed by a single experienced surgeon were randomly assigned to either the low-pressure group (8 mmHg - Group I) or the standard-pressure group (12 mmHg - Group II). We evaluated the operative and postoperative parameters from both urological and anesthesiological perspectives. All patients were treated using the AirSeal® insufflation system. RESULTS: No statistically significant differences were observed between the groups in terms of console time, estimated blood loss, time to first flatus, or hospital length of stay. PNP was increased due to bleeding in six patients in the 8 mmHg group and two patients in the 12 mmHg group. Except for the heart rate measured five minutes after the initial incision, there were no observed differences between the groups in terms of blood pressure, ventilation, and administered medications. The heart rate was significantly lower in Group I (54.4 vs. 68.8, p=0.006). Additionally, during the surgery, the number of manipulations performed by the anesthesiologists, including drug administrations and ventilator management, was significantly lower in Group I (6.1 vs. 9.6, p=0.041). CONCLUSION: In RARP, while the 8 mmHg PNP pressure does not demonstrate differences in operative parameters compared to the 12 mmHg pressure, it offers the advantage of requiring fewer anesthetic interventions, thus minimizing the impact on cardiovascular and respiratory systems.


Assuntos
Pneumoperitônio Artificial , Prostatectomia , Procedimentos Cirúrgicos Robóticos , Humanos , Prostatectomia/métodos , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Pneumoperitônio Artificial/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Laparoscopia/métodos , Pressão , Neoplasias da Próstata/cirurgia
4.
Zhongguo Yi Liao Qi Xie Za Zhi ; 48(3): 335-338, 2024 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-38863104

RESUMO

Objective: To design and test a device which is capable of accurately measuring and dynamically adjusting the axial pressure at the fracture end in real-time. Methods: Upon completion of the design, the pressure measurement and adjustment device was implemented in a canine tibial fracture external fixation model. A pressure sensor was mounted at the fracture end, and the displayed values of the pressure sensor were used as the standard for comparison. The relationship between the displayed values of the measurement and adjustment device and the pressure sensor under identical conditions was examined. Results: The device was utilized in external fixation models of tibial fractures in five beagles. A linear correlation was observed between the displayed values of the device and the pressure sensor at the fracture end. The measurement values from the device could be transformed into fracture end pressure through the application of coefficients, thereby facilitating accurate measurement and dynamic adjustment of the fracture end pressure. Conclusion: The pressure measurement and adjustment device at the fracture end is easy to operate, enabling precise measurement and dynamic regulation of the pressure at the fracture end. It is well-suited for animal experiments aimed at investigating the impact of axial compression on fracture healing, demonstrating promising potential for experimental applications.


Assuntos
Desenho de Equipamento , Pressão , Fraturas da Tíbia , Animais , Cães , Fixação de Fratura/instrumentação , Fixadores Externos , Consolidação da Fratura
5.
Ulus Travma Acil Cerrahi Derg ; 30(6): 437-443, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38863287

RESUMO

BACKGROUND: Numerous measurement techniques for intra-abdominal pressure have been explored, with the Kron Technique established as the gold standard. Despite its prominence, the search for alternative methods persists due to its lengthy application time, the requirement for additional equipment, and overall impracticality. This study investigated a quicker, more accessible method for effective intra-abdominal pressure measurement in the emergency department. It aimed to compare intra-abdominal pressure measurements in patients diagnosed with ileus using a digital manometer and the Kron Technique. METHODS: Conducted from October 2022 to February 2023, this single-center, prospective, single-blind method comparison study involved patients diagnosed with ileus at a tertiary emergency department. Intra-abdominal pressure was measured using both the Kron Technique and a digital manometer by separate practitioners blinded to the study results. RESULTS: The study included 30 patients. No statistically significant difference was observed in the intra-abdominal pressure measurements between the two methods (p<0.237). A very strong correlation existed between the two methods (Spearman's Rho = 0.998). Bland-Altman analysis showed a bias value of 0.091 mmHg for the digital manometer, with upper and lower agreement limits of -0.825 and 1.007 mmHg, respectively. The measurement time was significantly shorter with the digital manometer than with the Kron Technique (15 vs. 390.5 seconds; p<0.001). CONCLUSION: We believe that the intra-abdominal pressure measurement technique using a digital manometer is a method that can be effectively employed by healthcare professionals in emergency departments. This technique offers ease of use, requires minimal equipment, provides rapid results, and delivers reliable measurement values compared to the Kron Technique.


Assuntos
Serviço Hospitalar de Emergência , Íleus , Manometria , Pressão , Humanos , Estudos Prospectivos , Feminino , Masculino , Manometria/métodos , Manometria/instrumentação , Pessoa de Meia-Idade , Íleus/diagnóstico , Idoso , Método Simples-Cego , Adulto , Idoso de 80 Anos ou mais
6.
J Orthop Surg Res ; 19(1): 333, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38835085

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. METHODS: Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. RESULTS: The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. CONCLUSION: This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.


Assuntos
Simulação por Computador , Fíbula , Articulação do Joelho , Osteoartrite do Joelho , Osteotomia , Pressão , Humanos , Osteotomia/métodos , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/fisiopatologia , Fíbula/cirurgia , Articulação do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Análise de Elementos Finitos , Fenômenos Biomecânicos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto
7.
Arch Esp Urol ; 77(4): 440-445, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38840289

RESUMO

BACKGROUND: Ureteroscopic holmium laser lithotripsy has become one of the main methods of treating ureteral calculi. However, in the treatment of middle and upper ureteral calculi, ureteroscopy is difficult to operate owing to the high location of calculi. Thus, how to improve the treatment effect and reduce the stone migration has become the focus in clinical settings. On this basis, we evaluated the application effect of low-pressure perfusion combined with occluder in holmium laser lithotripsy for patients with middle and upper ureteral calculi. METHODS: This retrospective study selected 107 patients with middle and upper ureteral calculi who underwent low-pressure perfusion combined with ureteroscopic holmium laser lithotripsy from January 2021 to December 2022. We excluded 7 patients who did not meet the criteria, and ultimately included 100 patients. According to whether the occluder was used during the surgery, 100 patients were divided into groups A (n = 52, occluder) and B (n = 48, without occluder). The stone-migration rate during surgery, stone-clearance rate at 3 months after surgery, perioperative indicators, postoperative complication rate, and postoperative quality of life between the two groups were compared. RESULTS: The stone-migration rate in group A was significantly lower than that in group B, with statistically significant difference (p < 0.05). Both groups had no significant difference in stone-clearance rate at 3 months after surgery (p > 0.05). Group A had a significantly lower index of EuroQol (EQ) Five Dimensions Questionnaire and significantly higher score of EQ-Visual Analogue Scale than group B (all p < 0.001). CONCLUSIONS: Compared with the simple application of low-pressure perfusion, the combined application of low-pressure perfusion and occluder in ureteroscopic holmium laser lithotripsy can effectively reduce the stone migration and improve the postoperative quality of life.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Cálculos Ureterais , Humanos , Masculino , Estudos Retrospectivos , Cálculos Ureterais/terapia , Cálculos Ureterais/cirurgia , Feminino , Litotripsia a Laser/métodos , Litotripsia a Laser/instrumentação , Pessoa de Meia-Idade , Lasers de Estado Sólido/uso terapêutico , Adulto , Ureteroscopia/métodos , Perfusão , Pressão , Resultado do Tratamento , Idoso , Terapia Combinada
8.
J Acoust Soc Am ; 155(6): 3615-3626, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38833283

RESUMO

The current work investigated the effects of mass-loading the eardrum on wideband absorbance in humans. A non-invasive approach to mass-loading the eardrum was utilized in which water was placed on the eardrum via ear canal access. The mass-loaded absorbance was compared to absorbance measured for two alternative middle ear states: normal and stiffened. To stiffen the ear, subjects pressurized the middle ear through either exsufflation or insufflation concurrent with Eustachian tube opening. Mass-loading the eardrum was hypothesized to reduce high-frequency absorbance, whereas pressurizing the middle ear was hypothesized to reduce low- to mid-frequency absorbance. Discriminant linear analysis classification was performed to evaluate the utility of absorbance in differentiating between conditions. Water on the eardrum reduced absorbance over the 0.7- to 6-kHz frequency range and increased absorbance at frequencies below approximately 0.5 kHz; these changes approximated the pattern of changes reported in both hearing thresholds and stapes motion upon mass-loading the eardrum. Pressurizing the middle ear reduced the absorbance over the 0.125- to 4-kHz frequency range. Several classification models based on the absorbance in two- or three-frequency bands had accuracy exceeding 88%.


Assuntos
Orelha Média , Pressão , Membrana Timpânica , Humanos , Masculino , Feminino , Membrana Timpânica/fisiologia , Membrana Timpânica/anatomia & histologia , Orelha Média/fisiologia , Orelha Média/anatomia & histologia , Adulto , Adulto Jovem , Elasticidade , Estimulação Acústica , Tuba Auditiva/fisiologia , Tuba Auditiva/anatomia & histologia , Estribo/fisiologia , Água , Análise Discriminante
9.
J Bodyw Mov Ther ; 39: 350-355, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38876651

RESUMO

INTRODUCTION: This study aimed to determine whether massage pressure on the target muscles (biceps brachii muscle [BB] and the medial head of the gastrocnemius muscle [MG]) is related to the massage effect (reducing muscle stiffness). METHOD: Nine healthy participants participated in this study. A physiotherapist massaged the upper arms and lower legs of participants on a rigid desk in a laboratory. Massage was delivered for 10 min with a 3-min rest. The shear modulus (i.e., the muscle stiffness), assessed by shear wave elastography, was measured at various time points (before [PRE], immediately after [POST], and 5 [POST-5], 10, 15, and 20 min after the massage). The massage pressure data (N) were obtained only during massage by force plate sensors. RESULTS: The BB shear modulus was significantly reduced POST massage. The MG shear modulus significantly reduced POST massage and remained clearly reduced until POST-5. There was a negative correlation between the total massage pressure and the % change in the shear modulus in both muscles. DISCUSSION: Since the spindle (BB) and pennate (MG) muscles have structural differences, our results suggest that these differences may affect the pattern of changes in the shear modulus in response to massage. CONCLUSION: Massage pressure is related to the massage effect (reducing muscle stiffness), and its relationships to POST are not related to the differences in the morphologies of the spindle (BB) and pennate muscles (MG). However, differences in the morphologies of the spindle and pennate muscles may cause differences in the duration of the massage effects.


Assuntos
Massagem , Músculo Esquelético , Humanos , Massagem/métodos , Músculo Esquelético/fisiologia , Masculino , Adulto , Feminino , Adulto Jovem , Pressão , Técnicas de Imagem por Elasticidade/métodos
10.
J Bodyw Mov Ther ; 39: 410-414, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38876660

RESUMO

INTRODUCTION: The foot placement is a determinant of the base of support and influences standing balance. The reliability of postural stability tests with different foot placement angles is unclear. RESEARCH QUESTION: To determine and compare the intra- and inter-day reliability of the center of pressure-based postural stability while standing with different foot placement angles. METHOD: Twenty-five healthy adults (16 females and 9 males; age: 29 ± 6 years) completed 70 s trials of eyes open and eyes closed stability tests with 0°, 15°, 30°, and 45° angles between the feet while standing on a forceplate in three sessions: two sessions were in the same day, and the third session was one-week apart. The repeatability of measurements was tested using analysis of variance, interclass correlation, and standard error of measurements. RESULT: Throughout the three study sessions, there was no difference in postural stability while participants stood with different foot placement angles. The interclass correlation scores ranged from 0.71 to 0.96, the standard error of measurements ranged from 2.1% to 12.9%, and no significant systematic changes (p < 0.05) occurred between the testing sessions for any foot placements. Standing with a 45° angle between the feet with closed eyes showed higher reliability values than other conditions. The intra-day reliability scores were greater than inter-day reliability. DISCUSSION: The relative reliability of postural stability could be impacted by foot placement angles, which might alter ankle mobility and base of support dimensions. The advantages of larger foot placement angles on improving the relative reliability of postural stability could be better demonstrated in healthy people under challenging conditions such as standing with closed eyes. CONCLUSION: Standing with foot placement angles between 0° and 45° are reliable and a quantitative assessment of the center of pressure could be used to monitor the changes in postural stability between sessions.


Assuntos
, Equilíbrio Postural , Humanos , Feminino , Masculino , Equilíbrio Postural/fisiologia , Adulto , Pé/fisiologia , Reprodutibilidade dos Testes , Adulto Jovem , Posição Ortostática , Pressão , Fenômenos Biomecânicos/fisiologia
11.
Sci Rep ; 14(1): 13215, 2024 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-38851842

RESUMO

Using a curved carbon-fiber plate (CFP) in running shoes may offer notable performance benefit over flat plates, yet there is a lack of research exploring the influence of CFP geometry on internal foot loading during running. The objective of this study was to investigate the effects of CFP mechanical characteristics on forefoot biomechanics in terms of plantar pressure, bone stress distribution, and contact force transmission during a simulated impact peak moment in forefoot strike running. We employed a finite element model of the foot-shoe system, wherein various CFP configurations, including three stiffnesses (stiff, stiffer, and stiffest) and two shapes (flat plate (FCFP) and curved plate (CCFP)), were integrated into the shoe sole. Comparing the shoes with no CFP (NCFP) to those with CFP, we consistently observed a reduction in peak forefoot plantar pressure with increasing CFP stiffness. This decrease in pressure was even more notable in a CCFP demonstrating a further reduction in peak pressure ranging from 5.51 to 12.62%, compared to FCFP models. Both FCFP and CCFP designs had a negligible impact on reducing the maximum stress experienced by the 2nd and 3rd metatarsals. However, they greatly influenced the stress distribution in other metatarsal bones. These CFP designs seem to optimize the load transfer pathway, enabling a more uniform force transmission by mainly reducing contact force on the medial columns (the first three rays, measuring 0.333 times body weight for FCFP and 0.335 for CCFP in stiffest condition, compared to 0.373 in NCFP). We concluded that employing a curved CFP in running shoes could be more beneficial from an injury prevention perspective by inducing less peak pressure under the metatarsal heads while not worsening their stress state compared to flat plates.


Assuntos
Corrida , Sapatos , Corrida/fisiologia , Humanos , Fenômenos Biomecânicos , Pressão , Fibra de Carbono/química , Antepé Humano/fisiologia , Análise de Elementos Finitos , Estresse Mecânico , Suporte de Carga/fisiologia , Carbono/química , Desenho de Equipamento , Pé/fisiologia
12.
J Chromatogr A ; 1729: 465040, 2024 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-38838450

RESUMO

In this work, porous polyimide microfibers (PI-µF) were prepared by high-pressure wet spinning method, and successfully applied as adsorbents for solid phase extraction (SPE) of fluoroquinolones (FQs) in water and food samples. The PI-µFs of ∼10, 25, 50, 100 µm in diameter could be controlled by the inner diameter of quartz capillary nozzles. The flow resistance of SPE cartridges packed with 10 µm PI microfiber (10-PI-µF) and 25-PI-µF was comparable to or even lower than that of commercial SPE cartridges, while the flow resistance of 50-PI-µF and 100-PI-µF SPE cartridges was increased obviously due to tiny broken pieces. The 10-PI-µF and 25-PI-µF have a specific surface area of 102 m2 g-1 and 76 m2 g-1, mesopores of 22-32 nm, and large breakthrough volume of 110 mL/5 mg and 85 mL/5 mg for FQs, while the 50-PI-µF and 100-PI-µF had much lower specific surface area and hardly had retention for FQs. FQs from tap water, egg and milk samples were then extracted by PI-µF SPE, and analyzed by high performance liquid chromatography-fluorescence detector (HPLC-FLD). SPE parameters as type of elution solvent, elution solvent volume, pH value of sample solution, flow rate of sample solution, and breakthrough volume were first optimized in detail. Under the optimal conditions, the PI-µF SPE/HPLC-FLD method showed high recoveries (96.8%-107%), wide linearity (0.05-50 µg L-1, or 0.01-10 µg L-1), high determination coefficients (R2 ≥0.9992), and low limits of detection (LODs, 0.005-0.014 µg L-1). For the real tap water, egg and milk samples, the recoveries and RSDs were 81-119% and 0.8-9.8%, respectively. The results show that porous microfiber up to 25 µm in diameter is a promising solid-phase extraction adsorbent with the lowest flow resistance that can be used for trace organic pollutants in water and food samples.


Assuntos
Fluoroquinolonas , Limite de Detecção , Leite , Extração em Fase Sólida , Poluentes Químicos da Água , Extração em Fase Sólida/métodos , Fluoroquinolonas/análise , Fluoroquinolonas/isolamento & purificação , Fluoroquinolonas/química , Porosidade , Leite/química , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/isolamento & purificação , Poluentes Químicos da Água/química , Cromatografia Líquida de Alta Pressão/métodos , Animais , Ovos/análise , Adsorção , Pressão , Contaminação de Alimentos/análise , Resinas Sintéticas/química , Análise de Alimentos/métodos , Reprodutibilidade dos Testes
13.
Clin Biomech (Bristol, Avon) ; 116: 106282, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38850883

RESUMO

BACKGROUND: Rocker shoes can be used to reduce foot pressure and adjust lower limb kinetics for various patient population, such as people with diabetic peripheral neuropathy. Selecting adequate properties of the rocker sole is of great importance for its efficacy. This study investigated the capability of human-in-the-loop optimization (HILO) to individually optimize apex position and angle of rocker shoe to reduce peak pressure and collision work simultaneously. METHODS: Peak pressure, kinetic, and kinematic data were recorded from 10 healthy participants while walking at preferred speed wearing rocker shoes with adjustable apex position and angle. An evolutionary algorithm was used to find optimal apex parameters to reduce both peak pressure in medial forefoot and collision work. The optimized shoe (HILO shoe) was compared with generic optimal rocker settings (Chapman settings) and normal shoe. FINDINGS: Compared to normal shoe, the HILO shoe had lower plantar pressure (pHILO = 0.007; pChapman = 0.044) and Chapman shoe showed higher collision work (pHILO = 0.025; pChapman = 0.014). Both HILO and Chapman shoe had smaller push-off work than normal shoe (pHILO = 0.001; pChapman < 0.001) with the Chapman shoe exhibited earlier push-off onset (pHILO = 0.257; pChapman = 0.016). INTERPRETATION: The Human-in-the-loop optimization approach resulted in individualized apex settings which performed on average similar to Chapman settings but, were superior in selected cases. In these cases, medial forefoot could be further offloaded with apex angles larger than generic settings. The larger apex angle might increase the external ankle moment arm and push-off work. However, there is limited room for improvement on collision work compared to generic settings.


Assuntos
, Pressão , Sapatos , Caminhada , Humanos , Pé/fisiologia , Masculino , Adulto , Feminino , Caminhada/fisiologia , Fenômenos Biomecânicos , Desenho de Equipamento , Algoritmos , Adulto Jovem
14.
Clin Biomech (Bristol, Avon) ; 116: 106281, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38850882

RESUMO

BACKGROUND: Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed. METHODS: In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole. FINDINGS: Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe. INTERPRETATION: The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.


Assuntos
Pé Diabético , Desenho de Equipamento , Órtoses do Pé , Calcanhar , Pressão , Sapatos , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pé Diabético/prevenção & controle , Pé Diabético/fisiopatologia , Pé/fisiologia , Idoso , Caminhada/fisiologia
15.
J Biomech ; 170: 112177, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38838496

RESUMO

This study investigates the differences in peak plantar pressure between the amputated and intact limbs of transfemoral amputees when walking outdoors. Ten non-amputees (aged 24.4 ± 2.0 years, 176.9 ± 2.5 cm, 72.3 ± 7.9 kg) and six transfemoral amputees (48.5 ± 6.3 years, 173.8 ± 4.2 cm, 82.0 ± 11.9 kg) participated in the study. Over approximately 1.6 km, the participants encountered various obstacles, including stairs, uneven surfaces, hills, and level ground, both indoors and outdoors. Throughout the walking session, the peak plantar pressure in both feet was monitored using wearable insole sensors. For all terrains, the percentage asymmetry was determined. Significant changes in peak plantar pressure asymmetry were found between the intact and amputated limbs, particularly when walking on level ground indoors, uneven terrains, descending stairs, and on steep slopes outdoors (all p < 0.05). These findings highlight the greater peak plantar pressure asymmetry in transfemoral amputees when walking outside. In addition, this study revealed that not all terrains contribute uniformly to this asymmetry.


Assuntos
Amputados , , Pressão , Caminhada , Humanos , Caminhada/fisiologia , Amputados/reabilitação , Masculino , Adulto , Pessoa de Meia-Idade , Pé/fisiologia , Feminino , Fenômenos Biomecânicos , Fêmur/cirurgia , Fêmur/fisiologia , Membros Artificiais , Adulto Jovem
16.
Br J Surg ; 111(6)2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38877843

RESUMO

BACKGROUND: The aim was to ascertain the impact of irrigation technique on human intrarenal pressure during retrograde intrarenal surgery. METHODS: A parallel randomized trial recruited patients across three hospital sites. Patients undergoing retrograde intrarenal surgery for renal stone treatment with an 11/13-Fr ureteral access sheath were allocated randomly to 100 mmHg pressurized-bag (PB) or manual hand-pump (HP) irrigation. The primary outcome was mean procedural intrarenal pressure. Secondary outcomes included maximum intrarenal pressure, variance, visualization, HP force of usage, procedure duration, stone clearance, and clinical outcomes. Live intrarenal pressure monitoring was performed using a COMETTMII pressure guidewire, deployed cystoscopically to the renal pelvis. The operating team was blinded to the intrarenal pressure. RESULTS: Thirty-eight patients were randomized between July and November 2023 (trial closure). The final analysis included 34 patients (PB 16; HP 18). Compared with PB irrigation, HP irrigation resulted in significantly higher mean intrarenal pressure (mean(s.d.) 62.29(27.45) versus 38.16(16.84) mmHg; 95% c.i. for difference in means (MD) 7.97 to 40.29 mmHg; P = 0.005) and maximum intrarenal pressure (192.71(106.23) versus 68.04(24.16) mmHg; 95% c.i. for MD 70.76 to 178.59 mmHg; P < 0.001), along with greater variance in intrarenal pressure (log transformed) (6.23(1.59) versus 4.60(1.30); 95% c.i. for MD 0.62 to 2.66; P = 0.001). Surgeon satisfaction with procedural vision reported on a scale of 10 was higher with PB compared with HP irrigation (mean(s.d.) 8.75(0.58) versus 6.28(1.27); 95% c.i. for MD 1.79 to 3.16; P < 0.001). Subjective HP usage force did not correlate significantly with transmitted intrarenal pressure (Pearson R = -0.15, P = 0.57). One patient (HP arm) developed urosepsis. CONCLUSION: Manual HP irrigation resulted in higher and more fluctuant intrarenal pressure trace (with inferior visual clarity) than 100-mmHg PB irrigation. REGISTRATION NUMBER: osf.io/jmg2h (https://osf.io/).


Assuntos
Cálculos Renais , Pressão , Irrigação Terapêutica , Humanos , Irrigação Terapêutica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Cálculos Renais/cirurgia , Adulto , Idoso , Resultado do Tratamento
17.
J Int Med Res ; 52(6): 3000605241259442, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38867540

RESUMO

OBJECTIVE: To investigate the association between driving pressure (ΔP) and 90-day mortality in patients following lung transplantation (LTx) in patients who developed primary graft dysfunction (PGD). METHODS: This prospective, observational study involved consecutive patients who, following LTx, were admitted to our intensive care unit (ICU) from January 2022 to January 2023. Patients were separated into two groups according to ΔP at time of admission (i.e., low, ≤15 cmH2O or high, >15 cmH2O). Postoperative outcomes were compared between groups. RESULTS: In total, 104 patients were involved in the study, and of these, 69 were included in the low ΔP group and 35 in the high ΔP group. Kaplan-Meier analysis of 90-day mortality showed a statistically significant difference between groups with survival better in the low ΔP group compared with the high ΔP group. According to Cox proportional regression model, the variables independently associated with 90-day mortality were ΔP and pneumonia. Significantly more patients in the high ΔP group than the low ΔP group had PGD grade 3 (PGD3), pneumonia, required tracheostomy, and had prolonged postoperative extracorporeal membrane oxygenation (ECMO) time, postoperative ventilator time, and ICU stay. CONCLUSIONS: Driving pressure appears to have the ability to predict PGD3 and 90-day mortality of patients following LTx. Further studies are required to confirm our results.


Assuntos
Transplante de Pulmão , Humanos , Transplante de Pulmão/mortalidade , Transplante de Pulmão/efeitos adversos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Disfunção Primária do Enxerto/mortalidade , Disfunção Primária do Enxerto/etiologia , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Complicações Pós-Operatórias/mortalidade , Pressão , Oxigenação por Membrana Extracorpórea/mortalidade , Fatores de Risco
18.
Food Res Int ; 188: 114434, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823828

RESUMO

In this work, dispersions were prepared with commercial pea protein isolate (PPI) and subjected to different (i) high pressure homogenization (HPH) intensities (0 - 200 MPa) (room temperature, pH 7) or (ii) environmental conditions (60 °C, pH 7 or pH 12) to generate dispersions with distinct protein molecular and microstructural characteristics, impacting protein solubility. Besides, protein digestion was analyzed following the static INFOGEST in vitro digestion protocol. Generally, increasing pressure of the homogenization treatment was linked with decreasing particle sizes and enhanced protein digestion. More specifically, the dispersion that did not undergo HPH (0 MPa) as well as the dispersion treated at 60 °C, pH 7, had highly similar microstructures, consisting of large irregular particles (10 - 500 µm) with shell-like structures, and exhibited low solubility (around 15 % and 28 %, respectively), which resulted in limited proteolysis (35 % and 42 %, respectively). In contrast, the dispersion subjected to HPH at 100 MPa and the dispersion treated at 60 °C, pH 12 also had similar microstructures with small and homogeneous particles (<1 µm), and exhibited relatively good solubility (54 % and 31 %, respectively), which led to enhanced protein digestion levels (87 % and 74 %, respectively). This study highlights the potential of food processing on macronutrient (micro)structure and further gastrointestinal stability and functionality.


Assuntos
Digestão , Manipulação de Alimentos , Tamanho da Partícula , Proteínas de Ervilha , Pressão , Solubilidade , Proteínas de Ervilha/química , Concentração de Íons de Hidrogênio , Manipulação de Alimentos/métodos , Proteólise , Pisum sativum/química , Temperatura
19.
Nurs Open ; 11(6): e2187, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38837558

RESUMO

AIM: The commonly recommended endotracheal tube cuff pressure is 20-30 cmH2O. However, some patients require a cuff pressure of >30 cmH2O to prevent air leakage. The study aims to determine the risk factors that contribute to the endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. DESIGN: A multi-centre prospective observational study. METHODS: Eligible patients undergoing mechanical ventilation in the intensive care unit of three hospitals between March 2020 and July 2022 were included. The endotracheal tube cuff pressure to prevent air leakage was determined using the minimal occlusive volume technique. The patient demographics and clinical information were collected. RESULTS: A total of 284 patients were included. Among these patients, 55 (19.37%) patients required a cuff pressure of >30 cmH2O to prevent air leakage. The multivariate logistic regression results revealed that the surgical operation (odds ratio [OR]: 8.485, 95% confidence interval [CI]: 1.066-67.525, p = 0.043) was inversely associated with the endotracheal tube cuff pressure of >30 cmH2O, while the oral intubation route (OR: 0.127, 95% CI: 0.022-0.750, p = 0.023) and cuff inner diameter minus tracheal area (OR: 0.949, 95% CI: 0.933-0.966, p < 0.001) were negatively associated with the endotracheal tube cuff pressure of >30 cmH2O. Therefore, a significant number of patients require an endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. Several factors, including the surgical operation, intubation route, and difference between the cuff inner diameter and tracheal area at the T3 vertebra, should be considered when determining the appropriate cuff pressure during mechanical ventilation.


Assuntos
Intubação Intratraqueal , Respiração Artificial , Humanos , Estudos Prospectivos , Masculino , Feminino , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Pressão/efeitos adversos , Unidades de Terapia Intensiva
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...