Association of simultaneously measured four-limb blood pressures with cardiovascular function: a cross-sectional study.

BACKGROUND: Simultaneous measurement of four-limb blood pressures can improve the accuracy of cardiovascular disease diagnosis. This study aims to investigate the association of simultaneously measured four-limb blood pressures with cardiovascular function as the non-invasive diagnostic method of cardiovascular disease in primary care. METHODS: 229 subjects (62 males, mean age, 63.50 ± 11.13 years; 167 females, mean age, 59.47 ± 7.33 years) were enrolled. Four-limb blood pressure measurements were simultaneously performed using a blood pressure and pulse monitor device in the supine position. Cardiac functional parameters were also measured by using a cardiac hemodynamic detector in the same position. Data were statistically analyzed with SPSS15.0. RESULTS: The mean age of the 229 subjects was 60.56 ± 8.68 years. Cardiovascular functional parameters decreased with age and body mass index (BMI), only the total peripheral resistance (TPR) was in contrast. Age, BMI, left ankle diastolic pressure (LADP), high arm mean arterial pressure (HARMAP), left arm diastolic pressure (LARDP) and right ankle diastolic pressure (RADP) were significantly correlated with cardiovascular functional parameters. Cardiovascular functional parameters have significant differences with inter-arm difference in systolic blood pressure (SBP) between ≥10 and <10 mmHg, inter-ankle difference in SBP between ≥15 and ≥20 mmHg, inter-ankle difference in SBP between ≥15 and <10 mmHg and right ankle brachial index (RABI) between ≤0.9 and ≥1.0. After excluding 99 hypertensive patients, a part of cardiovascular functional parameters has still significant differences with inter-arm difference in SBP between ≥10 and ≥15 mmHg and RABI between ≤0.9 and ≥1.0. CONCLUSION: Age, BMI, LADP, HARMAP, LARDP and RADP were the determinants of cardiovascular functional parameters. In addition, a part of cardiovascular functional parameter is associated with inter-arm difference in SBP ≥10 mmHg, inter-ankle difference in SBP ≥15 mmHg and RABI ≤0.9, while these differences still existed after excluding 99 hypertensive patients. Hence, simultaneous measurement of four-limb blood pressures has become feasible and useful approach to the non-invasive diagnostic method of cardiovascular disease in primary care.

Non-invasive hemodynamic diagnosis based on non-linear pulse wave theory applied to four limbs.

Introduction: Hemodynamic diagnosis indexes (HDIs) can comprehensively evaluate the health status of the cardiovascular system (CVS), particularly for people older than 50 years and prone to cardiovascular disease (CVDs). However, the accuracy of non-invasive detection remains unsatisfactory. We propose a non-invasive HDIs model based on the non-linear pulse wave theory (NonPWT) applied to four limbs. Methods: This algorithm establishes mathematical models, including pulse wave velocity and pressure information of the brachial and ankle arteries, pressure gradient, and blood flow. Blood flow is key to calculating HDIs. Herein, we derive blood flow equation for different times of the cardiac cycle considering the four different distributions of blood pressure and pulse wave of four limbs, then obtain the average blood flow in a cardiac cycle, and finally calculate the HDIs. Results: The results of the blood flow calculations reveal that the average blood flow in the upper extremity arteries is 10.78 ml/s (clinically: 2.5-12.67 ml/s), and the blood flow in the lower extremity arteries is higher than that in the upper extremity. To verify model accuracy, the consistency between the clinical and calculated values is verified with no statistically significant differences (p < 0.05). Model IV or higher-order fitting is the closest. To verify the model generalizability, considering the risk factors of cardiovascular diseases, the HDIs are recalculated using model IV, and thus, consistency is verified (p < 0.05 and Bland-Altman plot). Conclusion: We conclude our proposed algorithmic model based on NonPWT can facilitate the non-invasive hemodynamic diagnosis with simpler operational procedures and reduced medical costs.

The application evaluation of an adjustable frame for four limbs disinfection in operation antisepsis / 中国实用护理杂志

Objective To design an adjustable frame for four limbs disinfection, and applied it to clinic, to prevent skin damage of eatagmatic limb due to heighten the limb for the preoperative disin-fection.Methods 180 patients who need to heighten limb for diaplasis were divided into the observation group and the control group averagely according to the sequence of operation time.Patients in the observa-tion group were heighten limbs by using the adjustable frame, while the control group were heighten limbs onto the fluid frame by traditional methods.Skin lesions, the contamination of the limb and the time for disinfection were observed.Results Skin lesions of the observation group and the control group were 2% and 20%, re-spectively,the difference was statistically significant.There was no case in the observation group was contami-nated and 16 cases were contaminated in the control group, the difference was statistically significant.The aver-age time for disinfection in the observation group was (17.6 ± 2.4)minutes, in the control group,(21.3 ± 3.2) minutes, the difference was also statistically significant.Conclusions Using the adjustable frame for limbs disinfection can reduce the skin damage, shorten the disinfection time and improve work efficiency.

Amputation of Four Limbs and Prosthetics A Clinical Comparison Between Myoelectric Prosthesis and Conventional Prostheisis / 대한정형외과학회잡지

Amputation is an unpleasant affair, generating a very negative aura that must be consciously combated. For optimal care of amputation, the surgeon needs not only to be comprehensive trained in reconstructive surgery but also to be knowledgeable about prosthetics. The evolution of an artificial arm can be traced first from the cosmetic prosthesis, then to that with passive movements, and lastly to an artificial limb with active movement which made it possible to restore to some degree the lost function of the amputation limb. But the gap between basic requirement of function and cosmesis is still present in conventional prosthesis. Myoelectric prosthesis was introduced for upper extremity amputees since 1960 by Korbinski and his co-workers and was most exciting improvement in the field of prosthetics. Two patients of bilateral above-elbow and bilateral below-knee amputees with myoelectric prostheses and conventional prostheses were compared in their function, cosmesis and acceptability of patient. Myoelectric prosthesis shows not only favorable cosmesis but also excellent function in range of motion and coordination of mechanical joints. And myoelectric prosthesis provides superior pinch force and requires less energy expenditure than a body-powered conventional prosthesis. So, in spite of the high cost of the appliance and of continued maintenance and repair, improvement in comfort, cosmesis and function have had to good level of acceptance of patients. Further research will undoubtedly improve the appearance, function and durability of the present electrically powered myoelectric prosthesis, making them even more acceptable and useful to lower limb and upper limb amputees.