Continuous Non-invasive Monitoring Research Articles

Noninvasive Monitoring to Demonstrate Postoperative Differences in Regional Hemodynamics in Newborn Infants With d-Transposition of the Great Arteries and Hypoplastic Left Heart Syndrome.

The adequacy of tissue O2 delivery in infants receiving intensive care is difficult to measure directly. Regional O2 (rSO2) and fractional tissue O2 extraction (FTOE), the ratio of O2 consumption to O2 delivery, obtained from newer noninvasive tools, such as near-infrared spectroscopy (INVOS) and microvascular tissue oximetry (T-Stat) can provide important information on the adequacy of tissue oxygenation and aid in managing critically ill infants. We prospectively evaluated differences in rSO2 and FTOE in 26 infants with hypoplastic left heart syndrome (HLHS) (n = 12) or d-transposition of the great arteries (d-TGA) (n = 14). Continuous noninvasive monitoring of SpO2, heart rate, and perfusion index with pulse oximetry, cerebral-rSO2 and renal-rSO2 with INVOS, and buccal tissue oxygenation using T-Stat were performed during immediate postoperative period for 24 hours. The SpO2 and rSO2 in infants with d-TGA were higher compared with the infants with HLHS at all measured sites (buccal mucosa, cerebral, and renal). Significant regional differences were also observed in FTOE across all infants with the highest at the buccal mucosa tissue level, followed by cerebral and renal measurement sites. As compared with infants with d-TGA, infants with HLHS had higher regional FTOE and heart rate, with a lower arterial O2 content and perfusion index. Our study demonstrates the utility of noninvasive hemodynamic monitoring to assess regional oxygenation and perfusion, as evidenced by significant differences in infants with HLHS and d-TGA, conditions with different circulation physiologies. Such comprehensive monitoring can potentially aid in evaluating treatment strategies aimed at preventing organ damage from O2 insufficiency.

Measurement of tissue oxygen saturation during arthroscopic surgery of knee with a tourniquet.

Tourniquets provide better tissue visibility during arthroscopic surgery. However, multiple postoperative adverse events associated with ischemia may be caused by excessive inflation pressure and duration. We aimed to evaluate the degree of tourniquet-induced ischemia using a noninvasive continuous real-time monitoring method and the relationship between changes in tissue oxygen saturation (StO2) and blood biochemical markers of ischemic injuries in patients undergoing arthroscopic knee surgery. This was a prospective observational study using near-infrared spectroscopy (NIRS). Data were collected from 29 consecutive patients who underwent arthroscopic procedures. Twenty-five patients underwent anterior cruciate ligament reconstruction, and four underwent meniscal repair. We investigated tourniquet-induced changes in StO2, monitored using NIRS, and blood biochemical markers of ischemic injuries. A significant decrease in the mean StO2 from the baseline was observed during tourniquet inflation in the operative legs. The average decrease in the mean StO2 was 58%. A comparison of mean StO2 between the nonoperative and operative legs before tourniquet deflation showed that mean values of StO2 in the operative legs were significantly lower than those in the nonoperative legs. No significant clinical relationships were observed between changes in StO2 and blood biochemical markers of ischemic injuries (creatine kinase) (p = 0.04, r = 0.38) or tourniquet duration (p = 0.05, r = 0.366). Our results demonstrated that StO2 could be used to evaluate tissue perfusion in real time but did not support the hypothesis that StO2 is a useful method for predicting the degree of tourniquet-induced injury during arthroscopic knee surgery.

Noninvasive continuous hemoglobin monitoring of blood transfusion in obstetric procedures

ABSTRACT Background Non-invasive Hb (SpHb) may allow for a faster detection of clinically important blood loss, improve perioperative transfusion practices significantly and enable a faster evaluation of a patient’s condition and a better blood treatment and may even reduce needless transfusions. This study determined the accuracy of continuous SpHb monitoring as a guide for fluid and blood transfusion practice using Masimo pulse co-oximetry in comparison with invasive Hb during elective cesarean section (CS). Methods This prospective cohort study was carried out on 60 pregnant women candidates for elective CS under general anesthesia. Participants were multigravida, aged between 18 and 45 years and carry a singleton fetus with ASA I–II. All had antepartum hemorrhage and were candidates for blood transfusion. Pre-induction of anesthesia (basal), pre-transfusion and post-transfusion SpHb and invasive Hb were assessed. The primary outcome parameter was the correlation between SpHb and invasive hemoglobin (Hb). Results There was a significant positive correlation between SpHb and Invasive Hb in baseline, pretransfusion and posttransfusion (r = 0.946, 0.902 and 0.698, respectively). Bland–Altman analysis between SpHb and invasive Hb reported low bias with moderate limits of agreement at baseline, pre-transfusion and post-transfusion [mean bias (limits of agreement): 0.348 (−0.584 and 1.280) g/dl, 0.314 (−0.561 and 1.188) g/dl and 0.348 (−0.584 and 1.280) g/dl, respectively] Conclusions In patients undergoing CS with antepartum hemorrhage, continuous SpHb through Masimo pulse co–oximetry demonstrated clinically acceptable accuracy of Hb measurement compared with Invasive Hb, even at low hemoglobin levels.

Noninvasive hypotension Prediction Index versus continuous blood pressure monitoring and intraoperative hypotension.

Noninvasive hypotension Prediction Index versus continuous blood pressure monitoring and intraoperative hypotension.

A Proof-of-Concept Electrochemical Skin Sensor for Simultaneous Measurement of Glial Fibrillary Acidic Protein (GFAP) and Interleukin-6 (IL-6) for Management of Traumatic Brain Injuries

This work demonstrates the use of a noninvasive, sweat-based dual biomarker electrochemical sensor for continuous, prognostic monitoring of a Traumatic Brain Injury (TBI) with the aim of enhancing patient outcomes and reducing the time to treatment after injury. A multiplexed SWEATSENSER was used for noninvasive continuous monitoring of glial fibrillary acidic protein (GFAP) and Interleukin-6 (IL-6) in a human sweat analog and in human sweat. Electrochemical impedance spectroscopy (EIS) and chronoamperometry (CA) were used to measure the sensor response. The assay chemistry was characterized using Fourier Transform Infrared Spectroscopy (FTIR). The SWEATSENSER was able to detect GFAP and IL-6 in sweat over a dynamic range of 3 log orders for GFAP and 2 log orders for IL-6. The limit of detection (LOD) for GFAP detection in the sweat analog was estimated to be 14 pg/mL using EIS and the LOD for IL-6 was estimated to be 10 pg/mL using EIS. An interference study was performed where the specific signal was significantly higher than the non-specific signal. Finally, the SWEATSENSER was able to distinguish between GFAP and IL-6 in simulated conditions of a TBI in human sweat. This work demonstrates the first proof-of-feasibility of a multiplexed TBI marker combined with cytokine and inflammatory marker detection in passively expressed sweat in a wearable form-factor that can be utilized toward better management of TBIs. This is the first step toward demonstrating a noninvasive enabling technology that can enable baseline tracking of an inflammatory response.

Continuous physiological signal measurement over 24-hour periods to assess the impact of work-related stress and workplace violence

Work-related stress has long been recognized as an essential factor affecting employees' health and wellbeing. Repeated exposure to acute occupational stressors puts workers at high risk for depression, obesity, hypertension, and early death. Assessment of the effects of acute stress on workers' wellbeing usually relies on subjective self-reports, questionnaires, or measuring biometric and biochemical markers in long-cycle time intervals. This study aimed to develop and validate the use of a multiparameter wearable armband for continuous non-invasive monitoring of physiological states. Two worker populations were monitored 24 h/day: six loggers for one day and six ICU nurses working 12-hr shifts for one week. Stress responses in nurses were highly correlated with changes in heart rate variability (HRV) and pulse transit time (PTT). A rise in the low-to high-frequency (LF/LH) ratio in HRV was also coincident with stress responses. HRV on workdays decreased compared to non-work days, and PTT also exhibited a persistent decrease reflecting increased blood pressure. Compared to loggers, nurses were involved in high-intensity work activities 45% more often but were less active on non-work days. The wearable technology was well accepted by all worker participants and yielded high signal quality, critical factors for long-term non-invasive occupational health monitoring.

Perioperative blood glucose variability and autonomic nervous system activity in on-pump cardiac surgery patients: Study protocol of a single-center observational study.

On-pump coronary artery bypass graft (CABG) and surgical valve replacement (SVR) are high-risk procedures. Several studies reported that perioperative blood glucose (BG) variability was independently associated with impaired postoperative outcome. However, the underlying mechanisms contributing to increased perioperative BG variability and to its deleterious impact remain unknown. The hypothesis of the study is that perioperative BG variability could be related to perioperative alteration of the autonomic nervous system (ANS) activity and to preoperative BG variability. We designed a prospective observational single-center study. Four groups of 30 patients will be studied: group 1, including insulin-requiring type 2 diabetic patients undergoing on-pump CABG; group 2, including non-insulin-requiring type 2 diabetic patients undergoing on-pump CABG; group 3, including non-diabetic patients undergoing aortic SVR; and group 4, including non-diabetic patient undergoing on-pump CABG. Preoperative (baseline) and postoperative BG variability will be quantified using the Abbott's Freestyle Libre Pro sensor allowing for continuous subcutaneous BG monitoring. Preoperative (baseline) and postoperative ANS activity will be measured using noninvasive continuous heart rate monitoring (Mooky HR memory®). Blood level and urinary concentration of inflammatory and endothelial dysfunction biomarkers will be measured from blood and urinary samples at the end of the surgery and on postoperative day 1 and 2. The primary objective is to describe the relationship between baseline BG variability and postoperative BG variability. The secondary objectives are to describe the relationship: between baseline and postoperative BG variability according to the diabetes phenotype and to the type of surgery; between the ANS activity and the BG variability; and between postoperative BG variability and, urinary and blood biomarkers.

The Value of Noninvasive Continuous Cardiac Output Monitoring in Assessment of Hemodynamic Status in Critically Ill Children

Access to reliable, rapid, and continuous hemodynamic monitoring parameters is essential for early diagnosis and prompt treatment of hemodynamic disorders in critically ill children. The aim of this observational study was to compare the accuracy of continuous non-invasive cardiac output monitoring (NICCOMO) device data with transthoracic echocardiography (TTE) and inferior vena cava (IVC) ultrasound findings in assessing cardiac output (C.I), circulatory fluid adequacy, and finally Determination of hemodynamic status in patients with Critical conditions hospitalized in the Pediatric Intensive Care Unit (PICU). In this observational study, forty-four critically ill children that were admitted to PICU were evaluated. We used NICCOMO, TTE, and IVC ultrasonography at the same time in critical patients. The association between NICCOMO parameters and echocardiogram cardiac index and IVC quality in ultrasound is compared. The agreement between CI measured by TTE and NICCOMO was assessed using the Bland-Altman analysis method. NICCOMO is not a reliable instrument for determining CI in children with an unstable hemodynamic status. However, the parameters of this device are reliable in assessing the patient's hemodynamic status. Findings showed that 90% of patients in the normal hemodynamic state in NICCOMO have SVR. I in the normal range (P<0.001), and all cases in hypervolemic state had volume overload IVC in ultrasonography analysis. Noninvasive continuous cardiac output monitoring could be used to estimate unstable patients’ hemodynamic status in the initial stages for making timely treatment-related decisions, but its use for accurate cardiac index measurement is not reliable in all cases.

Oxygenation in the NICU: there is more to it than meets the eye.

Dormishian and colleagues in their study address an issue that care teams in the NICU encounter on a daily basis, regarding motion artifacts during oxygenation monitoring. In our commentary, we discuss the available tools that allow continuous noninvasive monitoring of oxygenation in the NICU, and modalities that increase the time premature infants spend in the desired SpO2 range and impact their clinical outcomes.

A Concise and Systematic Review on Non-Invasive Glucose Monitoring for Potential Diabetes Management.

The current standard of diabetes management depends upon the invasive blood pricking techniques. In recent times, the availability of minimally invasive continuous glucose monitoring devices have made some improvements in the life of diabetic patients however it has its own limitations which include painful insertion, excessive cost, discomfort and an active risk due to the presence of a foreign body under the skin. Due to all these factors, the non-invasive glucose monitoring has remain a subject of research for the last two decades and multiple techniques of non-invasive glucose monitoring have been proposed. These proposed techniques have the potential to be evolved into a wearable device for non-invasive diabetes management. This paper reviews research advances and major challenges of such techniques or methods in recent years and broadly classifies them into four types based on their detection principles. These four methods are: optical spectroscopy, photoacoustic spectroscopy, electromagnetic sensing and nanomaterial based sensing. The paper primarily focuses on the evolution of non-invasive technology from bench-top equipment to smart wearable devices for personalized non-invasive continuous glucose monitoring in these four methods. With the rapid evolve of wearable technology, all these four methods of non-invasive blood glucose monitoring independently or in combination of two or more have the potential to become a reality in the near future for efficient, affordable, accurate and pain-free diabetes management.

A method to assess the hygro-mechanical behaviour of original panel paintings, through in situ non-invasive continuous monitoring, to improve their conservation: a long-term study on the Mona Lisa

• Non-invasive methods and equipment to measure and monitor panel painting's behaviour. • Technological analysis and state of conservation of the Mona Lisa ’s wooden panel. • Studying mechanical properties and conditions of an artwork painted on wood. • Monitoring mechanical response of panel paintings to environmental fluctuations. • Collecting data to feed and reliably calibrate numerical models. This paper describes an innovative method, and related equipment, developed by the authors to monitor non-invasively historic panel paintings under museum display conditions. This method permits in-depth knowledge about such artworks, allowing us to understand their reactions to climatic variations, and provides objective data on which conservation decisions can be confidently based, since the data are directly obtained from the individual artwork. Since 2004, following the invitation from the Louvre Museum and the C2RMF (National Centre for Research and Restoration of French Museums), the wooden panel on which Leonardo da Vinci painted his Mona Lisa has been studied by an international research team of wood technologists and engineers, including researchers from French and Italian universities and related scientific institutions (Montpellier, Clermont Auvergne, Poitiers, Florence), to understand its mechanical, hygroscopic and shape characteristics and behaviour, to evaluate its present state, and to provide suggestions for optimizing its conservation conditions. Non-invasive methods and equipment were therefore devised and implemented to measure (during the annual opening day of its display case) and automatically monitor (during the time the display case remains closed) both the deformations that the panel undergoes (mainly produced by the inevitable small climatic fluctuations within the case) and the constraining forces acting on the panel itself. The method and the related equipment, improved over the years, are based on miniature load cells and displacement transducers, whose outputs are automatically logged at desired time intervals, typically ranging between 30 min for monitoring during the whole year, and a few seconds for manual measurements, calibrations, and other selected events; the stored data can be downloaded both through a cable connection and wirelessly, by means of a specially developed connection apparatus. The panel is confined in a climate-controlled display case, which typically is opened only for a few hours once a year. Additionally, close restrictions must be respected, including absolute non-invasiveness, non-interference with the enjoyment of the artwork by the public, and compliance with strict procedures for safe and secure conservation. The implementation of this method has provided significant information about the actual behaviour of the panel during the whole year. Comparing several annual force-deformation curves, their good linearity suggests that no unacceptable stress or deformation has taken place in it, showing that the climatic conditions (air temperature and relative humidity) maintained in the display case can be considered favourable to the conservation of the artwork. Moreover, based on the collected data, reliable Finite Element Method (FEM) models are being developed and calibrated, with the aim of describing the mechanical behaviour of the panel and virtually evaluating the risk of damage (including the propagation of an ancient crack) deriving from external conditions or actions to which it would be unthinkable to submit the original historic artwork.

Intra-beat biomarker for accurate continuous non-invasive blood pressure monitoring

Accurate continuous non-invasive blood pressure (CNIBP) monitoring is the holy grail of digital medicine but remains elusive largely due to significant drifts in signal and motion artifacts that necessitate frequent device recalibration. To address these challenges, we developed a unique approach by creating a novel intra-beat biomarker (Diastolic Transit Time, DTT) to achieve highly accurate blood pressure (BP) estimations. We demonstrated our approach’s superior performance, compared to other common signal processing techniques, in eliminating stochastic baseline wander, while maintaining signal integrity and measurement accuracy, even during significant hemodynamic changes. We applied this new algorithm to BP data collected using non-invasive sensors from a diverse cohort of high acuity patients and demonstrated that we could achieve close agreement with the gold standard invasive arterial line BP measurements, for up to 20 min without recalibration. We established our approach's generalizability by successfully applying it to pulse waveforms obtained from various sensors, including photoplethysmography and capacitive-based pressure sensors. Our algorithm also maintained signal integrity, enabling reliable assessments of BP variability. Moreover, our algorithm demonstrated tolerance to both low- and high-frequency motion artifacts during abrupt hand movements and prolonged periods of walking. Thus, our approach shows promise in constituting a necessary advance and can be applied to a wide range of wearable sensors for CNIBP monitoring in the ambulatory and inpatient settings.

Design of an Out-Folded Patch Antenna With a Zeroth-Order Resonance for Non-Invasive Continuous Glucose Monitoring

This article proposes an out-folded patch antenna with a zeroth-order resonance (ZOR) that is robust to a high-dielectric condition of a human body for noninvasive continuous glucose monitoring (CGM). The proposed antenna has two faces of a tapered section and a rectangular patch separated by a gap, and those faces are connected through vias at two corners near the gap. Two identical antennas are fabricated on a flexible printed circuit board (FPCB), and the properties of ZOR are compared with those of the fundamental mode to demonstrate the feasibility. The ZOR of the proposed antenna exhibits a negligible frequency shift, and its quality factor is 2.9 times higher than the fundamental mode, when attached to the skin. The evaluation is further extended to a human experiment using the two antennas for real-time estimation of coupling strength according to the change in glucose concentration. The trend of measured coupling strength well describes that of the glucose concentration obtained from a glucose meter with a mean absolute relative difference of 12.23%. The results demonstrate that the proposed concept has a great potential to improve the accuracy of noninvasive estimation in microwave spectrum.

Design and analysis of a continuous optoelectronic pulse wave velocity blood pressure sensor with multiple-subject controlled experiments

The main purpose of this study is to perform the pulse wave velocity (PWV) measurements with a new noninvasive optoelectronic continuous-time wearable sensor design and to analyze the quantitative relation between the reference blood pressure (BP) measurement. PWV was measured at baseline 32 normotensive volunteers, including 15 females and 17 males aged between 23 and 41 years old. The day before the measurements, the volunteers were not allowed to drink alcohol, stay up late or use any medicine that would affect BP. Repeated BP measurements were performed with an average follow-up system at certain times of the day. Results: Equivalent constituents were established after questioning age, height, weight, physical activity levels in daily life, genetic predisposition for blood pressure and diabetic from all volunteers participating in the measurements. Systolic BP (SBP), diastolic BP (DBP), heart rate (HR), pulse pressure (PP), mean arterial pressure (MAP), distance between brachial to radial artery (D), pulse transit time between brachial to radial artery (brPTT) and PWV measurements were all collected to correlate results with the introduced sensor’s readings. Following the experimental results, a linear link was found between SBP and PWV when the two groups separated by gender related were examined and the correlation coefficients between them were r: 0.9915 in females and r: 0.9845 in males Measurements taken with the new non-invasive low-power continuous-time sensor design show that the PWV may in the near future be used as a screening tool to identify continuous SBP values in clinical practice. The new non-invasive design suggests that SBP has the strongest correlation with PWV among a variety of BP parameters. • Non-invasive continuous monitoring of blood pressure may improve the quality of life for patients. • Pulse wave velocity measurement (PWV) is one of the promising methods to measure blood pressure. • A simple wearable sensor has proven a distinguishable correlation between PWV readings and corresponding blood pressure. • A multi-subject human experiments from a variety of groups have suggested that PWV can be a candidate for blood pressure sensors.

Is Raman the best strategy towards the development of non-invasive continuous glucose monitoring devices for diabetes management?

Diabetes has no well-established cure; thus, its management is critical for avoiding severe health complications involving multiple organs. This requires frequent glycaemia monitoring, and the gold standards for this are fingerstick tests. During the last decades, several blood-withdrawal-free platforms have been being studied to replace this test and to improve significantly the quality of life of people with diabetes (PWD). Devices estimating glycaemia level targeting blood or biofluids such as tears, saliva, breath and sweat, are gaining attention; however, most are not reliable, user-friendly and/or cheap. Given the complexity of the topic and the rise of diabetes, a careful analysis is essential to track scientific and industrial progresses in developing diabetes management systems. Here, we summarize the emerging blood glucose level (BGL) measurement methods and report some examples of devices which have been under development in the last decades, discussing the reasons for them not reaching the market or not being really non-invasive and continuous. After discussing more in depth the history of Raman spectroscopy-based researches and devices for BGL measurements, we will examine if this technique could have the potential for the development of a user-friendly, miniaturized, non-invasive and continuous blood glucose-monitoring device, which can operate reliably, without inter-patient variability, over sustained periods.

Non-invasive continuous cardiac output monitoring in infants with hypoxic ischaemic encephalopathy

ObjectiveTo describe early, continuous, non-invasive measures of cardiac output (CO) and evolution over time in infants with hypoxic-ischaemic encephalopathy (HIE).Study designProspective observational study of 44 infants with HIE (23 mild, 17 moderate, 4 severe) and 17 term controls. Infants with HIE had non-invasive CO monitoring (NICOM) continuously in the neonatal unit. Term controls had NICOM recorded at 6 and 24 h. A mixed-modelling approach was used to assess change in CO over time by group.ResultsInfants with moderate HIE have significantly lower CO than the mild group at all timepoints (10.7 mls/kg/min lower, 95% CI:1.0,20.4, p = 0.03) which increases over time, driven by a gradual increase in stroke volume (SV). CO increased further during rewarming predominantly due to an increase in HR.ConclusionTH has a significant impact on HR but SV appears largely unaffected. NICOM may provide a non-invasive, continuous, low-cost alternative to monitoring CO in infants with HIE however further research is warranted.

Evaluating and Visualizing the Contribution of ECG Characteristic Waveforms for PPG-Based Blood Pressure Estimation.

Non-invasive continuous blood pressure monitoring is of great significance for the preventing, diagnosing, and treating of cardiovascular diseases (CVDs). Studies have demonstrated that photoplethysmogram (PPG) and electrocardiogram (ECG) signals can effectively and continuously predict blood pressure (BP). However, most of the BP estimation models focus on the waveform features of the PPG signal, while the peak value of R-wave in ECG is only used as a time reference, and few references investigated the ECG waveforms. This paper aims to evaluate the influence of three characteristic waveforms in ECG on the improvement of BP estimation. PPG is the primary signal, and five input combinations are formed by adding ECG, P wave, QRS complex, T wave, and none. We employ five common convolutional neural networks (CNN) to validate the consistency of the contribution. Meanwhile, with the visualization of Gradient-weighted class activation mapping (Grad-CAM), we generate the heat maps and further visualize the distribution of CNN’s attention to each waveform of PPG and ECG. The heat maps show that networks pay more attention to the QRS complex and T wave. In the comparison results, the QRS complex and T wave have more contribution to minimizing errors than P wave. By separately adding P wave, QRS complex, and T wave, the average MAE of these networks reaches 7.87 mmHg, 6.57 mmHg, and 6.21 mmHg for systolic blood pressure (SBP), and 4.27 mmHg, 3.65 mmHg, and 3.73 mmHg, respectively, for diastolic blood pressure (DBP). The results of the experiment show that QRS complex and T wave deserves more attention and feature extraction like PPG waveform features in the continuous BP estimation.

Optical Monitoring in Neonatal Seizures.

Background: Neonatal seizures remain a significant cause of morbidity and mortality worldwide. The past decade has resulted in substantial progress in seizure detection and understanding the impact seizures have on the developing brain. Optical monitoring such as cerebral near-infrared spectroscopy (NIRS) and broadband NIRS can provide non-invasive continuous real-time monitoring of the changes in brain metabolism and haemodynamics. Aim: To perform a systematic review of optical biomarkers to identify changes in cerebral haemodynamics and metabolism during the pre-ictal, ictal, and post-ictal phases of neonatal seizures. Method: A systematic search was performed in eight databases. The search combined the three broad categories: (neonates) AND (NIRS) AND (seizures) using the stepwise approach following PRISMA guidance. Results: Fifteen papers described the haemodynamic and/or metabolic changes observed with NIRS during neonatal seizures. No randomised controlled trials were identified during the search. Studies reported various changes occurring in the pre-ictal, ictal, and post-ictal phases of seizures. Conclusion: Clear changes in cerebral haemodynamics and metabolism were noted during the pre-ictal, ictal, and post-ictal phases of seizures in neonates. Further studies are necessary to determine whether NIRS-based methods can be used at the cot-side to provide clear pathophysiological data in real-time during neonatal seizures.

Cardiovascular Magnetic Resonance Imaging in the Early Detection of Cardiotoxicity Induced by Cancer Therapies.

The significant progress in cancer treatment, including chemotherapy, immunotherapy, radiotherapy, and combination therapies, has led to higher long-term survival rates in cancer patients, while the cardiotoxicity caused by cancer treatment has become increasingly prominent. Cardiovascular magnetic resonance (CMR) is a non-invasive comprehensive imaging modality that provides not only anatomical information, but also tissue characteristics and cardiometabolic and energetic assessment, leading to its increased use in the early identification of cardiotoxicity, and is of major importance in improving the survival rate of cancer patients. This review focused on CMR techniques, including myocardial strain analysis, T1 mapping, T2 mapping, and extracellular volume fraction (ECV) calculation in the detection of early myocardial injury induced by cancer therapies. We summarized the existing studies and ongoing clinical trials using CMR for the assessment of subclinical ventricular dysfunction and myocardial changes at the tissue level. The main focus was to explore the potential of clinical and preclinical CMR techniques for continuous non-invasive monitoring of myocardial toxicity associated with cancer therapy.

Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis.

The article deals with an overview of acute extremity compartment syndrome with a focus on the option of non-invasive detection of the syndrome. Acute extremity compartment syndrome (ECS) is an urgent complication that occurs most often in fractures or high-energy injuries. There is still no reliable method for detecting ECS. The only objective measurement method used in clinical practice is an invasive measurement of intramuscular pressure (IMP). The purpose of this paper is to summarize the current state of research into non-invasive measurement methods that could allow simple and reliable continuous monitoring of patients at risk of developing ECS. Clinical trials are currently underway to verify the suitability of the most studied method, near-infrared spectroscopy (NIRS), which is a method for measuring the local oxygenation of muscle compartments. Less explored methods include the use of ultrasound, ultrasound elastography, bioimpedance measurements, and quantitative tissue hardness measurements. Finding a suitable method for continuous non-invasive monitoring of the syndrome would greatly improve the quality of care for patients at risk. ECS must be diagnosed quickly and accurately to prevent irreversible tissue damage that can occur within hours of syndrome onset and may even warrant amputation if neglected.