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Sack RA, Pikkel YY, Shemy OL, Ramon Y, Ullmann Y, Zeltzer AA. Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA. Undersea Hyperb Med 2024; 51:1-5. [PMID: 38615347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Chronic wounds have a significant impact on a patient's quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called "hyperbaric treatment" trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001. Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.
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Affiliation(s)
- Ram A Sack
- Rambam Hyperbaric Pressure Chamber, Rambam Health Care Campus, Haifa, Israel
- Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yoav Yechezkel Pikkel
- Department of Plastic & Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ortal Leitner Shemy
- Department of Plastic & Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yitzhak Ramon
- Department of Plastic & Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yehuda Ullmann
- Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Plastic & Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Assaf A Zeltzer
- Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Plastic & Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
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Garlapati P, Vali P, Lakshminrusimha S, Smith BJ, Zavorsky GS. The Precision Between Transcutaneous Carbon Dioxide Versus P aCO2 in Infants Undergoing Therapeutic Hypothermia. Respir Care 2024; 69:339-344. [PMID: 37253608 PMCID: PMC10984588 DOI: 10.4187/respcare.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Infants with hypoxic-ischemic encephalopathy are often treated with therapeutic hypothermia and high-frequency ventilation. Fluctuations in PaCO2 during therapeutic hypothermia are associated with poor neurodevelopmental outcomes. Transcutaneous CO2 monitors offer a noninvasive estimate of PaCO2 represented by transcutaneously measured partial pressure of carbon dioxide (PtcCO2 ). We aimed to assess the precision between PtcCO2 and PaCO2 values in neonates undergoing therapeutic hypothermia. METHODS This was a retrospective chart review of 10 neonates who underwent therapeutic hypothermia requiring respiratory support over 2 y. A range of 2-27 simultaneous PtcCO2 and PaCO2 pairs of measurements per neonate were analyzed via linear mixed models and a Bland-Altman plot for multiple observations per neonate. RESULTS A linear mixed-effect model demonstrated that PtcCO2 and PaCO2 (controlling for sex) were similar. The 95% CI of the mean difference ranged from -2.3 to 5.7 mm Hg (P = .41). However, precision was poor as the PtcCO2 ranged from > 18 mm Hg to < 13 mm Hg than PaCO2 values for 95% of observations. CONCLUSIONS The neonates' PtcCO2 was as much as 18 mm Hg higher to 13 mm Hg lower than the PaCO2 95% of the time. Transcutaneous CO2 monitoring may not be a good trending tool, nor is it appropriate for estimating PaCO2 in patients undergoing therapeutic hypothermia.
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Affiliation(s)
- Pranav Garlapati
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Payam Vali
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Satyan Lakshminrusimha
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Brian J Smith
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Gerald S Zavorsky
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California.
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Tueguem Moyo T, Jéhannin P, Le Pabic E, Le Faucheur A, Omarjee L, Mahe G. Test-retest Reliability and Minimal Detectable Change in Exercise Oximetry in Claudicants. Ann Vasc Surg 2024; 99:19-25. [PMID: 37922963 DOI: 10.1016/j.avsg.2023.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO2) can be used to diagnose Lower Extremity Artery Disease (LEAD) and allows the quantification of limb ischemia during exercise on treadmill. Exercise-TcPO2 test-retest reliability in patients with LEAD and severe walking impairment is unknown. The aim of this study was to evaluate the test-retest reliability, standard error of measurement (SEM), and Minimal Detectable Change (MDC) of exercise-TcPO2 in patients with claudication. METHODS Data were collected from patients that performed 2 treadmill tests within a 1-month interval. Delta from Rest of Oxygen Pressure (DROP) values were measured at both buttocks (proximal) and both calves (distal). Test-retest reproducibility was assessed by recording transcutaneous oximetry measurements twice and expressed as SEM and intra-class correlation coefficients. MDC was calculated using the formula MDC = SEM x 1.96 x √ 2. RESULTS Twenty eight LEAD patients (61 ± 9 years old) were included. Intra-class correlation coefficients were 0.66 [0.50, 0.79] and 0.65 [0.49, 0.79] for the proximal and distal levels, respectively. The SEM of DROP at the proximal and distal levels were 7 [6, 9] mm Hg and 9 [8, 11] mm Hg, respectively. The SEM for all (proximal and distal) DROP values was 8 [7, 10] mm Hg and the MDC of DROP was 23 mm Hg. CONCLUSIONS Exercise-TcPO2 with measurement of DROP values has a moderate test-retest reliability in LEAD patients with a maximal walking distance ≤ 300m. For an individual, an improvement or deterioration in DROP of ≥ 23 mm Hg after an intervention would be required to be 95% confident that the change is significant. It should be considered in evaluating the impact of treatment in patients with claudication.
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Affiliation(s)
| | - Pierre Jéhannin
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | | | - Loukman Omarjee
- Vascular Medicine Unit, University Hospital, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Vascular Medicine Unit, Hospital, Redon, France; Inserm UMR 1241, Numecan Institute, Express Team, Univ Rennes, Rennes, France
| | - Guillaume Mahe
- Vascular Medicine Unit, University Hospital, Rennes, France; Univ Rennes, M2S - EA 7470, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Faculty of Medicine, Univ Rennes, Rennes, France.
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Saulnier L, Prigent H, Hartley S, Delord V, Bossard I, Stalens C, Lofaso F, Leotard A. Sleep disordered breathing assessment in patient with slowly progressive neuromuscular disease. Sleep Med 2024; 114:229-236. [PMID: 38237410 DOI: 10.1016/j.sleep.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common in patients with neuromuscular diseases (NMD). Focusing on hypercapnia may lead to the neglect of other SDB such as obstructive and/or central sleep apnea syndrome (SAS). Our objectives were to assess the risk of inappropriate SDB management according to different screening strategies and to evaluate the prevalence and determinants of isolated and overlapping sleep apnea in patients with slowly progressive NMD. METHODS This monocentric, cross-sectional, retrospective study analyzed medical records of adult NMD patients referred to a sleep department. Diagnostic strategies, including respiratory polygraphy (RP), nocturnal transcutaneous capnography (tcCO2), and blood gases (BG), were assessed for their performance in diagnosing SDB. Demographics and pulmonary function test results were compared between patients with or without SDB to identify predictors. RESULTS Among the 149 patients who underwent a full diagnostic panel (RP + tcCO2 + BG), 109 were diagnosed with SDB. Of these, 33% had isolated SAS, and central apneas were predominant. Using single diagnostic strategies would lead to inappropriate SDB management in two thirds of patients. A combination of 2 diagnostic tools resulted respectively in 21.1, 22.9 and 42.2 % of inappropriate SDB management for RP + tcCO2, RP + BG and tcCO2 + BG. CONCLUSION The significant prevalence of sleep apnea syndrome in patients with slowly progressive NMD highlights the need for increased awareness among clinicians. Improved diagnostics involve a systematic approach addressing both sleep apnea and diurnal and nocturnal alveolar hypoventilation to avoid inappropriate management and limit the consequences of SDB.
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Affiliation(s)
- Lucas Saulnier
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France; Unité de Recherche Clinique Paris Saclay Ouest, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Hélène Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, Versailles, 78000, France
| | - Sarah Hartley
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | | | - Isabelle Bossard
- Centre d'investigation Clinique 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Caroline Stalens
- AFM-Téléthon, Direction des Actions Médicales, Evry, 91000, France
| | - Frédéric Lofaso
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, Versailles, 78000, France
| | - Antoine Leotard
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, Versailles, 78000, France.
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Sun H, Wu Y, Sung L, Lin X, Tsai F, Lin Y, Tam K, Wang F, Chang S. Use of consecutive transcutaneous oxygen measurement when assessing the need for revascularization and association with the outcomes of ischemic diabetic ulcers. Int Wound J 2024; 21:e14635. [PMID: 38272805 PMCID: PMC10789651 DOI: 10.1111/iwj.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
This study compared the ankle-brachial index (ABI) with transcutaneous oxygen pressure (TcPO2 ) in assessing peripheral vascular disease (PVD) prevalence in 100 diabetic foot ulcer (DFU) patients. Patients were categorized into vascular or nonvascular reconstruction groups and underwent both ABI and TcPO2 measurements four times over 6 months. Predictive validity for PVD diagnosis was analysed using the area under the receiver-operating characteristic curve (AUC). The study found TcPO2 to be a superior predictor of PVD than ABI. Among the DFU patients, 51 with abnormal TcPO2 values underwent vascular reconstruction. Only TcPO2 values showed significant pretreatment differences between the groups and increased post-reconstruction. These values declined over a 6-month follow-up, whereas ABI values rose. For those with end-stage renal disease (ESRD), TcPO2 values saw a sharp decrease within 3 months. Pre-reconstruction TcPO2 was notably lower in amputation patients versus limb salvage surgery patients. In conclusion, TcPO2 is more effective than ABI for evaluating ischemic limb perfusion and revascularization necessity. It should be prioritized as the primary follow-up tool, especially for ESRD patients.
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Affiliation(s)
- Hao‐Yi Sun
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Yi‐Chun Wu
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Biomedical EngineeringNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Li‐Chin Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Division of Cardiology, Department of Internal Medicine, Shuang‐Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
- Taipei Heart InstituteTaipei Medical UniversityTaipeiTaiwan
- TMU Research Center of Urology and Kidney (TMU‐RCUK)Taipei Medical UniversityTaipeiTaiwan
| | - Xin‐Yi Lin
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
| | - Feng‐Chou Tsai
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Yen‐Kuang Lin
- Graduate Institute of Athletics and Coaching ScienceNational Taiwan Sport UniversityTaoyuanTaiwan
| | - Ka‐Wai Tam
- Division of General Surgery, Department of Surgery, Shuang‐Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
| | - Fu‐Yu Wang
- Cabrini HospitalMelbourneVictoriaAustralia
| | - Shun‐Cheng Chang
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
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Woo Y, Suh YJ, Lee H, Jeong E, Park SC, Yun SS, Kim JY. TcPO2 Value Can Predict Wound Healing Time in Clinical Practice of CLTI Patients. Ann Vasc Surg 2023; 91:249-256. [PMID: 36503018 DOI: 10.1016/j.avsg.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transcutaneous oxygen pressure (TcPO2) is a noninvasive, nonradiological test to measure local oxygen released from capillaries through the skin. Since it reflects the metabolic state of the lower limb, it can predict wound healing in patients with critical limb threatening ischemia (CLTI). The purpose of this study was to determine the effectiveness of TcPO2 test in evaluating wound healing potential of patients with CLTI. METHODS This was a retrospective, single-center, nonrandomized, and observational study. A prospectively registered database of patients who visited Vascular Surgery Department of St. Mary's Hospital for CLTI and underwent TcPO2 tests from October 1, 2015 to July 1, 2021 was reviewed. Patients were divided into 2 groups: (1) those who had amputation only; and (2) those who underwent revascularization procedures. Patients whose wound healing status could not be determined were excluded. The clinical characteristics of patients, patient characteristics related to lower TcPO2 value, treatment success rate, and time for the wound to be healed were analyzed. RESULTS A total of 84 patients were included in this study. There was no difference in background patient characteristics between the 2 groups despite better survival within 12 months and shorter healing time in the revascularization group. A total of 76 patients survived 12 months after surgery, and 63 patients were healed. Higher HbA1c, higher serum creatinine, history of stroke, and history of coronary artery disease were related to lower TcPO2 value on multiple linear regression. The cutoff value of TcPO2 was determined to be 40 mm Hg for predicting wound healing. This value was similar to those of previous studies. In addition, there was a negative correlation between TcPO2 and wound healing time. Correlations among the anklebrachial index (ABI), toe-brachial index (TBI), and TcPO2 were not determined because ABI and TBI for some patients could not be obtained due to wound condition. CONCLUSIONS The TcPO2 value can predict the wound healing process of ischemic lower extremity injury.
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Affiliation(s)
- Youngje Woo
- Geochang public health center, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hwasun Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eunsun Jeong
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Fabbri N. CORR Insights®: Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma. Clin Orthop Relat Res 2023; 481:550-552. [PMID: 36398332 PMCID: PMC9928836 DOI: 10.1097/corr.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Nicola Fabbri
- Professor of Orthopaedic Surgery, Chief, Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Grossman School of Medicine, New York, NY, USA
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Mi S, Jiang C, Feng X, Zhang L. Effect of Different Oxygen Delivery Methods on Transcutaneous Oxygen Pressure and Fraction of Inspired Oxygen During Noninvasive Positive Pressure Ventilation. Altern Ther Health Med 2022; 28:24-29. [PMID: 35325872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of different oxygen delivery methods during noninvasive positive-pressure ventilation (NPPV) on transcutaneous oxygen pressure (PtcO2), transcutaneous carbon dioxide pressure (PtcCO2) and fraction of inspired oxygen (FiO2) in order to find more effective oxygen delivery methods. METHODS A total of 20 healthy volunteers participated in this study, all of whom received NPPV. All volunteers received oxygen through a nasal cannula (NC) located in a mask or through a mask alone (OSTM) (oxygen flow rate was 3L/min and 5L/min), PtcO2 and PtcCO2 were measured, and the effects of the 2 methods of oxygen concentration on PtcO2 and PtcCO2 levels were evaluated during noninvasive ventilation. Then, the additional oxygen concentration was stopped, oxygen was delivered through the ventilator, and the oxygen concentration was adjusted so that the PtcO2 reached the same oxygen concentration level as noted through the NC or OSTM. This concentration of oxygen indirectly reflects FiO2 in different oxygen delivery methods. RESULTS When NPPV was used under the same pressure, FiO2 increased from 44.4% to 65.3% when oxygen was delivered through an NC compared with oxygen supplied by OSTM alone. PtcO2 was also significantly increased from 18.9% to 24.9%; the difference was significant (P < .05), while there was no significant change in PtcCO2 (P > .05). CONCLUSION When NPPV is used, an NC can obviously improve FiO2 and PtcO2 without increasing PtcCO2. It can save oxygen and is more suitable for NPPV during an emergency and for home use.
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Weber RE, Schulze KM, Colburn TD, Horn AG, Hageman KS, Ade CJ, Hall SE, Sandner P, Musch TI, Poole DC. Capillary hemodynamics and contracting skeletal muscle oxygen pressures in male rats with heart failure: Impact of soluble guanylyl cyclase activator. Nitric Oxide 2022; 119:1-8. [PMID: 34871799 PMCID: PMC9469501 DOI: 10.1016/j.niox.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
In heart failure with reduced ejection fraction (HFrEF), nitric oxide-soluble guanylyl cyclase (sGC) pathway dysfunction impairs skeletal muscle arteriolar vasodilation and thus capillary hemodynamics, contributing to impaired oxygen uptake (V̇O2) kinetics. Targeting this pathway with sGC activators offers a new treatment approach to HFrEF. We tested the hypotheses that sGC activator administration would increase the O2 delivery (Q̇O2)-to-V̇O2 ratio in the skeletal muscle interstitial space (PO2is) of HFrEF rats during twitch contractions due, in part, to increases in red blood cell (RBC) flux (fRBC), velocity (VRBC), and capillary hematocrit (Hctcap). HFrEF was induced in male Sprague-Dawley rats via myocardial infarction. After 3 weeks, rats were treated with 0.3 mg/kg of the sGC activator BAY 60-2770 (HFrEF + BAY; n = 11) or solvent (HFrEF; n = 9) via gavage b.i.d for 5 days prior to phosphorescence quenching (PO2is, in contracting muscle) and intravital microscopy (resting) measurements in the spinotrapezius muscle. Intravital microscopy revealed higher fRBC (70 ± 9 vs 25 ± 8 RBC/s), VRBC (490 ± 43 vs 226 ± 35 μm/s), Hctcap (16 ± 1 vs 10 ± 1%) and a greater number of capillaries supporting flow (91 ± 3 vs 82 ± 3%) in HFrEF + BAY vs HFrEF (all P < 0.05). Additionally, PO2is was especially higher during 12-34s of contractions in HFrEF + BAY vs HFrEF (P < 0.05). Our findings suggest that sGC activators improved resting Q̇O2 via increased fRBC, VRBC, and Hctcap allowing for better Q̇O2-to-V̇O2 matching during the rest-contraction transient, supporting sGC activators as a potential therapeutic to target skeletal muscle vasomotor dysfunction in HFrEF.
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Affiliation(s)
- Ramona E Weber
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA.
| | - Kiana M Schulze
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Trenton D Colburn
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Andrew G Horn
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - K Sue Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Stephanie E Hall
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Peter Sandner
- Bayer AG, Cardiology Research, Wuppertal, Germany and Hannover Medical School, Department of Pharmacology, Hannover, Germany
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA; Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - David C Poole
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA; Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
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Dervieux E, Théron M, Uhring W. Carbon Dioxide Sensing-Biomedical Applications to Human Subjects. Sensors (Basel) 2021; 22:188. [PMID: 35009731 PMCID: PMC8749784 DOI: 10.3390/s22010188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
Carbon dioxide (CO2) monitoring in human subjects is of crucial importance in medical practice. Transcutaneous monitors based on the Stow-Severinghaus electrode make a good alternative to the painful and risky arterial "blood gases" sampling. Yet, such monitors are not only expensive, but also bulky and continuously drifting, requiring frequent recalibrations by trained medical staff. Aiming at finding alternatives, the full panel of CO2 measurement techniques is thoroughly reviewed. The physicochemical working principle of each sensing technique is given, as well as some typical merit criteria, advantages, and drawbacks. An overview of the main CO2 monitoring methods and sites routinely used in clinical practice is also provided, revealing their constraints and specificities. The reviewed CO2 sensing techniques are then evaluated in view of the latter clinical constraints and transcutaneous sensing coupled to a dye-based fluorescence CO2 sensing seems to offer the best potential for the development of a future non-invasive clinical CO2 monitor.
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Affiliation(s)
- Emmanuel Dervieux
- BiOSENCY, 1137a Avenue des Champs Blancs, 35510 Cesson-Sévigné, France
| | - Michaël Théron
- ORPHY, Université de Bretagne Occidentale, 6 Avenue Victor le Gorgeu, 29238 Brest, France;
| | - Wilfried Uhring
- ICube, University of Strasbourg and CNRS, 23 rue du Loess, CEDEX, 67037 Strasbourg, France;
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Tufan TB, Sen D, Guler U. An Infra-Red-Based Prototype for a Miniaturized Transcutaneous Carbon Dioxide Monitor. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:7132-7135. [PMID: 34892745 DOI: 10.1109/embc46164.2021.9630469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
New types of miniaturized biomedical devices transform contemporary diagnostic and therapeutic techniques in medicine. This evolution has demonstrated exceptional promise in providing infrastructures for enabling precision health by creating diverse sensing modalities. To this end, this paper presents a prototype for transcutaneous carbon dioxide monitoring to diversify the measurable critical parameters for human health. Transcutaneous carbon dioxide monitoring is a noninvasive, surrogate method of assessing the partial pressure of carbon dioxide in the blood. The partial pressure of carbon dioxide is a vital index that can help understand momentarily changing ventilation trends. Therefore, it needs to be reported continuously to monitor the ventilatory status of critically ill patients. The proposed prototype employs an infrared LED as the excitation source. The infrared emission, which decreases in response to an increasing carbon dioxide concentration, is applied to a thermopile sensor that can detect the infrared intensity variations precisely. We have measured the changes in the partial pressure of carbon dioxide in the range of 0-120 mmHg, which covers humans' typical values, 35-45 mmHg. The prototype occupies an area of 25 cm2 (50 mm × 50 mm) and consumes 85 mW power.
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12
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Sørensen KM, Leicht RV, Carlsson CJ, Elvekjaer M, Porsbjerg C, Aasvang EK, Meyhoff CS. Agreement Between Transcutaneous Monitoring and Arterial Blood Gases During COPD Exacerbation. Respir Care 2021; 66:1560-1566. [PMID: 34074743 PMCID: PMC9993557 DOI: 10.4187/respcare.08510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcutaneous measurements of CO2 and O2 ([Formula: see text], [Formula: see text]) are noninvasive and allow for continuous monitoring in adults with exacerbation of COPD, but substantial accuracy issues may exist. We investigated agreement between results of arterial blood gas analysis and transcutaneous measurements of CO2 and O2 in patients with COPD. METHODS Adult subjects were monitored after acute admission to a respiratory intermediate care unit or ICU due to exacerbation of COPD and with ongoing noninvasive ventilation or immediately following extubation. Monitored variables were continuous transcutaneous measurement and simultaneous routine arterial blood gas analysis. Agreement between measurements was assessed by calculating bias with 95% limits of agreement for single-point estimates of [Formula: see text] versus [Formula: see text] and versus [Formula: see text], and for changes in transcutaneous measurements between 2 time points ([Formula: see text] and [Formula: see text]). We considered limits of agreement within ± 7.5 mm Hg to be acceptable. RESULTS A total of 57 transcutaneous measurements were made in 20 subjects for comparison with concurrent arterial blood gas analysis at 36 time points. The bias (limits of agreement) for [Formula: see text] and [Formula: see text] was 2.5 mm Hg (-10.6 to 15.6 mm Hg) and 11.2 mm Hg (-28.2 to 50.6 mm Hg), respectively. The bias for [Formula: see text] and [Formula: see text] was 2.3 mm Hg (-3.8 to 8.3 mm Hg) and -5.3 mm Hg (-37.5 to 27 mm Hg), respectively. CONCLUSIONS [Formula: see text] and [Formula: see text] did not accurately reflect results from arterial blood gas analyses in this study of mostly hypercapnic subjects. Agreement between changes in CO2 during the monitoring period was acceptable, however, and transcutaneous monitoring may be used for continuous monitoring of [Formula: see text] in conjunction with arterial blood gas analysis for reference.
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Affiliation(s)
- Kasper M Sørensen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca V Leicht
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian J Carlsson
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Umeda A, Ishizaka M, Ikeda A, Miyagawa K, Mochida A, Takeda H, Takeda K, Fukushi I, Okada Y, Gozal D. Recent Insights into the Measurement of Carbon Dioxide Concentrations for Clinical Practice in Respiratory Medicine. Sensors (Basel) 2021; 21:5636. [PMID: 34451079 PMCID: PMC8402333 DOI: 10.3390/s21165636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/28/2022]
Abstract
In the field of respiratory clinical practice, the importance of measuring carbon dioxide (CO2) concentrations cannot be overemphasized. Within the body, assessment of the arterial partial pressure of CO2 (PaCO2) has been the gold standard for many decades. Non-invasive assessments are usually predicated on the measurement of CO2 concentrations in the air, usually using an infrared analyzer, and these data are clearly important regarding climate changes as well as regulations of air quality in buildings to ascertain adequate ventilation. Measurements of CO2 production with oxygen consumption yield important indices such as the respiratory quotient and estimates of energy expenditure, which may be used for further investigation in the various fields of metabolism, obesity, sleep disorders, and lifestyle-related issues. Measures of PaCO2 are nowadays performed using the Severinghaus electrode in arterial blood or in arterialized capillary blood, while the same electrode system has been modified to enable relatively accurate non-invasive monitoring of the transcutaneous partial pressure of CO2 (PtcCO2). PtcCO2 monitoring during sleep can be helpful for evaluating sleep apnea syndrome, particularly in children. End-tidal PCO2 is inferior to PtcCO2 as far as accuracy, but it provides breath-by-breath estimates of respiratory gas exchange, while PtcCO2 reflects temporal trends in alveolar ventilation. The frequency of monitoring end-tidal PCO2 has markedly increased in light of its multiple applications (e.g., verify endotracheal intubation, anesthesia or mechanical ventilation, exercise testing, respiratory patterning during sleep, etc.).
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Affiliation(s)
- Akira Umeda
- Department of General Medicine, School of Medicine, IUHW Shioya Hospital, International University of Health and Welfare (IUHW), Yaita 329-2145, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara 324-8501, Japan
| | - Akane Ikeda
- Department of Rehabilitation, IUHW Shioya Hospital, International University of Health and Welfare (IUHW), Yaita 329-2145, Japan
| | - Kazuya Miyagawa
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara 324-8501, Japan
| | - Atsumi Mochida
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara 324-8501, Japan
| | - Hiroshi Takeda
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara 324-8501, Japan
- Department of Pharmacology, School of Pharmacy at Fukuoka, International University of Health and Welfare, Okawa 831-8501, Japan
| | - Kotaro Takeda
- Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake 470-1192, Japan
| | - Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, Chiba 264-0007, Japan
- Laboratory of Electrophysiology, Clinical Research Center, Murayama Medical Center, Musashimurayama 208-0011, Japan
| | - Yasumasa Okada
- Laboratory of Electrophysiology, Clinical Research Center, Murayama Medical Center, Musashimurayama 208-0011, Japan
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, MU Women's and Children's Hospital, University of Missouri, Columbia, MO 65201, USA
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Dervieux E, Bodinier Q, Uhring W, Théron M. Measuring hemoglobin spectra: searching for carbamino-hemoglobin. J Biomed Opt 2020; 25:JBO-200170RR. [PMID: 33098280 PMCID: PMC7610246 DOI: 10.1117/1.jbo.25.10.105001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 05/06/2023]
Abstract
SIGNIFICANCE The arterial carbon dioxide (CO2) partial pressure PaCO2 is a clinically relevant variable. However, its measurement requires arterial blood sampling or bulky and expensive transcutaneous PtcCO2 meters. While the spectrophotometric determination of hemoglobin species-such as oxy-hemoglobin (O2Hb) and deoxy-hemoglobin (HHb)-allowed for the development of pulse oximetry, the measurement of CO2 blood content with minimal discomfort has not been addressed yet. AIM Characterizing human carbamino-hemoglobin (CO2Hb) absorption spectrum, which is missing from the literature. Providing the theoretical background that will allow for transcutaneous, noninvasive PaCO2 measurements. APPROACH A tonometry-based approach was used to obtain gas-equilibrated, lysed, diluted human blood. Equilibration was performed with both CO2, dinitrogen (N2), and ambient air. Spectrophotometric measurements were carried out on the 235- to 1000-nm range. A theoretical background was also derived from that of pulse oximetry. RESULTS The absorption spectra of both CO2Hb and HHb were extremely close and comparable with that of state-of-the-art HHb. The above-mentioned theoretical background led to an estimated relative error above 30% on the measured amount of CO2Hb in a subject's blood. Auxiliary measurements revealed that the use of ethylene diamine tetraacetic acid did not interfere with spectrophotometric measurements, whereas sodium metabisulfite did. CONCLUSIONS CO2Hb absorption spectrum was measured for the first time. Such spectrum being close to that of HHb, the use of a theoretical background based on pulse oximetry theory for noninvasive PaCO2 measurement seems extremely challenging.
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Affiliation(s)
- Emmanuel Dervieux
- BiOSENCY, Cesson-Sévigné, France
- University of Strasbourg and CNRS, Strasbourg Cedex, France
- Address all correspondence to Emmanuel Dervieux,
| | | | | | - Michaël Théron
- Université de Bretagne Occidentale, ORPHY, Brest, France
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15
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Wong CK, Ho DTY, Tam AR, Zhou M, Lau YM, Tang MOY, Tong RCF, Rajput KS, Chen G, Chan SC, Siu CW, Hung IFN. Artificial intelligence mobile health platform for early detection of COVID-19 in quarantine subjects using a wearable biosensor: protocol for a randomised controlled trial. BMJ Open 2020; 10:e038555. [PMID: 32699167 PMCID: PMC7380847 DOI: 10.1136/bmjopen-2020-038555] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an outbreak of COVID-19 worldwide. As there is no effective therapy or vaccine yet, rigorous implementation of traditional public health measures such as isolation and quarantine remains the most effective tool to control the outbreak. When an asymptomatic individual with COVID-19 exposure is being quarantined, it is necessary to perform temperature and symptom surveillance. As such surveillance is intermittent in nature and highly dependent on self-discipline, it has limited effectiveness. Advances in biosensor technologies made it possible to continuously monitor physiological parameters using wearable biosensors with a variety of form factors. OBJECTIVE To explore the potential of using wearable biosensors to continuously monitor multidimensional physiological parameters for early detection of COVID-19 clinical progression. METHOD This randomised controlled open-labelled trial will involve 200-1000 asymptomatic subjects with close COVID-19 contact under mandatory quarantine at designated facilities in Hong Kong. Subjects will be randomised to receive a remote monitoring strategy (intervention group) or standard strategy (control group) in a 1:1 ratio during the 14 day-quarantine period. In addition to fever and symptom surveillance in the control group, subjects in the intervention group will wear wearable biosensors on their arms to continuously monitor skin temperature, respiratory rate, blood pressure, pulse rate, blood oxygen saturation and daily activities. These physiological parameters will be transferred in real time to a smartphone application called Biovitals Sentinel. These data will then be processed using a cloud-based multivariate physiology analytics engine called Biovitals to detect subtle physiological changes. The results will be displayed on a web-based dashboard for clinicians' review. The primary outcome is the time to diagnosis of COVID-19. ETHICS AND DISSEMINATION Ethical approval has been obtained from institutional review boards at the study sites. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Chun Ka Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Deborah Tip Yin Ho
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony Raymond Tam
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mi Zhou
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk Ming Lau
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Milky Oi Yan Tang
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Gengbo Chen
- Research and Development, Biofourmis, Singapore
| | | | - Chung Wah Siu
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ivan Fan Ngai Hung
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Gahier M, Hersant J, Hamel JF, Sempore Y, Bruneau A, Henni S, Abraham P. A Simple Scale for Screening Lower-Extremity Arterial Disease as a Possible Cause of Low Back Pain: a Cross-sectional Study Among 542 Subjects. J Gen Intern Med 2020; 35:1963-1970. [PMID: 32367389 PMCID: PMC7351938 DOI: 10.1007/s11606-020-05670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiological, imaging, and anatomical studies suggest an association between proximal arterial atherosclerosis and development of low back pain (LBP). OBJECTIVES We aimed to define (1) the frequency and (2) factors associated with exercise-induced proximal ischemia (EIPI) in individuals with LBP and (3) develop a clinical screening scale. DESIGN Monocentric cross-sectional study. PARTICIPANTS All patients with history of ongoing LBP referred to our exercise investigation laboratory for exercise transcutaneous oximetry (ex-tcPO2) between January 2011 and December 2017 (n = 542; mean age, 65.4 ± 10.9; 83.9% men). MAIN MEASURES EIPI was defined as a decrease from rest of oxygen pressure (DROP) below - 15 mmHg on the lumbar and/or buttock probes. Ex-tcPO2 is a reliable validated tool for diagnosing EIPI in comparison with arteriography and computed tomography angiography. Ex-tcPO2 was performed on a treadmill until symptom manifestation or exhaustion. Clinical data were collected using interview questionnaires, medical file review, and clinical examination. KEY RESULTS EIPI was diagnosed in 282 patients (52%). Age ≤ 70 years (OR, 2.22; 95% CI, 1.35-3.57; p = 0.002), a history of proximal revascularization (OR, 2.64; 95% CI, 1.50-4.65; p = 0.001), use of antiplatelet medication (OR, 1.71; 95% CI, 0.96-3.06; p = 0.069), a relationship between exercise and LBP (OR, 2.61; 95% CI, 1.49-4.57; p = 0.001), and an abnormal ankle to brachial index (OR, 2.87; 95% CI, 1.77-4.66; p < 0.0001) were identified as EIPI predictors. Using these items, we developed a screening scale that showed an area under the receiver operating characteristics curve of .756. At a score of ≥ 3, the sensitivity, specificity, and accuracy for EIPI were 84%, 55%, and 71%, respectively. CONCLUSIONS EIPI was common among our patients with LBP undergoing ex-TcPO2. Our screening scale could help better select the patients who require angiography.
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Affiliation(s)
- M Gahier
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.
| | - J Hersant
- Vascular Medicine, University Hospital, Angers, France
| | - J F Hamel
- Methodology and Biostatistics Department, Angers University Hospital, Angers, France
| | - Y Sempore
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - A Bruneau
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - S Henni
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
| | - P Abraham
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
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17
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Grangeat P, Gharbi S, Accensi M, Grateau H. First Evaluation of a Transcutaneous Carbon Dioxide Monitoring Wristband Device during a Cardiopulmonary Exercise Test .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:3352-3355. [PMID: 31946599 DOI: 10.1109/embc.2019.8857020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We introduce an innovative wristband wireless device based on a dual wavelength NDIR optical measurement and an optimized thermo-fluidic channel to improve the extraction of the carbon dioxide gas from the blood within the heated skin region. We describe a signal processing model combining an innovative linear quadratic model of the optical measurement and a fluidic model. The evaluation is achieved using a cardiopulmonary exercise test (CPET). We compare carbon dioxide tension measurement at the forearm level using our device, with an electrochemical measurement at the forearm level, and an optical measurement of the end-tidal exhaled breath. These curves demonstrate a significant reduction of the variability of carbon dioxide pressure measurement with respect to the pressure dynamic range during the test.
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Pilcher J, Thayabaran D, Ebmeier S, Williams M, Back G, Collie H, Richards M, Bibby S, Semprini R, Weatherall M, Beasley R. The effect of 50% oxygen on PtCO 2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials. BMC Pulm Med 2020; 20:125. [PMID: 32380988 PMCID: PMC7203892 DOI: 10.1186/s12890-020-1132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-concentration oxygen therapy causes increased arterial partial pressure of carbon dioxide (PaCO2) in patients with COPD, asthma, pneumonia, obesity and acute lung injury. The objective of these studies was to investigate whether this physiological response to oxygen therapy occurs in stable patients with neuromuscular disease or kyphoscoliosis, and bronchiectasis. METHODS Three randomised cross-over trials recruited stable patients with neuromuscular disease or kyphoscoliosis (n = 20), bronchiectasis (n = 24), and COPD (n = 24). Participants were randomised to receive 50% oxygen and 21% oxygen (air), each for 30 min, in randomly assigned order. The primary outcome was transcutaneous partial pressure of carbon dioxide (PtCO2) at 30 min. The primary analysis was a mixed linear model. RESULTS Sixty six of the 68 participants had baseline PtCO2 values < 45 mmHg. The intervention baseline adjusted PtCO2 difference (95% CI) between oxygen and room air after 30 min was 0.2 mmHg (- 0.4 to 0.9), P = 0.40; 0.5 mmHg (- 0.2 to 1.2), P = 0.18; and 1.3 mmHg (0.7 to 1.8), P < 0.001, in the neuromuscular/kyphoscoliosis, bronchiectasis and COPD participants respectively. CONCLUSIONS The small increase in PtCO2 in the stable COPD patients with high-concentration oxygen therapy contrasts with the marked increases in PaCO2 seen in the setting of acute exacerbations of COPD. This suggests that the model of studying the effects of high-concentration oxygen therapy in patients with stable respiratory disease is not generalisable to the use of oxygen therapy in the acute clinical setting. Appropriate studies of high-concentration compared to titrated oxygen in acute clinical settings are needed to determine if there is a risk of oxygen-induced hypercapnia in patients with neuromuscular disease, kyphoscoliosis or bronchiectasis. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000970549 Registered 16/9/15, ACTRN12615000971538 Registered 16/9/15 and ACTRN12615001056583 Registered 7/10/15.
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Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| | - Darmiga Thayabaran
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Stefan Ebmeier
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Mathew Williams
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Geraldine Back
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Hamish Collie
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Susan Bibby
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Ruth Semprini
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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Kotsiou OS, Karadontas V, Daniil Z, Zakynthinos E, Gourgoulianis KI. Transcutaneous carbon dioxide monitoring as a predictive tool for all-cause 6-month mortality after acute pulmonary embolism. Eur J Intern Med 2019; 68:44-50. [PMID: 31416659 DOI: 10.1016/j.ejim.2019.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) frequently remains undiagnosed. The partial pressure of carbon dioxide (PaCO2), a surrogate of dead-space ventilation, is useful in the evaluation of the degree of pulmonary artery occlusion. At present, there is no knowledge about the prognostic role of PaCΟ2 variations during the first hours of an acute PE. Transcutaneous measurement of CO2 (PtcCO2) is a simple, non-invasive method that correlates well with PaCO2 levels, evaluated in this study for the first time in patients with PE. PURPOSE To assess the correlation between PtcCO2 and PaCO2 levels in the acute phase of PE and the role of PtcCO2 in predicting 6-months mortality. METHODS This was a pilot study including 53 patients with acute PE who hospitalized in Respiratory Medicine Department at University Hospital of Larissa in central Greece during 15 months. PtcCO2 was constantly monitored for four hours after PE diagnosis with the TCM40 monitoring system (SmartCal). Simultaneous arterial blood gas measurements were performed. Each patient was prospectively recorded for six months via standard telephone calls. RESULTS PaCO2 and PtcCO2 values were well-correlated in the acute phase of PE. Decreased PtcCO2 levels in the first monitoring hour were associated with a higher risk of mortality. In the PE subgroup who died, the lower PtcCO2 level in the first hour of PE was a predictor of shorter survival time independently of gender, age, comorbidities, and smoking status. CONCLUSION PtcCO2 measurement, especially in the first hour after PE, seemed to be a valid tool in predicting all-cause 6-month mortality.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece.
| | - Vasileios Karadontas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
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Namgoong S, Yang JP, Han SK, Lee YN, Dhong ES. Influence of Peripheral Neuropathy and Microangiopathy on Skin Hydration in the Feet of Patients With Diabetes Mellitus. Wounds 2019; 31:173-178. [PMID: 31184593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Maintaining adequate skin hydration is crucial in the feet of patients with diabetes because xerotic skin may crack and develop fissures, thereby increasing vulnerability to ulceration and infection. The nervous system is considered the powerhouse for maintaining adequate skin hydration; however, no clinical study has assessed the effect of the nervous system on skin hydration. In addition, it is hypothesized that microcirculation may play an important role in maintaining adequate hydration in patients with diabetes. OBJECTIVE This study aims to evaluate the influence of peripheral nerve function and microvascularity on skin hydration in the feet of patients with diabetes mellitus and compare the effects of these 2 functions on skin hydration. MATERIALS AND METHODS This study included 266 patients with diabetic foot disease. Skin hydration was evaluated using corneometry and microvascularity by measuring the transcutaneous oximetry (TcpO₂) of the foot. The Semmes-Weinstein 5.07/10-g monofilament test, electromyography, and nerve conduction velocity test were conducted to evaluate peripheral neuropathy. Patient data were divided into 3 subgroups according to test values, and statistical comparisons were performed using the linear-by-linear association trend and Pearson's chi-square tests. RESULTS There was a significant correlation between skin hydration and TcpO₂. However, there was no significant correlation between skin hydration and peripheral nerve function (P = .338). CONCLUSIONS The results of this study demonstrated that skin hydration in the feet of patients with diabetes mellitus mainly is influenced by microcirculation rather than peripheral nerve function.
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Affiliation(s)
- Sik Namgoong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Phil Yang
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ye-Na Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Eun Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
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Stivalet O, Paisant A, Belabbas D, Omarjee L, Le Faucheur A, Landreau P, Garlantezec R, Jaquinandi V, Liedl DA, Wennberg PW, Mahé G. Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography. PLoS One 2019; 14:e0219082. [PMID: 31247050 PMCID: PMC6597112 DOI: 10.1371/journal.pone.0219082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whether or not defined criteria defined in patients suspected of having a PAD show a difference dependent on the resting ABI. METHODS In this prospective study, consecutive patients with exertional limb pain referred to our vascular center were included. All patients had an ABI, a treadmill exercise-oximetry test, a second treadmill test (both 10% slope; 3.2km/h speed) with post-exercise pressures, and a computed-tomography-angiography (CTA). The receiver-operating-characteristic curve was used to define a cut-off point corresponding to the best area under the curve (AUC; [CI95%]) to detect arterial stenosis ≥50% as determined by the CTA. RESULTS Sixty-three patients (61+/-11 years-old) were included. Similar AUCs from 0.72[0.63-0.79] to 0.83[0.75-0.89] were found for the different tests in the overall population. To detect arterial stenosis ≥50%, cut-off values of ABI, post-exercise ABI, post-exercise ABI decrease, post-exercise ankle pressure decrease, and distal delta from rest oxygen pressure (DROP) index were ≤0.91, ≤0.52, ≥43%, ≥20mmHg and ≤-15mmHg, respectively (p<0.01). In the subset of patients with an ABI >0.91, cut-off values of post-exercise ABI decrease (AUC = 0.67[0.53-0.78]), and DROP (AUC = 0.67[0.53-0.78]) were ≥18.5%, and ≤-15mmHg respectively (p<0.05). CONCLUSION Resting ABI is as accurate as exercise testing in patients with exertional limb pain. Specific exercise testing cut-off values should be used in patients with normal ABI to diagnose PAD.
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Affiliation(s)
- O. Stivalet
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine, CH de Saint Malo, Saint-Malo, France
| | - A. Paisant
- Radiology Department, CHU Rennes, Rennes, France
| | - D. Belabbas
- Radiology Department, CHU Rennes, Rennes, France
| | - L. Omarjee
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine Unit, CH de Redon, Redon, France
| | - A. Le Faucheur
- Univ Rennes; INSERM CIC, Rennes, France
- Ecole Normale Supérieure, Bruz, France
| | - P. Landreau
- Vascular Medicine Unit, CHU Rennes, Rennes, France
| | | | - V. Jaquinandi
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Univ Rennes; INSERM CIC, Rennes, France
| | - D. A. Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
| | - P. W. Wennberg
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
| | - G. Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Univ Rennes; INSERM CIC, Rennes, France
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
- * E-mail:
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Azzopardi YM, Gatt A, Chockalingam N, Formosa C. Agreement of clinical tests for the diagnosis of peripheral arterial disease. Prim Care Diabetes 2019; 13:82-86. [PMID: 30201222 DOI: 10.1016/j.pcd.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting. METHODS Fifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressure were compared in the detection of peripheral arterial disease. One hundred limbs were included for analysis. RESULTS This study showed different results in peripheral arterial disease screening tests in the same group of participants. The highest percentage of participants who had PAD was for the Doppler Waveform (93.0%). This was followed by TBPI (72.0%), ABPI (57.0%), ATP (35.0%), TCPO (30.0%) and pulse palpation (23.0%). The difference between these percentages is significant (p<0.0005). The magnitude of the effect size is medium/moderate (Cramer's V=0.498). CONCLUSION This study demonstrates that inconsistencies exist between the agreement of the 6 different modalities used to detect PAD. These findings should create an awareness amongst clinicians when interpreting results of these tests. The authors advocate for urgent, more robust studies utilizing a gold standard modality for the diagnosis of PAD in order to provide evidence regarding which screening modalities would yield the most valid results.
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Affiliation(s)
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
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23
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Eleftheriadou I, Tentolouris A, Grigoropoulou P, Tsilingiris D, Anastasiou I, Kokkinos A, Perrea D, Katsilambros N, Tentolouris N. The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:165-170. [PMID: 30446479 DOI: 10.1016/j.jdiacomp.2018.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/25/2018] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
AIMS To study the impact of diabetic neuropathy, both peripheral sensorimotor (DPN) and cardiac autonomic neuropathy (CAN), on transcutaneous oxygen tension (TcPO2) in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 163 participants were recruited; 100 with T2DM and 63 healthy individuals. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI) values ≤0.90. Diagnosis of DPN was based on neuropathy symptom score and neuropathy disability score (NDS), while diagnosis of CAN on the battery of the cardiovascular autonomic function tests. TcPO2 was measured using a TCM30 system. RESULTS Patients with T2DM had lower TcPO2 levels when compared with healthy individuals. Among the diabetic cohort, those who had either PAD, DPN or CAN had significantly lower TcPO2 values than participants without these complications. Multivariate linear regression analysis, after controlling for diabetes duration, diastolic blood pressure, HbA1c, albumin to creatinine ratio and CAN score, demonstrated that TcPO2 levels were significantly and independently associated with current smoking (p = 0.013), ABI (p = 0.003), and NDS (p = 0.013). CONCLUSION Presence of DPN is independently associated with impaired cutaneous perfusion. Low TcPO2 in subjects with DPN may contribute to delay in healing of diabetic foot ulcers, irrespectively of PAD.
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Affiliation(s)
- Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Pinelopi Grigoropoulou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Anastasiou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexandros Kokkinos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research, Athens University Medical School, Athens, Greece
| | - Nikolaos Katsilambros
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
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24
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Coppola A, Montalcini T, Gallotti P, Luzi L, Pujia A, Giustina A, Gazzaruso C. Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women. Endocrine 2019; 63:177-181. [PMID: 30302662 DOI: 10.1007/s12020-018-1782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Several studies suggested that abnormalities in tissue perfusion of external genitalia and vagina can lead to female sexual dysfunctions (FSDs) and can be associated to metabolic and cardiovascular risk factors. However, there are some technical difficulties in assessing these abnormalities. The measurement of oxygen partial pressure is a noninvasive method to measure oxygen partial pressure (pO2) at the skin surface to assess tissue perfusion. The aim of this study was to evaluate whether transmucosal oxygen tension (TmPO2) can be measured at the mucosal surface of clitoris and whether the measurements are reliable. METHODS TmPO2 was measured in six young healthy women by using a device to measure transcutaneous pO2 on the skin and by choosing a small sensor, usually used for newborns. The identical procedure for the detection of pO2 at the skin surface was used. RESULTS The mean value of TmPO2 was 42.3 mmHg (range: 24.1-53.4 mmHg). All the trend curves of the TmPO2 showed the same behavior: after a stabilization time, there was a stable pO2 (plateau phase) that corresponds to the TmPO2 of the clitoris. These curves had a similar trend to those recorded at the skin surface. CONCLUSIONS TmPO2 can be easily measured at the mucosal surface of clitoris. Large epidemiological studies in healthy and unhealthy women and in women with FSD are needed to establish both the normal range of TmPO2 and the meaning that different values of TmPO2 can have on sexual and general health of the women.
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Affiliation(s)
- A Coppola
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - T Montalcini
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - P Gallotti
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - L Luzi
- Department of Biomedical Sciences for Health, University of Milan, 20100, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, 20097, San Donato Milanese, Italy
| | - A Pujia
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - A Giustina
- Chair of Endocrinology, San Raffaele Vita-Salute University, Milan, Italy
| | - C Gazzaruso
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy.
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25
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Bardsley G, Pilcher J, McKinstry S, Shirtcliffe P, Berry J, Fingleton J, Weatherall M, Beasley R. Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial. BMC Pulm Med 2018; 18:157. [PMID: 30285695 PMCID: PMC6171193 DOI: 10.1186/s12890-018-0720-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In exacerbations of chronic obstructive pulmonary disease, administration of high concentrations of oxygen may cause hypercapnia and increase mortality compared with oxygen titrated, if required, to achieve an oxygen saturation of 88-92%. Optimally titrated oxygen regimens require two components: titrated supplemental oxygen to achieve the target oxygen saturation and, if required, bronchodilators delivered by air-driven nebulisation. The effect of repeated air vs oxygen-driven bronchodilator nebulisation in acute exacerbations of chronic obstructive pulmonary disease is unknown. We aimed to compare the effects of air versus oxygen-driven bronchodilator nebulisation on arterial carbon dioxide tension in exacerbations of chronic obstructive pulmonary disease. METHODS A parallel group double-blind randomised controlled trial in 90 hospital in-patients with an acute exacerbation of COPD. Participants were randomised to receive two 2.5 mg salbutamol nebulisers, both driven by air or oxygen at 8 L/min, each delivered over 15 min with a 5 min interval in-between. The primary outcome measure was the transcutaneous partial pressure of carbon dioxide at the end of the second nebulisation (35 min). The primary analysis used a mixed linear model with fixed effects of the baseline PtCO2, time, the randomised intervention, and a time by intervention interaction term; to estimate the difference between randomised treatments at 35 min. Analysis was by intention-to-treat. RESULTS Oxygen-driven nebulisation was terminated in one participant after 27 min when the PtCO2 rose by > 10 mmHg, a predefined safety criterion. The mean (standard deviation) change in PtCO2 at 35 min was 3.4 (1.9) mmHg and 0.1 (1.4) mmHg in the oxygen and air groups respectively, difference (95% confidence interval) 3.3 mmHg (2.7 to 3.9), p < 0.001. The proportion of patients with a PtCO2 change ≥4 mmHg during the intervention was 18/45 (40%) and 0/44 (0%) for oxygen and air groups respectively. CONCLUSIONS Oxygen-driven nebulisation leads to an increase in PtCO2 in exacerbations of COPD. We propose that air-driven bronchodilator nebulisation is preferable to oxygen-driven nebulisation in exacerbations of COPD. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry number ACTRN12615000389505 . Registration confirmed on 28/4/15.
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Affiliation(s)
- George Bardsley
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - Janine Pilcher
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Steven McKinstry
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Philippa Shirtcliffe
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - James Berry
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Wellington School of Medicine & Health Sciences, University of Otago Wellington, Wellington, New Zealand
| | - James Fingleton
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - Mark Weatherall
- Wellington School of Medicine & Health Sciences, University of Otago Wellington, Wellington, New Zealand
| | - Richard Beasley
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
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26
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Deev R, Plaksa I, Bozo I, Mzhavanadze N, Suchkov I, Chervyakov Y, Staroverov I, Kalinin R, Isaev A. Results of 5-year follow-up study in patients with peripheral artery disease treated with PL-VEGF165 for intermittent claudication. Ther Adv Cardiovasc Dis 2018; 12:237-246. [PMID: 29996720 PMCID: PMC6116753 DOI: 10.1177/1753944718786926] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effective treatment of chronic lower limb ischemia is one of the most challenging issues confronting vascular surgeons. Current pharmacological therapies play an auxiliary role and cannot prevent disease progression, and new treatment methods are needed. In 2011, a plasmid VEGF65-gene therapy drug was approved in Russia for the treatment of chronic lower limb ischemia ( ClinicalTrials.gov identifier: NCT03068585). The objective of this follow-up study was to evaluate the long-term safety and efficacy of gene therapy in patients with limb ischemia of atherosclerotic genesis. AIMS To evaluate the long-term safety and efficacy of the therapeutic angiogenesis, 36 patients in the treatment group (pl- VEGF165) and 12 patients in the control group participated in a 5-year follow-up study. Planned examinations were carried out annually for 5 years after pl- VEGF165 administration. RESULTS Differences in the frequency of major cardiovascular events (pl- VEGF165 5/36 versus control 2/12; p = 0.85), malignancies (pl- VEGF165 1/36 versus control 0/12; p = 0.38) and impaired vision (there was none in either group) over the 5-year follow-up period did not achieve statistical significance. The target limb salvage was 95% ( n = 36) and 67% ( n = 12) in the pl- VEGF165 and control groups, respectively. The pain-free walking distance value increased by 288% from 105.7 ± 16.5 m to 384 ± 39 m in the treatment group by the end of the fifth year, with a peak of 410.6 ± 86.1 m achieved by the end of the third year. The ankle-brachial index (ABI) increased from 0.47 ± 0.01 to 0.56 ± 0.02 by the end of the first year, with a subsequent slight decrease to 0.51 ± 0.02 by the fifth year. The maximum increment of transcutaneous oximetry test (tcoO2) by 36%, from 66.6 ± 3.7 mm Hg to 90.7 ± 4.9 mm Hg, was observed by the end of the second year. CONCLUSION The therapeutic effect of angiogenesis induction by gene therapy persists for 5 years.
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Affiliation(s)
- Roman Deev
- Human Stem Cells Institute, Moscow, Russia Ryazan I.P. Pavlov State Medical University, Ryazan, Russia
| | - Igor Plaksa
- Human Stem Cells Institute, Moscow, Russia Moscow City Oncology Hospital No 62, Moscow, Russia
| | - Ilia Bozo
- Human Stem Cells Institute, Moscow, Russia A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Igor Suchkov
- Ryazan I.P. Pavlov State Medical University, Ryazan, Russia
| | | | | | - Roman Kalinin
- Ryazan I.P. Pavlov State Medical University, Ryazan, Russia
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27
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Fagher K, Katzman P, Löndahl M. Transcutaneous oxygen pressure as a predictor for short-term survival in patients with type 2 diabetes and foot ulcers: a comparison with ankle-brachial index and toe blood pressure. Acta Diabetol 2018; 55:781-788. [PMID: 29707757 PMCID: PMC6060900 DOI: 10.1007/s00592-018-1145-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022]
Abstract
AIMS Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is considered a marker for cardiovascular risk. Transcutaneous oxygen pressure (TcPO2), a test associated with microvascular function, has in several studies shown better correlation with diabetic foot ulcer (DFU) healing. Whether a low TcPO2 could be a marker for mortality in the high-risk population of DFU patients has not been evaluated before. The aim of this study was to evaluate the predictive value of TcPO2 in comparison with ABI and toe blood pressure (TBP) on 1-year mortality in type 2 diabetes patients with DFU. METHODS Type 2 diabetes patients aged ≤ 90 years, with one DFU who attended our multidisciplinary DFU-unit during year 2013-2015 and were screened with TcPO2, ABI and TBP were retrospectively evaluated. One-year mortality was assessed from the national death register in Sweden. RESULTS A total of 236 patients (30% women) with a median age of 76 (69-82) years were evaluated in this study. Within 1 year, 14.8% of the patients died. TcPO2 < 25 mmHg was associated with a higher 1-year mortality compared with TcPO2 ≥ 25 mmHg (27.7 vs. 11.6%, p = 0.003). TBP and ABI did not significantly influence 1-year mortality. In a Cox regression analysis adjusted for confounders, TcPO2 was independently predicting 1-year mortality with a hazard ratio for TcPO2 < 25 mmHg of 2.8 (95% CI 1.34-5.91, p = 0.006). CONCLUSIONS This study indicates that a low TcPO2 is an independent prognostic marker for 1-year mortality among patients with type 2 diabetes and DFU.
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Affiliation(s)
- K Fagher
- Clinical Sciences in Lund, Lund University, Lund, Sweden.
- Department of Endocrinology, Skåne University Hospital, 22185, Lund, Sweden.
| | - P Katzman
- Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, 22185, Lund, Sweden
| | - M Löndahl
- Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, 22185, Lund, Sweden
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28
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Henni S, Ammi M, Gourdier AS, Besnier L, Signolet I, Colas-Ribas C, Picquet J, Abraham P. Ankle brachial index is equally predictive of exercise-induced limb ischemia in diabetic and non-diabetic patients with walking limitation. J Diabetes Complications 2018; 32:702-707. [PMID: 29724591 DOI: 10.1016/j.jdiacomp.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/20/2018] [Accepted: 03/25/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND In diabetic patients, arterial stiffness may impair compressibility of vessels and result in higher ankle to brachial index (ABI) than in non-diabetic subjects. METHODS We studied 1972 non-diabetic and 601 diabetic patients, with suspected peripheral artery disease, Exercise transcutaneous oxygen pressure (Ex-tcpO2), expressed in DROP index (limb tcpO2 change minus chest tcpO2 change), is insensitive to arterial stiffness and can estimate exercise-induced regional blood flow impairment (RBFI). A minimal DROP <-15 mm Hg indicates the presence of RBFI (positive test). ABI was simplified to a category variable (ABIc) by rounding ABI to the closest first decimal. RESULTS In the ABIc range 0.4 to 1.1 linear regression for mean DROP values were: y = 34 x - 53; (R2 = 0.211) and y = 33 x - 52; (R2 = 0.186) in diabetic and Non-diabetic patients, respectively. Both Db and non-D patients showed a high proportion of positive Ex-tcpO2 tests for ABIc in the normal range (ABIc: 1.0 and over) from 27.1 to up to 58%. More than half of patients with borderline ABI (ABIc = 0.9) had RBFI during exercise. it was 65.6% in diabetic and 58.5% non-diabetic patients. CONCLUSIONS Resting ABI was not a better predictor of exercise-induced RBFI in non-Db than in Diabetic patients. Our results highlights the interest of still measuring resting-ABI in diabetic patients to argue for the vascular origin of exertional limb pain, but also of performing exercise tests in patients with walking impairment.
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Affiliation(s)
- Samir Henni
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France; Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France
| | - Myriam Ammi
- Vascular and Thoracic Surgery, University Hospital, 49933 Angers Cedex 09, France
| | - Anne-Sophie Gourdier
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Louis Besnier
- Radiology Department, University Hospital, 49933 Angers Cedex 09, France
| | - Isabelle Signolet
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Christophe Colas-Ribas
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Jean Picquet
- Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France; Vascular and Thoracic Surgery, University Hospital, 49933 Angers Cedex 09, France
| | - Pierre Abraham
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France; Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France.
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29
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Vriens B, D'Abate F, Ozdemir BA, Fenner C, Maynard W, Budge J, Carradice D, Hinchliffe RJ. Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration. Diabet Med 2018; 35:895-902. [PMID: 29633431 DOI: 10.1111/dme.13634] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/27/2022]
Abstract
AIM Peripheral artery disease is common in people with diabetes-related foot ulceration and is a risk factor for amputation. The best method for the detection or exclusion of peripheral artery disease is unknown. This study investigated the utility of clinical examination and non-invasive bedside tests in screening for peripheral artery disease in diabetes-related foot ulceration. METHODS Some 60 people presenting with new-onset ulceration participated. Accuracy of pulses, ankle pressure, toe pressure, toe-brachial index (TBI), ankle-brachial pressure index (ABPI), pole test at ankle, transcutaneous oxygen pressure and distal tibial waveform on ultrasound were examined. The gold standard diagnostic test used was > 50% stenosis in any artery or monophasic flow distal to calcification in any ipsilateral vessel on duplex ultrasound. RESULTS The negative and positive likelihood ratios of pedal pulse assessment (0.75, 1.38) and the other clinical assessment tools were poor. The negative and positive likelihood ratios of ABPI (0.53, 1.69), transcutaneous oxygen pressure (1.10, 0.81) and ankle pressure (0.67, 2.25) were unsatisfactory. The lowest negative likelihood ratios were for tibial waveform assessment (0.15) and TBI (0.24). The highest positive likelihood ratios were for toe pressure (17.55) and pole test at the ankle (10.29) but the negative likelihood ratios were poor at 0.56 and 0.74. CONCLUSIONS Pulse assessment and ABPI have limited utility in the detection of peripheral artery disease in people with diabetes foot ulceration. TBI and distal tibial waveforms are useful for selecting those needing diagnostic testing.
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Affiliation(s)
- B Vriens
- Vascular Department, Colchester General Hospital, Colchester Hospital University NHS Foundation Trust, Colchester
| | - F D'Abate
- St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London
| | - B A Ozdemir
- St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London
| | - C Fenner
- St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London
| | - W Maynard
- St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London
| | - J Budge
- St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London
| | - D Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull
| | - R J Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
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Liu Z, Chi J, Feng Z. Observation of curative effect of nasal continuous positive airway pressure combined with high-dose ambroxol for neonatal respiratory failure. Pak J Pharm Sci 2018; 31:1663-1666. [PMID: 30203757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To observe and analyze the effectiveness of nasal continuous positive airway pressure for neonatal respiratory failure. The 200 newborns with respiratory failure treated in our hospital. They were enrolled as study subjects and assigned to study group and reference group with equal number of cases. The study group was treated with continuous positive airway pressure plus high-dose ambroxol, while the reference group only received high-dose ambroxol. The overall treatment effect was compared between the two groups. Observation of the overall treatment efficacy of the study group and the reference group showed that the study group was superior to the reference group, P<0.05; comparison of such treatment indicators as disappearance of shortness of breath, disappearance of cyanosis, disappearance of groaning, assisted ventilation duration, hospital stay showed that the study group was significantly superior to the reference group, P<0.05; comparison of arterial oxygen partial pressure, oxygen saturation, and carbon dioxide partial pressure showed differences between groups, P<0.05. Treatment of neonatal respiratory failure with nasal continuous positive airway pressure plus high-dose ambroxol can achieve good results and reduce hospital stay.
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Affiliation(s)
- Zhen Liu
- BaYi Children's Hospital, Clinical Medical College in PLA Army General Hospital, Southern Medical University, Beijing, China / National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China / Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Jinghan Chi
- BaYi Children's Hospital, Clinical Medical College in PLA Army General Hospital, Southern Medical University, Beijing, China / National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China / Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Zhichun Feng
- BaYi Children's Hospital, Clinical Medical College in PLA Army General Hospital, Southern Medical University, Beijing, China / National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China / Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
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Henni S, Mahe G, Lamotte C, Laurent R, Riviere AB, Aubourg M, Sarlon G, Laneelle D, Long A, Signolet I, Picquet J, Feuilloy M, Abraham P. Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain. Eur J Intern Med 2018; 52:28-34. [PMID: 29306678 DOI: 10.1016/j.ejim.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/05/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In lower extremity peripheral artery disease (PAD), transcutaneous oximetry at exercise (Ex-TcpO2) has been largely validated in research practice, but evidence of routine practice in various vascular laboratories is missing. We hypothesized that Ex-TcPO2 would change the diagnosis hypotheses, investigations and treatments for patients referred for exertional limb pain. MATERIAL & METHODS A multicenter prospective trial was conducted in nine different referral centers. Investigators performed Ex-TcpO2 and recorded investigations and treatments already scheduled for the patient. We encoded referral physician's diagnostic hypothesis. Before Ex-TcpO2, vascular physicians were asked to give their diagnosis hypotheses. A minimal decrease from rest of oxygen pressure (DROP)<minus 15mmHg defined the presence of exercise-induced ischemia on the area of interest. After Ex-TcPO2, we recorded post-test diagnostic hypothesis and investigations and treatments to be cancelled or performed. We compared the diagnosis hypotheses, scheduled investigations and treatments, before and after the Ex-TcpO2. RESULTS We included 603 patients (485 males: 80.4%), aged 64.7±9.8years. The post-test diagnosis hypothesis differed in 266 patients (44.1%; p<0.0001) and in 96 patients (15.9%) from the pre-test hypothesis of referring and vascular physician, respectively. This led to the recommendation to cancel 27 scheduled investigations or treatments of a total cost of ~130,000 euros. DISCUSSION Ex-TcPO2 in patients with exertional limb pain is applicable in various vascular institutions, and significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain.
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Affiliation(s)
- Samir Henni
- Explorations vasculaires adulte enfant, University Hospital, Angers, France
| | - Guillaume Mahe
- Unité de Médecine Vasculaire, INSERM CIC 1414, Université de Rennes 1, University Hospital, Rennes, France
| | - Christophe Lamotte
- Department of Internal Medicine, University Hospital, 59037 Lille Cedex, France
| | - Remi Laurent
- Département de pathologie vasculaire, Hôpital St Philibert, BP 249, 59462 Lomme Cedex, France
| | | | | | - Gabrielle Sarlon
- Unité de Médecine Vasculaire, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France; Unité INSERM 1062, INRA 1260, Aix-Marseille Université, France
| | - Damien Laneelle
- Médecine Vasculaire, Centre Hospitalier Universitaire, 14033 Caen cedex 9, France
| | - Anne Long
- Médecine Vasculaire, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, University Hospital, Lyon, France; Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69003 Lyon, France
| | - Isabelle Signolet
- Explorations vasculaires adulte enfant, University Hospital, Angers, France
| | - Jean Picquet
- Department of Vascular and Cardiothoracic Surgery, University Hospital, Angers, France; Mitovasc Institute, UMR CNRS-6015, INSERM-1083, University of Angers, France
| | | | - Pierre Abraham
- Explorations vasculaires adulte enfant, University Hospital, Angers, France; Mitovasc Institute, UMR CNRS-6015, INSERM-1083, University of Angers, France.
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Trucco F, Pedemonte M, Fiorillo C, Tan HL, Carlucci A, Brisca G, Tacchetti P, Bruno C, Minetti C. Detection of early nocturnal hypoventilation in neuromuscular disorders. J Int Med Res 2018; 46:1153-1161. [PMID: 29210305 PMCID: PMC5972237 DOI: 10.1177/0300060517728857] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO2/SpO2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity < 60%). Nocturnal hypoventilation was defined as tcPCO2 > 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO2 < 88% for > 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.
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MESH Headings
- Adolescent
- Blood Gas Monitoring, Transcutaneous
- Carbon Dioxide/blood
- Child
- Female
- Humans
- Hypercapnia/blood
- Hypercapnia/diagnosis
- Hypercapnia/physiopathology
- Hypoventilation/blood
- Hypoventilation/diagnosis
- Hypoventilation/physiopathology
- Male
- Muscular Dystrophies/blood
- Muscular Dystrophies/diagnosis
- Muscular Dystrophies/physiopathology
- Muscular Dystrophy, Duchenne/blood
- Muscular Dystrophy, Duchenne/diagnosis
- Muscular Dystrophy, Duchenne/physiopathology
- Myopathies, Structural, Congenital/blood
- Myopathies, Structural, Congenital/diagnosis
- Myopathies, Structural, Congenital/physiopathology
- Oximetry/methods
- Oxygen/blood
- Retrospective Studies
- Sclerosis/blood
- Sclerosis/diagnosis
- Sclerosis/physiopathology
- Spinal Muscular Atrophies of Childhood/blood
- Spinal Muscular Atrophies of Childhood/diagnosis
- Spinal Muscular Atrophies of Childhood/physiopathology
- Vital Capacity/physiology
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Affiliation(s)
| | - Marina Pedemonte
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Chiara Fiorillo
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Hui-leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Giacomo Brisca
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Paola Tacchetti
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genova, Italy
| | - Carlo Minetti
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
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Abstract
Skin oxygen tension (TcPo2) was measured at 43°C on patients (n=27) with venous ulcers. Measurements were made at ulcer edge and, proximally on the same limb for control. Similar measurements were also made on healthy volunteers (n=14) in the medial aspects of the distal third of the legs. TcPo2 at ulcer edge was significantly lower (P=0.001) than control values which in turn were lower than that measured on healthy volunteers. TcPo2 reflects skin nutrition. While low TcPo2 at ulcer edges might be the result of pericapillary barriers to oxygen transport, the control values measured on apparently normal skin suggest the need for further studies.
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Affiliation(s)
- R Mani
- Department of Medical Physics, University of Southampton Hospitals
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Affiliation(s)
- H Price
- Hospital for Sick Children, London
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35
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Teatini U, Ballerini L, Romei Longhena G, Savino R, Maltagliati L, Masi F, Colombo R, Cimino R, Manfredi A. Microcirculation as a Novel Marker of Membrane Biocompatibility. Int J Artif Organs 2018; 29:1117-20. [PMID: 17219351 DOI: 10.1177/039139880602901204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It is possible to consider microcirculation as a kind of “witness” of the complex biological reactions triggered by the dialytic treatment. The reactivity of microcirculation to the dialytic stress may represent a measure of the overall biocompatibility of the membrane. In this study we tested the hypothesis that different synthetic membranes may have different biological effects, particularly related to microcirculation. Subjects and Methods In this crossover study, we observed 16 chronically hemodialyzed patients. All patients were treated with the EVAL membrane; we recorded the TcPO2 during the second treatment of the week. All patients were then switched to the hf-PS membrane. During the study observation we did not change the dialytic prescription or the pharmacologic treatment. Results From the beginning of the session until 90', the behavior of TcPO2 is similar for both the membranes. From 120' to the end of the treatment in sessions with the EVAL membrane, the TcPO2 values come back to the starting level, whereas in the treatments with hf-PS the TcPO2, the values remain at a lower level; there was a significant difference between EVAL and hf-PS in the values recorded. Arterial blood gas values of paO2 and paCO2 are quite similar in the treatments with both the membranes, without any significant difference. Conclusions The analysis of microcirculation by means of TcPO2 measurement is a useful tool to obtain a “clinical” measure of biocompatibility of the dialytic treatment and different membranes may have different impacts on TcPO2.
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Affiliation(s)
- U Teatini
- Renal Unit, Bollate Hospital, Bollate, Milan, Italy.
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Kawecki M, Pasek J, Cieślar G, Sieroń A, Knefel G, Nowak M, Glik J. Computerized planimetry evaluation of hyperbaric oxygen therapy in the treatment of diabetic foot. ADV CLIN EXP MED 2018. [PMID: 29521041 DOI: 10.17219/acem/66392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diabetic foot ulcer is one of the major complications of diabetes mellitus in adults. OBJECTIVES The aim of the study was to conduct a planimetry evaluation of the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of patients with vascular disorders caused by diabetic foot. MATERIAL AND METHODS The study included 94 patients, 30 females (32%) and 64 males (68%), aged 33-76 years, with diabetes lasting 1.5-32 years, who underwent HBOT due to diabetic foot. All patients from that group underwent vascular procedures prior to HBOT. In qualifying patients for hyperbaric oxygen therapy, transcutaneous oximetry method was applied (30-60 exposures in hyperbaric oxygen at pressure of 2.5 ATA). Progress in wound healing was evaluated by computerized planimetry system IRIS 4. RESULTS In 26 patients the wounds were completely closed and in 37 patients the topical state was significantly improved - the wound surface decreased by 34% in average. During the treatment, in 11 patients amputation of fingers and metatarsal necrotic bones was performed, while in 9 patients amputation was prevented. CONCLUSIONS A planimetry evaluation showed that the application of HBOT in the treatment of diabetic foot enhances foot ulcer healing, reduces tissue damage, contributes to the reduction of complications related to soft tissue and bone infections.
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Affiliation(s)
- Marek Kawecki
- Centre for Burns Treatment, Siemianowice Śląskie, Poland
- Department of Health Sciences, Technical-Humanistic Academy, Bielsko-Biała Poland
| | - Jarosław Pasek
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
- Academy of Jan Długosz in Częstochowa, Institute of Physical Education Tourism and Physiotherapy, Częstochowa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
- Academy of Jan Długosz in Częstochowa, Institute of Physical Education Tourism and Physiotherapy, Częstochowa, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | | | - Mariusz Nowak
- Academy of Jan Długosz in Częstochowa, Institute of Physical Education Tourism and Physiotherapy, Częstochowa, Poland
| | - Justyna Glik
- Centre for Burns Treatment, Siemianowice Śląskie, Poland
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Katsui S, Inoue Y, Yamamoto Y, Igari K, Kudo T, Uetake H. In Patients with Severe Peripheral Arterial Disease, Revascularization-Induced Improvement in Lower Extremity Ischemia Can Be Detected by Laser Speckle Contrast Imaging of the Fluctuation in Blood Perfusion after Local Heating. Ann Vasc Surg 2017; 48:67-74. [PMID: 29217439 DOI: 10.1016/j.avsg.2017.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/21/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously reported the utility of the perfusion value (PV) fluctuation slope for detecting severe ischemia in the lower limb. Our approach was based on a thermal load test mimicking the well-known physiological reaction termed "cold-induced vasodilation," which is known to occur as a 3-phase phenomenon. The slope parameter quantifies the decrease in PVs accompanying the relative cooling (third phase) following the transient increase in blood flow (second phase) induced by the applied thermal load. This phenomenon of "relative" cold-induced vasodilation (rCIVD) can be monitored using laser speckle contrast imaging (LSCI) after applying the thermal load (LTL test). Here, we aimed to determine whether the slope parameter obtained via the LTL test also reflects the improvement in hemodynamics after revascularization. METHODS The study enrolled 16 patients (18 limbs), who underwent revascularization for peripheral arterial disease (PAD). The measurements were performed at 2 sites in each limb (in total, 34 sites; 2 sites in one patient were excluded because of significant movement during the measurement). For each site, we recorded the slope describing the behavior of PVs (decrease or plateau) in the third phase of rCIVD, following the initial, heating-induced increase in perfusion (second phase of rCIVD). The plateau group (group P), which included patients with an abnormal rCIVD, and the decrease group (group D), which included patients with a normal rCIVD, were defined based on perfusion slope values of <0.20 and ≥ 0.20 perfusion units/min, respectively. We also quantified the transient increase in perfusion (from baseline to peak) as a descriptor of perfusion behavior during the second phase of rCIVD. RESULTS In group P, the change in median values (25-75%) of the slope, transcutaneous oxygen tension, and ankle-brachial index (ABI) from before to after operation was (-0.02 [-0.04 to 0.02]; 4 [1-11]; and 0.08 [0-0.27]) to (0.39 [0.32-0.59]; 46 [37-54]; and 0.81 [0.72-0.90]). Conversely, in group D, the change in the median values of the slope, transcutaneous oxygen tension, and ABI between before and after operation was (0.38 [0.32-0.49]; 40.5 [35-45]; and0.58 [0.57-0.65]) to (0.44 [0.30-0.64]; 52 [43-56]; and 0.92 [0.81-0.99]). Sites exhibiting perfusion pattern of group D in the third phase of rCIVD showed no significant change in slope after revascularization (P = 0.21), whereas the slope in group P increased significantly after revascularization, becoming similar to the postoperative slopes in group D (P = 0.81). The amount of transient increase in perfusion, which quantified the behavior in the second phase of rCIVD, showed a similar behavior. Preoperatively, all patients in group P had rest pain and/or ulcer of the foot, whereas only few patients in group D had such symptoms. CONCLUSIONS Normal rCIVD response in the LTL test indicates less-than-severe ischemia, while abnormal rCIVD response measured via the LTL test indicates severe ischemic symptoms, such as critical limb ischemia. Notably, patients with an abnormal rCIVD response can develop a normal rCIVD response following revascularization, thereby reflecting an improvement in blood flow. The LTL test assessing rCIVD response can be useful for detecting severe limb ischemia, such as critical limb ischemia (CLI), and determining the departure from severe limb ischemia by revascularization.
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Affiliation(s)
- Sotaro Katsui
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yoshinori Inoue
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yohei Yamamoto
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kimihiro Igari
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Uetake
- Department of Surgical Specialties, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
Twelve subjects wore an N95 filtering facepiece respirator (N95 FFR), one tight-fitting full facepiece powered air-purifying respirator (PAPR), two loose-fitting PAPRs, and one elastomeric/PAPR hybrid for 1 hr each during treadmill walking at 5.6 km/hr while undergoing physiological and subjective response monitoring. No significant interaction (p ≥ .05) was noted between the five respirators in heart rate, respiratory rate, oxygen saturation, transcutaneous carbon dioxide, and perceptions of breathing effort or discomfort, exertion, facial heat, and overall body heat. Respirator deadspace heat/humidity were significantly greater for the N95 FFR, whereas tympanic forehead skin temperatures were significantly greater for the hybrid PAPR. Temperature of the facial skin covered by the respirator was equivalent for the N95 FFR and hybrid PAPR, and both were significantly higher than for the other three PAPRs. Perception of eye dryness was significantly greater for a tight-fitting full facepiece PAPR than the N95 FFR and hybrid PAPR. At a low-moderate work rate over 1 hr, effects on cardiopulmonary variables, breathing perceptions, and facial and overall body heat perceptions did not differ significantly between the four PAPRs and a N95 FFR, but the tight-fitting, full facepiece PAPR increased perceptions of eye dryness. The two loose-fitting PAPRs and the full facepiece tight-fitting PAPR ameliorated exercise-induced increases in facial temperature, but this did not translate to improved perception of facial heat and overall body heat.
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Affiliation(s)
- Jeffrey B Powell
- a National Institute for Occupational Safety and Health/National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Jung-Hyun Kim
- a National Institute for Occupational Safety and Health/National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
| | - Raymond J Roberge
- a National Institute for Occupational Safety and Health/National Personal Protective Technology Laboratory , Pittsburgh , Pennsylvania
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Hermes D, Nguyen M, Winawer J. Neuronal synchrony and the relation between the blood-oxygen-level dependent response and the local field potential. PLoS Biol 2017; 15:e2001461. [PMID: 28742093 PMCID: PMC5524566 DOI: 10.1371/journal.pbio.2001461] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/22/2017] [Indexed: 01/07/2023] Open
Abstract
The most widespread measures of human brain activity are the blood-oxygen-level dependent (BOLD) signal and surface field potential. Prior studies report a variety of relationships between these signals. To develop an understanding of how to interpret these signals and the relationship between them, we developed a model of (a) neuronal population responses and (b) transformations from neuronal responses into the functional magnetic resonance imaging (fMRI) BOLD signal and electrocorticographic (ECoG) field potential. Rather than seeking a transformation between the two measures directly, this approach interprets each measure with respect to the underlying neuronal population responses. This model accounts for the relationship between BOLD and ECoG data from human visual cortex in V1, V2, and V3, with the model predictions and data matching in three ways: across stimuli, the BOLD amplitude and ECoG broadband power were positively correlated, the BOLD amplitude and alpha power (8-13 Hz) were negatively correlated, and the BOLD amplitude and narrowband gamma power (30-80 Hz) were uncorrelated. The two measures provide complementary information about human brain activity, and we infer that features of the field potential that are uncorrelated with BOLD arise largely from changes in synchrony, rather than level, of neuronal activity.
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Affiliation(s)
- Dora Hermes
- Department of Psychology, New York University, New York, New York, United States of America
- Brain Center Rudolf Magnus, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Psychology, Stanford University, Stanford, California, United States of America
| | - Mai Nguyen
- Department of Psychology, Princeton University, Princeton, New Jersey, United States of America
| | - Jonathan Winawer
- Department of Psychology, New York University, New York, New York, United States of America
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Raposio E, Bertozzi N, Moretti R, Grignaffini E, Grieco MP. Laser Doppler Flowmetry and Transcutaneous Oximetry in Chronic Skin Ulcers: A Comparative Evaluation. Wounds 2017; 29:190-195. [PMID: 28762949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION/OBJECTIVE Laser Doppler Flowmetry (LDF) and transcutaneous oximetry (TcpO2) are established methods for investigating cutaneous perfusion. To date, no study previously performed has compared data obtained from these 2 methodologies in cases of chronic cutaneous ulcers. MATERIALS AND METHODS Laser Doppler Flowmetry and TcpO2 were performed in 25 consecutive outpatients with chronic lower limb ulcers (group A, experimental; 9 women and 16 men; mean age 67 years [range, 52-81 years]) and 25 age- and sex-matched healthy control subjects (group B, control) enrolled for the study. Ulcer aetiologies included 12 peripheral arterial occlusive disease, 9 chronic venous insufficiencies, and 4 pressure ulcers. Data were analyzed with Shapiro-Wilk and Wilcoxon-Mann-Whitney tests. RESULTS A statistically significant difference (P < .05) was found between LDF values of the 2 groups. No statistically significant differences were found between the 2 groups regarding the TcpO2 measurements. CONCLUSION The data confirmed the soundness of LDF while investigating local perfusion in patients with chronic cutaneous ulcers. The same diagnostic accuracy was not obtained by means of TcpO2.
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Winkler MKL, Dengler N, Hecht N, Hartings JA, Kang EJ, Major S, Martus P, Vajkoczy P, Woitzik J, Dreier JP. Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients. J Cereb Blood Flow Metab 2017; 37:1841-1856. [PMID: 27025768 PMCID: PMC5435278 DOI: 10.1177/0271678x16641424] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/27/2015] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
Multimodal neuromonitoring in neurocritical care increasingly includes electrocorticography to measure epileptic events and spreading depolarizations. Spreading depolarization causes spreading depression of activity (=isoelectricity) in electrically active tissue. If the depression is long-lasting, further spreading depolarizations occur in still isoelectric tissue where no activity can be suppressed. Such spreading depolarizations are termed isoelectric and are assumed to indicate energy compromise. However, experimental and clinical recordings suggest that long-lasting spreading depolarization-induced depression and isoelectric spreading depolarizations are often recorded outside of the actual ischemic zones, allowing the remote diagnosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Here, we analyzed simultaneous electrocorticography and tissue partial pressure of oxygen recording in 33 aneurysmal subarachnoid hemorrhage patients. Multiple regression showed that both peak total depression duration per recording day and mean baseline tissue partial pressure of oxygen were independent predictors of outcome. Moreover, tissue partial pressure of oxygen preceding spreading depolarization was similar and differences in tissue partial pressure of oxygen responses to spreading depolarization were only subtle between isoelectric spreading depolarizations and spreading depressions. This further supports that, similar to clustering of spreading depolarizations, long spreading depolarization-induced periods of isoelectricity are useful to detect energy compromise remotely, which is valuable because the exact location of future developing pathology is unknown at the time when the neurosurgeon implants recording devices.
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Affiliation(s)
- Maren KL Winkler
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
| | - Nora Dengler
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Eun J Kang
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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Carmona C, Alorda B, Gracia L, Perez-Vidal C, Salinas A. A ZigBee-based wireless system for monitoring vital signs in hyperbaric chambers: Technical report. Undersea Hyperb Med 2017; 44:243-256. [PMID: 28779581 DOI: 10.22462/5.6.2017.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper presents the replacement of a traditional wired communication link of the hyperbaric chambers with a wireless ZigBee-based system. This move allows a reduction in the costs of seals capable of withstanding the internal pressures and gives rise to a more versatile system. The new system is able to capture and process individual vital signs like the electrocardiography signal, and other analog sources, sending the data to an external computer and allowing analysis, representation and sharing with medical staff. This system solves such problems as the attenuation of the signal produced by the metal walls of the hyperbaric chamber and has a coverage area large enough to manage up to six patients with an effective data rate conversion of 2kHz. Furthermore, a battery-based and multiparameter platform is designed for multipatient hyperbaric chambers.
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Affiliation(s)
- Cristian Carmona
- Illes Balears University, Ctra, Valldemossa km 7.5 Ed. Mateu Orfila, 07122 Palma, Spain
| | - Bartomeu Alorda
- Illes Balears University, Ctra, Valldemossa km 7.5 Ed. Mateu Orfila, 07122 Palma, Spain
| | - Luis Gracia
- Instituto IDF, Universitat Politecnica de Valencia, 46022 Valencia, Spain
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Huang K, Ma Y, Wang J, Shi S, Fu L, Liu J, Li L, Lu H, Liang X, Liu Y, Jiang H. The correlation between transcutaneous oxygen tension and microvascular complications in type 2 diabetic patients. J Diabetes Complications 2017; 31:886-890. [PMID: 28242269 DOI: 10.1016/j.jdiacomp.2017.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 01/16/2023]
Abstract
AIMS This study aimed to assess whether transcutaneous oxygen tension (TcPO2) was associated with the presence of microvascular complications in type 2 diabetic (T2D) patients and whether TcPO2 could act as an independent risk factor for predicting the occurrence of microvascular events in these patients. METHODS We recruited 436 patients with T2D. Based on the presence of diabetic kidney disease, diabetic retinopathy, and/or diabetic peripheral neuropathy, the patients were divided into groups with and without microvascular complications. The differences between these 2 groups were examined using the chi-square test and the t test. The influencing factors of diabetic microangiopathy were studied using a logistic regression analysis. RESULTS The results showed that sex, diabetes duration, smoking history, TcPO2, and HbA1c were independent risk factors for the occurrence of diabetic microvascular events (P<0.05). In particular, the risk of developing microvascular complications was 10.16 times higher in patients with low TcPO2 than that in those with high TcPO2 (OR=10.157, 95% CI: 4.602-22.418). CONCLUSION This study showed that TcPO2 was significantly negatively associated with the occurrence of microvascular events in type 2 diabetic patients and that TcPO2 may be an independent risk factor for predicting the occurrence of microvascular complications in these patients. These results suggest that for type 2 diabetes mellitus with clinically reduced TcPO2, we should pay close attention to the occurrence of microvascular complications and engage in early prevention.
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Affiliation(s)
- Ke Huang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Yujin Ma
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Jie Wang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Shousen Shi
- The 150th Central Hospital of PLA, Luoyang, China
| | - Liujun Fu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Jie Liu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Liping Li
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Haibo Lu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Xiaoli Liang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Yanyun Liu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003
| | - Hongwei Jiang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China, 471003.
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Nilius G, Katamadze N, Domanski U, Schroeder M, Franke KJ. Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia. Int J Chron Obstruct Pulmon Dis 2017; 12:1039-1045. [PMID: 28408814 PMCID: PMC5383083 DOI: 10.2147/copd.s126970] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known. OBJECTIVES This study compared the effects of pressure-controlled (spontaneous timed [ST]) non-invasive ventilation (NIV) and NIV with intelligent volume-assured pressure support (IVAPS) in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality. METHODS This prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG) and transcutaneous carbon dioxide pressure (PtcCO2) measurement. Patients rated their subjective experience (total score, 0-45; lower scores indicate better acceptability). RESULTS Fourteen patients were included (4 females, age 59.4±8.9 years). The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7) and IVAPS (8.3±10.2) conditions (P=0.064). There were also no clinically relevant differences in PtcCO2 between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg). Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH2O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]). Overall patient assessment scores were similar, although there was a trend toward less discomfort during IVAPS. CONCLUSION Our results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep quality or inducing ventilation- associated events.
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Affiliation(s)
- Georg Nilius
- HELIOS Klinik Hagen-Ambrock
- Internal Medicine I, Witten/Herdecke University, Witten, Germany
| | - Nato Katamadze
- HELIOS Klinik Hagen-Ambrock
- Internal Medicine I, Witten/Herdecke University, Witten, Germany
| | | | | | - Karl-Josef Franke
- HELIOS Klinik Hagen-Ambrock
- Internal Medicine I, Witten/Herdecke University, Witten, Germany
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Park D, Lee GJ, Kim HY, Ryu JS. Different characteristics of ventilator application between tracheostomy- and noninvasive positive pressure ventilation patients with amyotrophic lateral sclerosis. Medicine (Baltimore) 2017; 96:e6251. [PMID: 28272226 PMCID: PMC5348174 DOI: 10.1097/md.0000000000006251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to investigate the appropriate home ventilator settings for patients with amyotrophic lateral sclerosis (ALS).In total, 71 patients with ALS, who had received either a noninvasive positive pressure ventilation (NIPPV) or tracheostomy positive pressure ventilation (TPPV), were included. Accordingly, patients were divided into 2 groups (the TPPV and NIPPV groups). We retrospectively evaluated the values used in home ventilators for patients with ALS, who had maintained a stable level of CO2 on both the arterial blood gas analysis (ABGA) and transcutaneous blood gas monitoring. To measure the main outcome, we also investigated the actual body weight (ABW) and predicted body weight (PBW) of patients, and the following setting values of ventilators were also recorded: the inspired tidal volume (VTi), minute ventilation (MV), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), and inspiratory time (Tins).VTi and MV showed a significantly positive correlation with both PBW and ABW of patients in the TPPV group. However, both VTi and MV had greater significant correlation with PBW than ABW in the TPPV group. In addition, VTi and MV did not show a significantly positive correlation with either PBW or ABW in the NIPPV group.In patients with ALS, PBW was more useful for predicting VTi and MV than ABW. Moreover, it will be helpful to know the differences of setting values between TPPV and NIPPV, especially because ALS patients are usually treated with TPPV due to the initial difficulties associated with NIPPV.
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Affiliation(s)
- Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungju
| | - Ha Young Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
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Abstract
Temporal changes in cerebral blood flow induced by jaw movement have yet to be investigated. To assess the influence of pattern and intensity of muscle contraction during jaw movement on task-induced change in cerebral blood flow, we performed bilateral transcranial Doppler ultrasound examination during clenching, gum chewing, and tooth tapping in healthy volunteers. A random-effects model analysis revealed a significant increase in middle cerebral artery blood flow velocity during clenching (high muscle activity) and gum chewing (moderate muscle activity), compared with the preceding rest period; however, such an increase was not detected during tooth tapping (low muscle activity). Cerebral blood flow was greater on the working side during the intensive isometric contraction of the masseter muscle in clenching. These results suggest that task-induced change in cerebral blood flow during jaw movement is influenced by the change in peripheral circulation evoked by muscle contraction.
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Affiliation(s)
- Y Hasegawa
- Division of Oromaxillofacial Regeneration, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita City, Osaka, 565-0871, Japan
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Cesarone MR, Belcaro G, Ippolito E, Ricci A, Ruffini M, Dugall M. Microcirculatory Efficacy of Topical Treatment with Aescin + Essential Phospholipids Gel on Transcutaneous PO2 in Venous Insufficiency. Angiology 2016; 55 Suppl 1:S7-10. [PMID: 15156250 DOI: 10.1177/000331970405500602] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A gel including aescin, essential phospholipids (EPL), and heparin (EG) has been used for many years for local treatment of venous, microcirculatory alterations (varicose veins, chronic venous insufficiency). Bruises, swelling, thrombophlebitis, and contusions are effectively treated with this compound. The aim of this study was the evaluation of the efficacy of the effects of an AEPL (aescin+EPL) gel on the microcirculation in subjects with chronic venous insufficiency, venous hypertension (CVH), and venous microangiopathy. Transcutaneous PO2 was measured at the perimalleolar region. After 2 weeks of treatment, all individual values (100%) were significantly increased (p<0.05). In all patients, PO2 increased, indicating a decrease in level of venous microangiopathy. Considering transcutaneous skin PO2, treatment with AEPL in areas of venous microangiopathy is beneficial in the prevention of ulceration and improves skin healing.
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Affiliation(s)
- M R Cesarone
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, G. D'Annunzio University, Italy
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Shu Q, Liang F, Chen L, Liu J, Wu S. Are Oxygen and Related Compounds the Mechanisms Underlying Acupoint Function? A Review of Acupoint Oxygen Specificity Studies. Complement Med Res 2016; 23:336-343. [PMID: 27924794 DOI: 10.1159/000448207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oxygen specificity of acupoints has been studied for nearly 30 years. Studies have considered oxygen partial pressure, nitric oxide, carbon dioxide, and other factors. The results of the experiments have shown that the content of oxygen and oxygen-related compounds is statistically significantly different between acupoint and non-acupoint tissues. Despite certain differences in the methods and results across studies, including some contradictory experimental data, most reports agree that metabolic activity, utilization of oxygen, and activity of oxygen-related compounds were higher in acupoint tissues than in non-acupoint tissues. The characteristics of an acupoint may be based on the anatomical structure of the surrounding tissue. Modern sensor needle technology has been widely applied in the study of acupoint oxygen specificity, providing scientific and objective evidence. However, the study of acupoint oxygen specificity has not been without controversy. In order to give practical significance to this research, study design, repeatability of experimental conditions, and homogeneity of subjects should be considered more precisely. Also, more attention should be paid to clinical relevance, i.e., by inclusion of clinical cases and observation of the de-qi effect and clinical responses in the future.
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Nishio H, Minakata K, Kawaguchi A, Kumagai M, Ikeda T, Shimizu A, Yokode M, Morita S, Sakata R. Transcutaneous oxygen pressure as a surrogate index of lower limb amputation. INT ANGIOL 2016; 35:565-572. [PMID: 26871392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION A large number of clinical trials of therapeutic angiogenesis in patients with critical limb ischemia have been conducted in recent years. However, limb amputation, which is used as a primary endpoint in such studies, is not often required in Japan, which can make it difficult to carry out related clinical trials. Transcutaneous oxygen pressure (TcPO2) is widely used to evaluate the severity of limb ischemia, to decide the level of amputation, and to predict wound healing after limb amputation. The aim of the present study was to elucidate whether TcPO2 can be a surrogate index of limb ischemia, and to define an appropriate cutoff value for wound healing after limb amputation using meta-analysis. EVIDENCE ACQUISITION A computer search was performed to identify studies describing the association between TcPO2 and limb ischemic events. From these, studies focused on wound healing after limb amputation were combined and analyzed. EVIDENCE SYNTHESIS Eleven studies were identified for inclusion in this analysis. The analysis demonstrated that TcPO2 20 mmHg was a valid cutoff value for limb amputation and TcPO2 30 mmHg would be an appropriate value for wound healing after limb amputation. CONCLUSIONS TcPO2 of 20 and 30 mmHg were considered appropriate cutoff values for limb amputation and wound healing after amputation, respectively.
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Affiliation(s)
- Hiroomi Nishio
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan -
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Papp H, Sarusi A, Farkas AS, Takacs H, Kui P, Vincze D, Ivany E, Varro A, Papp JG, Forster T, Farkas A. Hyperventilation assists proarrhythmia development during delayed repolarization in clofilium-treated, anaesthetized, mechanically ventilated rabbits. J Physiol Pharmacol 2016; 67:731-737. [PMID: 28011953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/31/2016] [Indexed: 06/06/2023]
Abstract
Hyperventilation reduces partial pressure of CO2 (PCO2) in the blood, which results in hypokalaemia. Hypokalaemia helps the development of the life-threatening torsades de pointes type ventricular arrhythmia (TdP) evoked by repolarization delaying drugs. This implies that hyperventilation may assist the development of proarrhythmic events. Therefore, this study experimentally investigated the effect of hyperventilation on proarrhythmia development during delayed repolarization. Phenylephrine (an α1-adrenoceptor agonist) and clofilium (as a representative repolarization delaying agent inhibiting the rapid component of the delayed rectifier potassium current, IKr) were administered intravenously to pentobarbital-anaesthetized, mechanically ventilated, open chest rabbits. ECG was recorded, and the onset times and incidences of the arrhythmias were determined. Serum K+, pH and PCO2 were measured in arterial blood samples. Clofilium prolonged the rate corrected QT interval. TdP occurred in 15 animals (TdP+ group), and did not occur in 14 animals (TdP- group). We found a strong, positive, linear correlation between serum K+ and PCO2. There was no relationship between the occurrence of TdP and the baseline K+ and PCO2 values. However, a positive, linear correlation was found between the onset time of the first arrhythmias and the K+ and PCO2 values. The regression lines describing the relationship between PCO2 and onset time of first arrhythmias were parallel in the TdP+ and TdP- groups, but the same PCO2 resulted in earlier arrhythmia onset in the TdP+ group than in the TdP- group. We conclude that hyperventilation and hypocapnia with the resultant hypokalaemia assist the multifactorial process of proarrhythmia development during delayed repolarization. This implies that PCO2 and serum K+ should be controlled tightly during mechanical ventilation in experimental investigations and clinical settings when repolarization-delaying drugs are applied.
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Affiliation(s)
- H Papp
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - A Sarusi
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - A S Farkas
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - H Takacs
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - P Kui
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - D Vincze
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - E Ivany
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - A Varro
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - J G Papp
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - T Forster
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - A Farkas
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary.
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