Counterpulsation Research Articles

The Method of Enhanced External Counterpulsation in Clinical Practice

Chronic non- infectious diseases represent an important medical and social problem for the healthcare system. Optimal pharmacotherapy is not always effective enough, and the use of surgical treatment methods is not possible in all patients. In addition, an important link in the comprehensive management of such patients is dosed physical activity, however, in most of them, low exercise tolerance does not allow them to exercise, starting a vicious circle that leads to a decrease in the functional reserve of the body. In this case, the use of non-pharmacological treatment methods, for example, enhanced external counterpulsation, may be useful. This review is devoted to the analysis of literature data on the possibilities of using this method, which is important in clinical practice.

Exploring Functional And Symptomatic Improvements By Sex After Enhanced External Counterpulsation Therapy

Exploring Functional And Symptomatic Improvements By Sex After Enhanced External Counterpulsation Therapy

Reduction in the risk of contrast-induced nephropathy using enhanced external counter-pulsation in patients with chronic kidney disease

Objective To evaluate the efficacy of EECP in the prevention of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). Methods A prospective trial was undertaken in the participants. A total of 280 patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 who underwent percutaneous coronary artery procedures were enrolled and divided into two groups: the control group (n = 100) and the EECP group (n = 180). All patients received extracellular fluid volume expansion therapy with 0.9% normal saline, and patients in the EECP groups were also treated with EECP. The renal function indexes of the two groups were determined 48–72 h after coronary artery procedures. Results In the EECP group, the BUN and serum creatinine (Scr) after coronary artery procedures were significantly lower than those before coronary artery procedures (BUN: 8.4 ± 3.5 vs. 6.6 ± 2.7 mmol/L, p < 0.001; Scr: 151.9 ± 44.7 vs. 144.5 ± 48.3 μmol/L, p < 0.001), while the eGFR was significantly increased (43.6 ± 11.4 vs. 47.1 ± 13.9 ml/min/1.73 m2, p < 0.001). The degree of Scr elevation was lower in the EECP group than in the control group (12.4 ± 15.0 vs. 20.9 ± 24.8 μmol/L, p = 0.026). Additionally, the EECP group had a lower incidence of post-procedures Scr elevation than the control group (36.5 vs. 48.0%, p = 0.042), a higher incidence of post-procedures eGFR elevation (62.2 vs. 48.0%, p = 0.021), and a lower risk of CIN (1.1 vs. 6.0%, p = 0.019). Conclusion EECP therapy has a protective effect on renal function and can reduce the risk of CIN in patients with CKD.

NIM–TTL and TTL–NIM converters for single particle pulse counting experiments

Abstract Low-cost interface circuits are detailed that convert negative-going NIM signals to TTL and TTL to NIM, using high-speed digital and analogue components to convert between formats. By converting NIM pulses derived from single particle detectors to TTL logic, the large suite of TTL compatible devices available to manipulate, control and measure TTL signals can be exploited. Conversion of TTL pulses to NIM allows them to be used to trigger timing events, e.g. in time of flight measurements and coincidence studies. Examples using these techniques are presented.

Mobilization of Endogenous CD34+/CD133+ Endothelial Progenitor Cells by Enhanced External Counter Pulsation for Treatment of Refractory Angina.

Adult stem cell therapy via intramyocardial injection of autologous CD34+ stem cells has been shown to improve exercise capacity and reduce angina frequency and mortality in patients with refractory angina (RA). However, the cost of such therapy is a limitation to its adoption in clinical practice. Our goal was to determine whether the less costly, less invasive, and widely accessible, FDA-approved alternative treatment for RA patients, known as enhanced external counterpulsation (EECP), mobilizes endogenous CD34+ stem cells and whether such mobilization is associated with the clinical benefits seen with intramyocardial injection. We monitored changes in circulating levels of CD34+/CD133+ and CD34+/KDR+ cells in RA patients undergoing EECP therapy and in a comparator cohort of RA patients undergoing an exercise regimen known as cardiac rehabilitation. Changes in exercise capacity in both cohorts were monitored by measuring treadmill times (TT), double product (DP) scores, and Canadian Cardiovascular Society (CCS) angina scores between pre- and post-treatment treadmill stress tests. Circulating levels of CD34+/CD133+ cells increased in patients undergoing EECP and were significant (β = -2.38, p = 0.012) predictors of improved exercise capacity in these patients. CD34+/CD133+ cells isolated from RA patients could differentiate into endothelial cells, and their numbers increased during EECP therapy. Our results support the hypothesis that mobilized CD34+/CD133+ cells repair vascular damage and increase collateral circulation in RA patients. They further support clinical interventions that can mobilize adult CD34+ stem cells as therapy for patients with RA and other vascular diseases.

Exploring Functional Improvements by Sex in Six-Minute Walk Test, Exertional Angina, and Dyspnea After Enhanced External Counterpulsation Therapy.

The objective of this study was to explore functional improvements by sex for patients with refractory angina pectoris using a 6-min walk test (6MWT) after enhanced external counterpulsation (EECP) therapy. All patients who completed EECP from 2015 to 2023 were identified for analysis retrospectively, utilizing the electronic medical record. Patients completed 35 1-hr EECP sessions 5 d/wk over 7wk. All baseline and post-EECP intervention 6MWT, exertional angina, and dyspnea measurements were assessed on the first and last sessions, respectively. Paired and unpaired t tests and linear and stepwise multivariable regression analyses were performed. The cohort consisted of 116 patients (24 female) with a mean age of 69±13yr. After EECP, there was a mean improvement of 128 m (72%) in distance walked during the 6MWT ( P <.001) with 126±91 m improvement in males and 134±73 m in females. The improvement in angina and dyspnea scores was 3.5±2.1 and 4.2±2.4, respectively. There were no differences between the sexes for improvements in 6MWT distance, angina, or dyspnea. Univariate associations for change in 6MWT distance included body mass index (BMI; adjusted R2 =.05) and being a nonsmoker (adjusted R2 =.03). The only independent predictor for increasing distance during 6MWT was BMI (adjusted R2 =.1; P =.001). Patients who have refractory angina pectoris can improve their functional capacity while simultaneously decreasing exertional angina and dyspnea using EECP. This study highlights the equal efficacy of EECP therapy for females.

Unveiling the Mysteries of Contrast-Induced Acute Kidney Injury: New Horizons in Pathogenesis and Prevention.

The utilization of contrast media (CM) in clinical diagnostic imaging and interventional procedures has escalated, leading to a gradual increase in the incidence of contrast-induced acute kidney injury (CI-AKI). Presently, the scarcity of effective pharmacological treatments for CI-AKI poses significant challenges to clinical management. Firstly, we explore the pathogenesis of CI-AKI in this review. Beyond renal medullary ischemia and hypoxia, oxidative stress, cellular apoptosis, and inflammation, emerging mechanisms such as ferroptosis, release of neutrophil extracellular traps (NETs), and nitrosative stress, which offer promising avenues for the management of CI-AKI, are identified. Secondly, a comprehensive strategy for the early prevention of CI-AKI is introduced. Investigating the risk factors associated with CI-AKI is essential for the timely identification of high-risk groups. Additionally, exploring early sensitive biomarkers is crucial for early diagnosis. A synergistic approach that combines these sensitive biomarkers, CI-AKI risk factors, and disease risk prediction models enhances both the accuracy and efficiency of early diagnostic processes. Finally, we explore recent pharmacological and non-pharmacological interventions for the management of Cl-AKI. Beyond the traditional focus on the antioxidant N-acetylcysteine (NAC), we look at active compounds from traditional Chinese medicine, including tetramethylpyrazine (TMP), salvianolic acid B (Sal B), as well as emerging preventive medications like N-acetylcysteine amide (NACA), alprostadil, and others, which all showed potential benefits in animal and clinical studies for CI-AKI prevention. Furthermore, innovative strategies such as calorie restriction (CR), enhanced external counterpulsation (EECP), and mesenchymal stem cell therapy are highlighted as providing fresh insights into Cl-AKI prevention and management.

Effect of enhanced external counterpulsation on coronary microcirculation dysfunction (CMD) in patients with coronary artery disease (EECP-CMD II): study protocol of a single-centre, open-label, parallel group, randomised controlled trial

IntroductionCoronary microcirculation dysfunction (CMD) is prevalent in patients with coronary artery disease (CAD). Current therapies for CMD are focused on pharmacotherapy, non-pharmacological treatments such as enhanced external counterpulsation (EECP) have...

Successful Coronary Collateralization Identified Noninvasively Using Quantitative PET Myocardial Perfusion Imaging in Patients With Chronic Total Coronary Occlusion Treated With External Counterpulsation

Successful Coronary Collateralization Identified Noninvasively Using Quantitative PET Myocardial Perfusion Imaging in Patients With Chronic Total Coronary Occlusion Treated With External Counterpulsation

Constraining the Selection-corrected Luminosity Function and Total Pulse Count for Radio Transients

Studying transient phenomena, such as individual pulses from pulsars, has garnered considerable attention in the era of astronomical big data. Of specific interest to this study are rotating radio transients (RRATs), nulling, and intermittent pulsars. This study introduces a new algorithm named LuNfit, tailored to correct the selection biases originating from the telescope and detection pipelines. Ultimately LuNfit estimates the intrinsic luminosity distribution and nulling fraction of the single pulses emitted by pulsars. LuNfit relies on Bayesian nested sampling so that the parameter space can be fully explored. Bayesian nested sampling also provides the additional benefit of simplifying model comparisons through the Bayes ratio. The robustness of LuNfit is shown through simulations and applying LuNfit onto pulsars with known nulling fractions. LuNfit is then applied to three RRATs, J0012+5431, J1538+1523, and J2355+1523, extracting their intrinsic luminosity distribution and burst rates. We find that their nulling fractions are 0.4(2), 0.749(5), and 0.995(2), respectively. We further find that a log-normal distribution likely describes the single pulse luminosity distribution of J0012+5431 and J1538+1523, while the Bayes ratio for J2355+1523 slightly favors an exponential distribution. We show the conventional method of correcting selection effects by “scaling up” the missed fraction of radio transients can be unreliable when the mean luminosity of the source is faint relative to the telescope sensitivity. Finally, we discuss the limitations of the current implementation of LuNfit while also delving into potential enhancements that would enable LuNfit to be applied to sources with complex pulse morphologies.

Predictors of Serotonin Syndrome in Acute Poisoning with 5-Hydroxytryptamine Modulators.

5-Hydroxytryptamine (5-HT) modulators are commonly prescribed medications with potentially life-threatening outcomes, particularly serotonin syndrome (SS). Early prediction of SS is critical not only to avoid lethal drug combinations but also to initiate appropriate treatment. The present work aimed to recognize the significant predictors of SS through a retrospective cross-sectional study that was conducted among patients exposed to an overdose of 5-HT modulators and admitted to a poison control center where 112 patients were enrolled. Of them, 21 patients were diagnosed with SS, and 66.7% of patients with SS were exposed to long-term co-ingestion. There was a noticeable surge in SS between April and May, and 52.4% of patients who suffered from SS were admitted after suicidal exposure (p < 0.05). Patients with SS showed severe presentation indicated by high-grade poison severity scores (PSS) and low Glasgow coma scales (GCS). PSS was a significant predictor of SS with an area under the curve of 0.879. PCO2, pulse, GCS, HCO3, and erythrocytic count were other significant predictors of SS. Combinations of serotonergic agents increase the likelihood of developing SS. Clinicians should be vigilant when prescribing a combination of serotonergic therapy, particularly for patients on illicit sympathomimetic and over-the-counter medications like dextromethorphan.

Evaluation of enhanced external counterpulsation for diabetic foot based on a patient-specific 0D-1D cardiovascular system model

Background and objectiveDiabetic foot (DF) complications often lead to severe vascular issues. This study investigated the effectiveness of enhanced external counterpulsation (EECP) and its derived innovative compression strategies in addressing poor perfusion in DF. Although developing non-invasive and efficient treatment methods for DF is critical, the hemodynamic alterations during EECP remain underexplored despite promising outcomes in microcirculation. This research sought to address this gap by developing a patient-specific 0D-1D model based on clinical ultrasound data to identify potentially superior compression strategies that could substantially enhance blood flow in patients with DF complications. MethodsData were gathered from 10 patients with DF utilizing ultrasound for blood flow rate and computed tomography angiography (CTA) to identify lower limb conditions. Clinical measurements during standard EECP, with varying cuff pressures, facilitated the creation of a patient-specific 0D-1D model through a two-step parameter estimation process. The accuracy of this model was verified via comparison with the clinical measurements. Four compression strategies were proposed and rigorously evaluated using this model: EECP-Simp-I (removing hip cuffs), EECP-Simp-II (further removing the cuffs around the lower leg), EECP-Impr-I (removing all cuffs around the affected side), and EECP-Impr-II (building a loop circulation from the healthy side to the affected side). ResultsThe predicted results under the rest and standard EECP states were generally closely aligned with clinical measurements. The patient-specific 0D-1D model demonstrated that EECP-Simp-I and EECP-Impr-I contributed similar enhancement to perfusion in the dorsal artery (DA) and were comparable to standard EECP, while EECP-Simp-II had the least effect and EECP-Impr-II displayed the most significant enhancement. Pressure at the aortic root (AO) remained consistent across strategies. ConclusionsEECP-Simp-I is recommended for patients with DF, emphasizing device simplification. However, EECP-Simp-II is discouraged as it significantly diminished blood perfusion in this study, except in cases of limb fragility. EECP-Impr-II showed superior enhancement of blood perfusion in DA to all other strategies but required a more complex EECP device. Despite increased AO pressure in all the proposed compression strategies, safety could be guaranteed as the pressue remained within a safe range.

Reversible photoluminescence shift in imidazolium l-tartrate crystal triggered by acoustic shock waves

Abstract Imidazolium l-tartrate crystal has been grown by employing the slow evaporation technique using de-ionized water as the solvent. An impact study on the exposure of shock pulses on the surface of the material has been carried out and the influence of shock waves on its photo luminance has been investigated. In the present work, in order to carry out the experiment, a shock wave of Mach number 1.5 has been utilized which has been generated by a semi-automated Reddy Tube. Imidazolium tartrate crystal is made into a fine powder and split into four identical parts to be used for further characterization. A series of shock waves such as 25, 50, and 75 are impacted on the respective samples while keeping one of the samples as the control. The powder X-ray diffraction analysis reveals that the observed increase in peak intensity and peak shifting is due to the increase in the number of shock pulses from 25 to 75. FTIR is performed to analyze the presence of functional groups in the material before and after shock exposure. Photoluminescence measurements are also carried out for the pre- and post-shocked samples to determine the nature of optical emission with respect to various shock pulse counts. The above experimental analyzes confirm that the title sample undergoes a reversible photoluminescence shift induced by shock waves.

ДОЛГОСРОЧНАЯ ЭФФЕКТИВНОСТЬ УСИЛЕННОЙ НАРУЖНОЙ КОНТРПУЛЬСАЦИИ У ПАЦИЕНТОВ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ИШЕМИЧЕСКОГО ГЕНЕЗА

Aim. To study the long-term effect of complex therapy with the addition of enhanced external counterpulsation (EECP) on exercise tolerance, quality of life and systolic heart function in patients with ischemic chronic heart failure (CHF). Material and methods. Patients with ischemic CHF NYHA class II-III (n=20) included in the study. Patients, in addition to optimal medical therapy, were treated with EECP (35 hours, the standard protocol, 1 course every 6 months). The duration of observation was 5 years. Baseline, 12, 24, 36, 48 and 60 months performed assessment of NT-proBNP level, clinical status, exercise tolerance (6-minute walk test – 6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire – MLHFQ), left ventricular ejection fraction (LVEF) according to echocardiography. The composite primary endpoint (CPE) included adverse cardiovascular events, new cases of atrial fibrillation (AF), diabetes mellitus (DM), decreased renal function, and hospitalizations due to CHF. Results. During the observation period (60 months), significant stable positive dynamics were noted in exercise tolerance (6MWT distance increased by 59.3%), clinical status, LVEF, NT-proBNP level, quality of life (MLHFQ). The incidence of myocardial infarction was 5%, revascularization – 15%, new cases of AF – 5%, decreased renal function – 10%, hospitalizations for CHF – 35%. There were no cases of strokes, deaths or new cases of diabetes. The prevalence of CPE was 70% over a 5-year period. Conclusion. A stable positive effect of EECP treatment of patients with ischemic heart failure on functional status and clinical outcomes has been demonstrated.

Критичність паливовмісних матеріалів в об'єкті "Укриття"

The article presents the results of the analysis of the validity of simplifications and assumptions accepted by researchers in the models of neutron-physical characteristics of fuel-containing materials (FCM) in the "Shelter" object (SO). The analysis and substantiation of the FCM nuclear safety will be one of the important issues during the SO operation for a long time, until the moment of retrieval and disposal of nuclear materials from the ChNPP Unit 4 destroyed in 1986. A significant number of nuclear materials in the SO are uncontrolled, and the geometry of their location is also little known. Therefore, the use of traditional methods of nuclear safety analysis to determine the conditions for reaching criticality in the volume of FCM can lead to significant uncertainties, depending on the assumptions and simplifications made in FCM models. In contrast to traditional nuclear facilities with design characteristics and control systems, there is no possibility to deterministically influence the FCM, and accordingly to determine their dynamic characteristics in the SO. In such conditions, it is necessary to take a responsible approach to obtain and interpret the values of FCM parameters by control systems of the SO. For example, in 1990, one of the neutron flux detectors recorded an abnormal change in the neutron pulse count rate for about 100 hours. This event is often called a “neutron incident”, and it formed the basis of some models, in which the possibility of reaching criticality in one of the FCM clusters is assumed. The article presents the results of the study on the physical possibility of the anomalous event in 1990, as well as the results of the analysis of simplifications and assumptions made in models of FCM criticality. An important result of the conducted research is the justification of the need to include in the FCM criticality model the effects of reactivity on fuel and water temperature, as well as to take into account delayed neutrons.

Not so cryptic-differences between mating calls of Hyla arborea and Hyla orientalis from Bulgaria.

Anurans are among the most vocally active vertebrate animals and emit calls with different functions. In order to attract a mate, during the breeding season male frogs produce mating calls which have species-specific structure and parameters, and have been successfully used to resolve issues in taxonomy and phylogenetic relations. This is particularly useful when closely related taxa are concerned, as many species are morphologically almost identical, but still their status is well-supported by molecular and genetic data, suggesting the existence of mechanisms for reproductive isolation. Such is the case for treefrogs from the Hyla arborea group, which are now recognized as several distinct species. The present study aims to establish differences in call parameters between the European tree frog, Hyla arborea, and the Eastern tree frog, Hyla orientalis, which both occur on the territory of Bulgaria. Using autonomous audio loggers, calls from six sites (three in the range of H. arborea and three in the range of H. orientalis) were recorded between 7 p.m. and 12 a.m. during the breeding season in 2020-2023. The following parameters in a total of 390 mating calls were analyzed: call count, pulse count, call series duration, call period, peak (dominant) frequency, entropy. Results indicated that sites formed two distinct groups, which corresponded to the known distribution ranges of H. arborea and H. orientalis. The first two components of the PCA explained 71% of the total variance, with variables call count, call series duration, peak frequency and entropy being most important for differentiation between the sites. This study presents the first attempt to differentiate between the calls of these two sister taxa, which both fall within the "short-call treefrogs" group, and results are discussed in terms of known data for mating calls in Hyla sp., as well as limitations and future perspectives.

Amorphous carbon derived from daily carbon ink for wide detection range, low-cost, eco-friendly and flexible pressure sensor

Flexible pressure sensor has important applications in wearable electronic system. However, most reported flexible pressure sensors still face problems such as expensive raw materials, complex preparation processes, and narrow pressure detection ranges. Inspired by low-cost daily carbon ink and filter paper, a flexible pressure sensor is designed and fabricated using a simple dip-coating method. The proposed pressure sensor consists of two filter papers coated with carbon ink as sensitive layers, fabric conductive tapes as flexible electrodes, and polyimide tape as packaging layer. The filter paper has a fibrous microstructure, which is beneficial for improving the pressure sensing performance of the pressure sensor. The main component of carbon ink is amorphous carbon, which has a moderate conductivity. The results indicate that the pressure sensor exhibits wide detection range (0.1–100 kPa), high sensitivity of 0.627 kPa−1 (0.1–15 kPa), short response/recovery times (230 ms/290 ms) and good durability (4000 cycles at 50 kPa). In addition, the pressure sensor can be used for physiological and motion monitoring, such as pulse and step count. This work provides an optional strategy for developing wide detection range, low-cost, eco-friendly and flexible pressure sensor.

A multimorbid patient with heart failure and long-term treatment with enhanced external counterpulsation: a case report

A multimorbid patient with heart failure and long-term treatment with enhanced external counterpulsation: a case report

СРЕДНЕСРОЧНЫЕ ЭФФЕКТЫ УСИЛЕННОЙ НАРУЖНОЙ КОНТРПУЛЬСАЦИИ НА МАРКЕРЫ ГЛИКЕМИЧЕСКОГО КОНТРОЛЯ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ИШЕМИЧЕСКОГО ГЕНЕЗА

Aim. To study the effects of complex therapy with the addition of enhanced external counterpulsation (EECP) on exercise tolerance, echocardiographic parameters, markers of glycemic control and clinical outcomes in patients with ischemic chronic heart failure (CHF) with concomitant type 2 diabetes mellitus (DM). Material and methods. Patients with ischemic CHF II-III functional class with type 2 DM were randomized into group 1 (n=20) – optimal medical therapy (OMT) and EECP (35 hours, 2 courses per year), group 2 (n=21) – OMT and EECP (35 hours, 1 course per year), control group (n=20) – OMT and placebo-counterpulsation (35 hours, 1 course per year). The primary endpoint was achieving an HbA1c level of ≤7%. Secondary endpoints included the development of a combined endpoint (CEP: cases of adverse outcomes, hospitalizations for CHF, new onsets of atrial fibrillation, decreased renal function), as well as an increase after 12 months in the distance covered in 6-minue walk test (6MWT) by 20% or more from the baseline. Results. After 12 months, the proportion of patients achieving an HbA1c level of ≤7% in group 1 increased by 30%, in group 2 – by 14.3%, and remained the same in the control group (p=0.005). The proportion of patients with an increase in distance traveled according to 6MWT data &gt;20% after 12 months in the 1st, 2nd and control groups was 100%, 76.2% and 15.0%, respectively (p&lt;0.001). The development of CEP was observed in 3 (15.0%) patients of the 1st group, 7 (33.3%) – of the 2nd group and 12 (60.0%) – of the control group (including 1 case of death), p =0.003. Conclusion. Over a 12-month study period in patients with ischemic heart failure and type 2 diabetes, the addition of EECP to OMT after 12 months demonstrated an improvement in the clinical status of patients, which was accompanied by a decrease in levels of markers of glycemic control and the incidence of adverse outcomes compared with the placebo counterpulsation group.

Enhanced external counterpulsation treatment improves multi-organ hemodynamics for postoperative liver transplantation patient. A case report

IntroductionPost liver transplantation (LT) patients endure high morbidity rate of multi-organ ischemic symptoms following reperfusion. We hypothesize that enhanced external counterpulsation (EECP) as a typical non-invasive assisted circulation procedure, which can efficiently inhibit the relative ischemic symptoms via the systemic improvement of hemodynamics.Case presentationA 51-year-old male patient, 76 kg, 172 cm, received orthotopic LT surgery for viral hepatitis B induced acute-on-chronic liver failure hepatic failure. His medical records revealed ischemic symptoms in multi-organ at the time of hospital discharge, including headache, refractory insomnia, abdominal paralysis, and lower limb pain. The EECP treatment was introduced for assisted rehabilitation and to improve the postoperative quality of life. Doppler Ultrasound examination showed significant augmentation of blood flow volume in the carotid arteries, the hepatic artery, the portal vein and the femoral artery during EECP intervention. A standard 35-hour EECP treatment led to significant improvement in quality of life, e.g. sleep quality and walking ability.ConclusionWe report a case of multi-organ ischemic symptoms in a post LT patient. EECP treatment can significantly improve the quality of life via the systematic promotion of hemodynamics.