Abdominal Belt Research Articles

Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study.

In patients treated with noninvasive ventilation, sleep-related breathing changes can modify patient-ventilator interactions, which could reduce its effectiveness. The aim of this prospective observational study was to determine the impact of sleep/wake state on leaks, upper airway obstructive events, and asynchronies in patients treated by long-term noninvasive ventilation. Stable patients adapted to noninvasive ventilation were considered for nocturnal polysomnography. Unintentional leaks, upper airway obstructive events, and asynchronies were compared between sleep and awake periods. Twenty-eight patients were enrolled. Underlying diagnoses were neuromuscular disease (n = 11), chest wall disease (n = 8), and obesity-hypoventilation (n = 9). Leaks were more frequent in sleep than in awake periods, with a median of 10% (interquartile range [IQR], 0%-75%) vs 1% (IQR, 0%-9%) of time (P < .001), respectively. During sleep, asynchronies with and without associated leak affected 27% of breaths (IQR, 16%-39%) compared with non-leak-related asynchronies that were recorded in 8% (IQR, 3%-25%) of breaths (P < .001). Asynchronies affecting more than 10% of total breaths were more frequent in sleep (25 patients, 89%) than in awake time (8 patients, 29%; P = .25). Eleven patients (39%) presented with 5 or more upper airway obstructive events without reduction in ventilatory drive per hour of sleep. In patients adapted to home noninvasive ventilation, leaks, asynchronies, and upper airway obstructive events are frequent during the night and are concentrated in sleep periods. Asynchronies are often associated with leaks. These findings may have clinical implications considering that in patients with low sleep efficiency respiratory events could be underestimated if sleep is not evaluated. Martí S, Ferré A, Sampol G, etal. Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study. J Clin Sleep Med. 2022;18(1):225-233.

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration?

The first-choice therapy for adults with moderate/severe obstructive sleep apnea is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. This cross-sectional study was conducted in adults diagnosed with moderate/severe obstructive sleep apnea [baseline apnea-hypopnea index (AHI) ≥ 15.0 events/h] who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep laboratory setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values delineated during the titration; all P-values > .005. However, the median residual AHI was significantly higher in males vs females: 2.7 events/h vs 2.2 events/h (P = .008). Body mass index (β: 0.292, P < .001), baseline AHI (β: 0.167, P < .001), and age (β: 0.065, P = .035) were independent predictors of the therapeutic CPAP level settings. Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95thpercentile CPAP requirement during an auto-adjusting CPAP titration. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration? JClin Sleep Med. 2021;17(9):1815-1820.

Quality of poly(somno)graphy recordings in children.

The aim of the study was to assess the scorability of the signals of four poly(somno)graphy devices and transcutaneous carbon dioxide tracings (PtcCO2 ) of one device in children. The presence (0%, < 25%, 25%-50%, 50%-75%, 75%-99%, 100% of recording time) and quality (bad, average, good) of the signal of each sensor were analysed. During a 5-month period, 364 poly(somno)graphies were performed in 12 different hospital units. Forty-one children had poor/bad cooperation, and 13 severe behaviour disorders. Seventy-one and 293 poly(somno)graphies were performed in children aged ≤ 2 and > 2years, respectively; nine poly(somno)graphies failed. For the four poly(somno)graphy devices, the signal was present during 99% of recording time for the electroencephalogram, 99% for thoracic belt, 97% for abdominal belt, 97% for body position, 95% for the microphone, 92% for pulse oximetry, 87% for tracheal sound, 71% for oronasal thermistor, 52% (41% for ≤ 2years, 55% for > 2years old) for nasal pressure and 86% for PtcCO2 . The signal was of good quality in 98% of poly(somno)graphies for body position, 96% for microphone, 96% for thoracic belt, 95% for pulse oximetry, 91% for abdominal belt, 91% for tracheal sound, 82% for oronasal thermistor, 78% for electroencephalogram, 73% for nasal pressure and 46% of PtcCO2 recordings. The scorability was comparable between devices. Nasal pressure and oronasal thermistor had the lowest scorability, especially in children aged ≤ 2years. This underlines the necessity of the development or improvement of alternative, ideally face-free, sensors, or miniaturized devices adapted for infants and children.

Human respiratory monitoring during sleep using a two-channel bioradar

permanent sleep deprivation and a decrease in sleep quality. Currently, in clinical practice, the method of polysomnography is used to detect sleep disorders. This method is expensive, labor and time-consuming, as well as uncomfortable for the patient. Therefore, at present, the problem of creating accurate, reliable and comfortable for the patients methods for assessing the sleep quality, as well as identifying and monitoring various sleep disorders, remains an up-to-date task of modern biomedical engineering. One of these methods is bioradiolocation, which allows detecting sleep disorders based on the variability of the breathing pattern of a sleeping person. However, because the amplitude of chest movements during breathing in different directions differs by an order of magnitude, the quality of the signal received by the bioradar during sleep also varies depending on the orientation of the sleeping person relative to the bioradar. To overcome this problem, in this article we propose a combined use of two bioradars oriented at different angles towards to the sleeping person. Thus, the aim of this work was to develop a bioradar system that provides reliable registration of the breathing pattern for various positions of a sleeping person. During the experiments, we used two monochromatic bioradars "BioRASCAN-24" with probing frequencies in the range of 24.0 and 24.1 GHz, located at an angle of 90 ° to each other. In this work, we used bioradar data recorded for seven volunteers who underwent polysomnographic research at the sleep laboratory of Almazov National Medical Research Centre. During the night, a parallel recording of bioradar signals and polysomnographic data was carried out for each subject using the Embla N7000 system (Natus Neurology Inc., USA). The duration of the experimental recording for each subject was from 7 to 9 hours. An algorithm was developed to extract a breathing pattern from a bioradar signal and estimate the respiratory rate of a sleeping person. It consisted of the following stages: synchronization of the bioradar and polysomnographic signals, demodulation, exclusion from consideration of signal fragments containing motion artifacts, signal filtering in order to isolate the breathing pattern, assessment of respiration rate in the inter-artifact periods for each of the bioradars separately, the final estimation of the respiration rate for the inter-artifact periods, taking into account the combination of data for both radars. Bioradar signal processing algorithms were done utilizing Matlab 2020b. To assess the accuracy of the proposed algorithm, we compared the respiratory rates calculated for each 30-second epoch using bioradar data with similar parameters calculated by the abdominal belt polysomnography sensor. The efficiency of the proposed algorithm was estimated by the accuracy and the mean absolute error. The results obtained for seven volunteers showed that the developed two-channel bioradar system turned out to be more accurate and reliable than a single bioradar. In the course of further research, it is planned to expand the dataset to include data from volunteers not only with sleep-related breathing disorders, but also with other sleep disorders. Although this work was carried out with the involvement of only seven volunteers, it is nevertheless an important step towards the development of a reliable view-independent bioradar system for assessing breathing rate during sleep.

Immediate Effects of Abdominal Pressure Belt on Limited of Stability and Gait Parameter in Patients after Chronic Stroke: one-group pretest-posttest design

Immediate Effects of Abdominal Pressure Belt on Limited of Stability and Gait Parameter in Patients after Chronic Stroke: one-group pretest-posttest design

Effectiveness Of Esophageal Gastric Junction Tumor Motion With And Without A Pneumatic Abdominal Compression In Precise IGRT Era

To investigate the effect of a pneumatic abdominal compression belt (PACB) on suppressing the movement of primary lesions in the esophageal gastric junction (EGJ). Ten patients with EGJ adenocarcinoma were treated with preoperative concurrent chemoradiotherapy. Titanium clips A and B were placed on the upper and lower edges of the gross tumor with a gastroscope, respectively. Forty sets of images of the two titanium clips located in the EGJ were obtained by 4DCT in 10 patients in the supine position with and without a PACB. Of the 10 patients, 5 were treated with a PACB, and the other 5 were not. All patients received CBCT for the first 5 fractions and the 7th, 12th, 17th and 22nd fractions before treatment, and 90 sets of images were obtained for analysis. Paired t-tests and independent t-tests were used to test for differences. With and without a PACB, in the cranio-caudal (CC) direction, the internal motion of clip A was 0.0 ± 0.1 cm and 0.1 ± 0.1 cm (P = 0.001), respectively. With and without PACB, in the left-right (LR), anterior-posterior (AP) and cranio-caudal (CC) directions, the internal motion of clip B was (0.1 ± 0.1), (0.1 ± 0.1), and (0.1 ± 0.1) cm and (0.2 ± 0.1), (0.2 ± 0.1), and (0.5 ± 0.3) cm (P = 0.000, 0.000 and 0.000), respectively. The inter-fraction motion of clip B in the LR, AP and CC directions was (0.2 ± 0.2), (0.2 ± 0.2), and (0.2 ± 0.2) cm and (0.7 ± 0.8), (0.7 ± 0.7), and (0.5 ± 0.4) cm (P = 0.002, 0.002 and 0.005) with or without a PACB, respectively. To ensure that 90% of the tumor volume receives 95% of the prescription dose, 0.9, 0.9 and 0.9 cm ITV margins in the LR, AP and CC directions are suggested for EGJ lesions with PACB to better cover the tumor intra- and inter-fraction movements. A pneumatic abdominal compression belt can reduce the intra- and inter-fraction movements of EGJ tumors during preoperative radiotherapy.

Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive.

Trauma providers seek to accurately assess the risk of patients with abdominal seat belt sign (ASBS). As hospital costs continue to rise, identification of strategies to safely discharge emergency department (ED) patients has become crucial. The purpose of this study is to 1) describe a large cohort of patients by type of ASBS and 2) determine the value of computed tomography (CT) of the abdomen and pelvis as a screening tool to rule out intra-abdominal injury (IAI) and support discharge of stable patients. We conducted a retrospective case series of all patients presenting to our urban, Level I trauma center from 2013-2015. We studied motor vehicle collision patients who presented with ASBS. We further classified individuals into ASBS groups: Abrasion, Ecchymosis, Abrasion+Ecchymosis, or Unknown ASBS to examine differences between groups. In one of the largest described cohorts, the ASBS remained associated with IAI, most commonly, solid organ injury. Of 425 patients, 36.1% had some IAI on CT, but only 13.6% required laparotomy. Categorizing the type of skin injury in ASBS, we found that both abrasion and ecchymosis were associated with IAI. Initial CT performed with 100% sensitivity. This study shows that ED trauma patients with significant seat belt abrasion or contusion can have IAI. With the very high sensitivity of modern abdominal CT scanners, clinicians could consider safe ED discharge of stable ASBS patients while providing strong return precautions. Our large cohort strengthens the evidence on decision-making in ASBS patients to ensure outcomes and use of health care resources.

Does Abdominal Seat Belt Sign Warrant Admission After a Negative CT Scan? A Cost-Utility Analysis

BackgroundRapid deceleration against a seat belt during a motor vehicle collision (MVC) may result in an abdominal seat belt sign (ASBS), which is associated with a higher risk of hollow viscus injury (HVI). After a negative abdominal CT scan, management of patients with ASBS is variable, but recent evidence suggests emergency department (ED) discharge may be safe. Therefore, we hypothesized that discharge from the ED is cost-effective compared with 23-h observation or hospital admission for patients with ASBS and a negative CT. MethodsA cost-utility model was developed for an evaluable patient with ASBS and negative CT scan using TreeAge software. ED discharge was compared with 23-h observation and admission. Analysis was from a health care–based third-party payer perspective. Quality-adjusted life years (QALYs) were based on 3-y expected outcomes. Probability and costs were estimated from published literature and the Healthcare Cost and Utilization Project. ResultsIn our base case, ED discharge was the most cost-effective strategy, yielding a cost of $706 with 2.86 QALYs. The average costs of 23-h observation and hospital admission were $2600 and $8,827, respectively, with 2.87 QALYs gained each. The strategy of ED observation becomes cost-effective when the rate of HVI after ED discharge exceeds 2.3%. In a Monte Carlo simulation, ED discharge was the optimal strategy in 91% of 1000 trials of the model. ConclusionsED discharge is a cost-effective strategy for evaluable patients with ASBS and a negative abdominal CT and remains so when the risk of HVI after ED discharge is higher than currently assumed.

0597 Precision of Sleep-Disordered Breathing Event Classification Using Simulated Home Sleep Apnea Testing in Patients with Spinal Cord Injury, or Disease

Abstract Introduction Sleep-disordered breathing (SDB) is highly prevalent among patients with spinal cord injury or disease (SCI/D). In-laboratory polysomnography (PSG) is difficult for these patients due to functional limitations and the physical construction of most sleep laboratories. Our objective was to evaluate the concordance between simulated HSAT and PSG in identifying SDB severity and subtypes of respiratory events in this patient population. Methods Within a larger study, 33 Veterans with SCI/D completed one night of in-laboratory PSG. Limited-channel HSAT was simulated by extracting 5 channels from PSG signals to include nasal pressure, thermistor, thoracic and abdominal belts, and oxygen saturation. Results Mean age of patients was 59.8 ± 10.9 years; 87.9% were male, and the average BMI was 28.1 ± 6.3. The mean Apnea-Hypopnea Index (AHI) from PSG was 35.5 ± 22.7. The mean Respiratory Event Index (REI) based on simulated HSAT was 22.5 ± 18.6. Thirty-one patients (93.9%) had SDB defined as AHI ≥5/hour. Simulated limited-channel HSAT accurately identified 32 out of 33 patients (96.96%). When SDB was further classified into mild (AHI 5-15 events/hr), moderate (AHI 15-30 events/hr), and severe (AHI&amp;gt;30/hr), simulated HSAT consistently underestimated the severity of underlying SDB. Spearman correlation between estimating AHI (PSG-HSAT) and subtypes of respiratory events was primarily accounted for by the difference in the number of hypopneas (r=0.72, -0.021 and -0.001 for hypopneas, obstructive and central apneas, respectively). Conclusion Our findings support the diagnostic utility of HSAT in SCI/D patients with SDB; however, HSAT underestimation of SDB may lead to difficulties in optimizing therapy. The misclassification of SDB severity is mainly driven by the number of hypopneas. Classification of hypopneas as obstrcutive or central may shed further light on the nature of this difference. Further research on the usability of HSAT devices in this patient population is needed. Support VA Rehabilitation Research and Development Service (RX002116; PI Badr and RX002885; PI Sankari) and NIH/NHLBI (K24HL143055; PI: Martin)

Hydrogen sulphide stimuli shorten exhalation during sleep as well as in wakefulness

In the attentive waking state, pleasant odours often prolong inhalation while unpleasant odours often shorten the exhalation. It should be checked whether this induced breathing pattern is maintained even during sleep. 23 healthy normosmic adults were examined by polysomnography for one night and randomized pulsed either with H2S, phenylethyl alcohol (PEA) or CO2 via a flow olfactometer. The determination of the sleep stages was based on the standard polysomnography curves. From the breathing curves (respiratory nasal pressure breathing, thoracic or abdominal belt breathing) a low-artefact curve was selected and seven breaths were measured from their breathing signal around the trigger impulse. The duration of inspiration (DIN) and the duration of the expiration (DEX) were determined from the six prestimulatory breaths and from breath with the stimulus onset and thus defined a reaction index (RI) indicating whether there is a significant change in shortening or prolonging DIN and/or DEX. These different RI were corrected by the spontaneous baseline RI and analysed according to the type of stimulus and the sleep stages. Reaction indices with reductions of DEX were larger than spontaneous RI and RI for PEA and H2S stimulation. In the case of CO2 irritation, RI with reductions of DIN and DEX were larger than with olfactory stimulation. All RI were equal in their amount between sleep stages. In REM, the difference between olfactory RI with shortened DEX between H2S and PEA stimulation was greatest. When stimulated with an unpleasant smell in sleep, the respiratory reaction pattern from the awake state is preserved. RI with shortened DEX can be considered as an imperfect arousal.

An abundant new genus and species of fan worms (Polychaeta: Sabellidae) from Hawaii.

A new genus and species of Hawaiian sabellid polychaete, Euchonoides moeone n. gen. et n. sp. is described. This new species has consistently been one of the most abundant polychaetes collected in Mamala Bay, Hawaii, reaching densities of 141,046 ind. m-2 and representing up to 30.6% of all polychaetes collected in that region. The species has a small body (~2 mm length) with a reduced number of abdominal chaetigers (8-10), and is distinguished by the presence of the following features: 1) three pairs of radioles; 2) radiolar skeleton with two longitudinal rows of cells from radiole base to third proximal pair of pinnules, remainder of each radiole skeleton with single rows of cells; 3) pinnules unpaired, alternating (snowflake arrangement); 4) thoracic uncini acicular with a large tooth above the main fang followed by a series of small ones; 5) thoracic chaetiger 3 enlarged; 6) a wide belt on third abdominal chaetiger; and 7) a pre-pygidial depression composed of three chaetigers, with lateral wings, among a combination of several others features. Histological sections have shown that the abdominal belt seems to be a clitellum-like structure where oogenesis takes place. The new genus is compared with other plesiomorphic genera sharing similar morphological features. Patterns of abundance of the new species are presented for the past 27 years in Mamala Bay.

Complicated Abdominal Seat Belt Injuries in Children

Background: The proper use of security accessories in cars has resulted in the reduction of morbidity and mortality both in adults and children. Improper use of abdominal seat belt is associated in some cases with severe abdominal injuries. Objectives: Investigation of the treatment outcomes of children who suffered complicated abdominal seat belt injuries between 1998 and 2013. Methods: We present five cases of children aged 6-14 years, who suffered complicated abdominal injuries due to improper use of the seat belt. Abdominal injuries included injuries to the liver, spleen, small bowel (duodenum, jejunum, and ileum), colon and aorta, mesenterial bleeding, retroperitoneal bleeding, bowel obstruction and pelvic fractures. Results: Three children were operated on within a few hours of admission due to peritoneal irritation, hemodynamic instability after fluid resuscitation, bowel injuries including perforation and bowel ischemia. Two children who were hemodynamically stable, were operated on after few days. One of them had a diagnosis of aortic injury and the other, bowel obstruction. The first child was treated in two stages: i. repair of duodenal rupture, and ii. repair of the aortic injury by using interposition Gore-Tex graft. For the child with bowel obstruction, segmental resection and primary anastomosis were performed. The operation and postoperative periods for all children were uneventful, and all five children are healthy today. Conclusion: 1) The abdominal seat belt should always be used in conjunction with the chest seat belt. 2) An abdominal seat belt sign should always raise the possibility of complicated abdominal injuries. 3) Gastrointestinal tract injuries are common in this setting. 4) Aortic injury is rare; however, it can easily be missed initially. 5) Abdominal aortic trauma is associated with duodenal injuries in almost all cases.

Role of limited vs full polysomnography as a diagnostic tool of obstructive sleep apnea

Introduction Obstructive sleep apnea (OSA) is the commonest breathing disorder during sleep and usually presents with sleep fragmentation, hypoxia, and excessive day sleepiness. Polysomnography (PSG) is still the device of choice for OSA diagnosis. Objective The aim was to compare the validity of limited PSG (measuring nasal flow of air, effort of respiratory muscles, heart rate, and oxygen saturation) with full PSG in diagnosis of OSA. Patients and methods Any patient who presented with snoring associated with excessive daytime sleepiness, Epworth sleep scale greater than or equal to 10, BMI greater than 30, or apnea-hypopnea index (AHI) greater than or equal to 5 events/h admitted to Chest Department, Faculty of Medicine, Tanta University Hospitals during the period from June 2018 to April 2019 was included in the study and subjected to full and limited PSG for two consecutive nights. Limited PSG included the following channels: nasal cannula and nasal thermistor, snoring microphone, the abdominal belt, the thoracic belt, the SOMNO screen plus, and the pulse oximetry lead. Results Limited PSG was comparable to full one, with insignificant difference in measuring AHI in total, moderate, and severe OSA cases. There was a significant positive correlation between AHI measured by full and limited PSG in both moderate and severe OSA cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in measurement of AHI by limited PSG were higher in severe than in moderate OSA cases, which indicates that the limited PSG is more sensitive, more specific, and more accurate in the diagnosis of severe cases than moderate ones. Conclusion Limited PSG is a reliable diagnostic device of OSA, as it has excellent agreement with AHIs determined by full PSG besides its lower cost.

Orthostatic Renal Transplant Compression Following Weight Gain Leading to Acute Kidney Injury

BackgroundWe present a first case of orthostatic renal graft compression and acute kidney injury following weight gain. Case ReportA 61-year-old male with a second cadaveric transplant presented with acute kidney injury - creatinine rise from 80 to 210 μmol/L (0.90 to 2.38 mg/dL). His medical history included diabetes, hypertension, ischemic heart disease, and obesity despite bariatric surgery. Renal biopsy was consistent with acute tubular necrosis. Serial renovascular duplex studies showed absence of diastolic flow and reduced renal perfusion despite a patent renal transplant artery and vein. Raising the fatty apron cephalad normalized renal blood flow with resistive indices throughout the kidney. Subsequent laparascopy ruled out adhesional obstruction and carbon dioxide angiogram confirmed normal transplant vessels, anastomotic sites, and intrarenal branches. He was treated with bedrest and an abdominal support belt with improvement of creatinine to 100 to 110 μmol/L (1.1-1.2 mg/dL). ConclusionsTransplant physicians and surgeons need to be aware of positional renal graft compression from an enlarged bulky omentum and fatty apron. Diagnosis requires positional sonography.

The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation

IntroductionGuidelines surrounding abdominal seat belt sign (SBS) were made prior to the use of modern computed tomography (CT) imaging. We sought to prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI). MethodsA prospective cohort of patients with SBS was compiled over one year. Subjects were divided into those with and without HVI. Covariate distributions were summarized by group. Bivariate tests and logistic regression were used to investigate associations between covariates and HVI. ResultsOf 220 patients with SBS, the incidence of HVI was 7% (n = 15). Radiographic findings were strongly associated with HVI and no patients with a negative CT scan had HVI. Free fluid was seen in 80% (12) of patients with HVI, whereas it was found in only 11% (23) without injury. A composite variable for negative CT scan was found to be associated with the absence of HVI: (Fisher's exact 1-tailed p, doubled = 0.014). ConclusionIn this study, the incidence of HVI with SBS is lower than previously reported, and no patients with negative CT imaging required an operation for HVI—suggesting there is a population of patients with SBS who could be discharged from the emergency room. A prospective multicenter study is needed to confirm these findings.

Validity analysis of respiratory events of polysomnography using a plethysmography chest and abdominal belt.

Respiratory inductive plethysmography (RIP) is recommended as an alternative respiratory sensor for the identification of each apnea and hypopnea event in polysomnography. Using this sensor, the cumulative RIP results from the chest and abdomen (RIP sum) and time-derived results of the RIP sum (RIP flow) are calculated to track respiratory flow. However, the effectiveness of this sensor and the calculated respiratory results is still unclear, and validation studies for the scoring of respiratory events in polysomnography are rare. Two hundred subjects were selected according to the severity of obstructive sleep apnea. A sleep specialist re-evaluated the respiratory events based on RIP flow data in a single-blind study. Statistical analysis was conducted with paired respiratory events scored in each of the RIP flow and polysomnography datasets. All respiratory events scored from the RIP flow were strongly correlated with those identified with standard sensors of polysomnography, regardless of disease severity. Most of the respiratory parameters from RIP flow trended toward underestimation. The RIP flow obtained from the alternative RIP sensor was appropriate for the diagnosis of obstructive sleep apnea based on a receiver operating characteristic curve. Scored respiratory events from RIP flow data effectively reflected the respiratory flow and statistically correlated with the results from standard polysomnography sensors. Therefore, analyzing RIP flow utilizing an RIP sensor is considered a reliable method for respiratory event scoring.

Heat Application on Lumbar and Suprapubic Pain During the Onset of Labour Using a New Abdominal Two-Pocket Belt: A Randomised and Controlled Trial

Background: Midwives from the Obstetrics and Gynaecology Unit at University Hospital Germans Trias i Pujol, Badalona, have developed a device for the application of thermal therapy on lumbar and suprapubical areas when labour pain appears. Objective: To assess the beneficial effects of heat application on lumbo-suprapubical pain during initial stages of labour. Study design: Randomized, parallel, open, non-blind clinical trial. Methods: Participants were pregnant women in the prodromal, early and active labour (up to 4-5 cm of dilation), with lumbo-suprapubic pain. The study was conducted in the delivery ward of Hospital Universitari Germans Trias I Pujol, in Badalona (Catalonia, Spain) during 2017-2018. One hundred and thirty-four childbearing women giving birth between September 2017 and March 2018 participated. The intervention group (n=67) received local heat at a temperature between 38-39°C on the lumbo-suprapubic areas for 30 minutes using an elastic pelvic belt as a pain relief device and was compared to a control group in which no heat was used. Primary outcomes were: pain level perception measured with a Visual Analogic Scale and a satisfaction index regarding the utilization of the belt device in the intervention group by using a specific ad-hoc non-validated questionnaire designed for the study. Results: Among the 134 participants: 41% (55) were in prodromal labour, 53.7% (72) in early labour and 5.2% (7) in active labour (up to ≤ 4-5 cm); groups were not balanced for the phases of labour. The pre-intervention pain level in the intervention group was 0.71 points higher (6.28 ± 1.59) than in the control group (5.57 ± 1.87) p=0.02. At 30 minutes of heat application, pain level in the study group decreased 0.65 points (5.88 ± 1.82) while it increased in the control group (6.53 ± 1.85) p=0.046. The difference between basal pain level and post-intervention, was 0.39 ± 1.35 in the intervention group while in the control group it was 0.95 ± 1.11 (p=0.000) in the Visual Analogic Scale. The global satisfaction index for the pelvic elastic belt was 15.38 ± 2.15 (range 5-19) which corresponds to 80.94% over 100% of the maximal punctuation. Conclusion: Heat application on both lumbar and suprapubic areas in case of labour pain is effective in relieving pain. The heat pads subjection device, a new abdominal two-pocket belt, obtained positive feedback from women in the study group who used it and answered the satisfaction questionnaire.

Maternal health care wearing equipment based on fetal information monitoring

In order to monitor the fetal information in real time and ensure the health of the pregnant women themselves and their fetuses during pregnancy, a kind of health wearing equipment, abdominal care belt is designed in this study, which can be worn by pregnant women and can be monitored by modern mobile medical APP, and verifies the related performance of the design through a series of experiments. The results show that the safety, practicability and aesthetics of the abdominal care belt designed in this study are all up to the standard. Therefore, the abdominal care belt designed in this study is a relatively successful product, which is expected to be applied in the future and enter the market, so that pregnant women during pregnancy can be more relaxed and convenient.

SmartHypnos: Developing a Toolbox for Polysomnographic Data Visualization and Analysis.

In this paper we present the first steps in developing SmartHypnos, an easy to use and user friendly graphical user interface, which aims to provide polysomngographic data visualization and the detection and classification of sleep related events. Currently SmartHypnos supports the visualization of EEG, ECG, EOG and EMG signals, and respiratory signals such as nasal pressure, thermistor, oxygen saturation, thoracic and abdominal belt recordings. All these are incorporated into an interface that provides quick and effortless access to the signals mentioned above. The interface displays automatic sleep staging capabilities as well as the detection of apnea events with accuracy rates surpassing 80%. It is expected that SmartHypnos will reduce the time required to analyze sleep data and also reduce possible human errors.

Impact of different respiratory monitoring techniques on respiration-dependent stroke-volume measurements assessed by real-time magnetic resonance imaging

PurposeQuantitative blood flow measurements in thoracic vessels are dependent on the patient's respiration due to intrathoracic pressure changes. Several registration techniques for tracing the patient's breathing curve exist exploiting various physiological characteristics. In the presented study two registration techniques were investigated to estimate the time-shift between the associated respiration curves and the impact on respiration-dependent hemodynamic measures. Materials and methodsUsing flow-sensitive real-time magnetic resonance imaging (3.0T, temporal resolution=24–26ms) data were acquired during a 13s time-interval under normal physiological (no) and forced breathing (fo) in the ascending aorta (AAo) and inferior vena cava (IVC). Breathing curves were obtained by using (1) an abdominal placed respiratory belt (=standard, RB) and (2) by applying a self-developed edge-detection software (ED). Respiration curves were divided into four intervals (end-expiration, inspiration, end-inspiration and expiration) to generate respiration-dependent stroke volumes (SVs) and cardiac indices (CIs). Data were available from 12 healthy controls (16.2±8.8yrs) and 18 Fontan-patients (18.6±7.1yrs). ResultsRespiration curves acquired with RB differs from and are shifted compared to those obtained by ED (controls: average shift=207±168ms, Fontan-patients: average shift=106±235ms). This time-shift results in statistical significant differences in cardiac indices CIAAo,fo in controls (ΔCIAAo,fo: expiration: +0.16L/min/m2, p=0.018), in CIIVC,no in Fontan-patients (ΔCIIVC,no: end-expiration: +0.94L/min/m2, p=0.002 and end-inspiration: −1.04L/min/m2, p=0.017) and in CIIVC,fo in Fontan-patients (ΔCIIVC,fo: end-expiration: +1.31L/min/m2, p=0.009; inspiration: −2.26L/min/m2, p=0.008 and end-inspiration: −1.87L/min/m2, p=0.029). ConclusionsA time-shift between both applied respiratory tracking techniques was observed resulting in significant differences in respiration-dependent CIs, which could influence the clinical decision-making.