Sphygmomanometer Cuff Research Articles

Low to Moderate Arsenic Exposure May Not Increase the Risk of Incident Hypertension (P18-011-19)

ObjectivesCardiovascular disease is the leading cause of death in the world, and hypertension is the key modifiable risk factor. Risk factors for hypertension include high salt intake, obesity, stress, and environmental factors. Among environmental exposures, some studies suggest the possibility that arsenic plays a role in hypertension, but more evidence is needed to properly evaluate the association between arsenic exposure and hypertension. MethodsWe used a sub-cohort data from a longitudinal study, the China Health and Nutrition Survey. We followed up 2530 non-hypertensive participants aged 20–65 years old who had blood pressure data and toenail samples measured in 2009 through 2015. We measured blood pressure with sphygmomanometer and standard cuff and arsenic concentration in toenail samples by using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression models to estimate the association between arsenic quartiles and incident hypertension. ResultsThe average arsenic concentration was 0.48 (±0.60) mg/kg and the median was 0.33 mg/kg. The incidence of hypertension was 24.4% during the six follow-up years, varying from 26.2% in the first (lowest) quartile to 21.6% in the fourth (highest) quartile. Compared to the first quartile, the relative risk (RR) was 0.98 (95% CI: 0.74–1.29), 0.97 (95% CI: 0.73–1.29), and 0.74 (95% CI: 0.55–0.99) from the second to the fourth quartile, respectively, controlled for age, gender, body mass index, and some other cofounders. ConclusionsLow to moderate arsenic exposure might decrease the risk of hypertension. More research is needed to fully determine the effects of arsenic exposure on hypertension. Funding SourcesThe Eunice Kennedy Shriver National Institute of Child Health and Human Development.(NICHD), NIH; The Fogarty International Center, NIH; Department of Nutrition & Carolina Population Center, The University of North Carolina at Chapel Hill; Chinese Center for Disease Control and Prevention

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration.

ABSTRACTObjective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury.Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration.Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration).Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.

Non-invasive determination of reference arterial blood pressure indices of healthy Alsatian and Boerboel dogs

In order to evaluate and manage Boerboels and Alsatians under critical and emergency care, knowledge of ranges and causes of variability of normal arterial blood pressure (ABP) indices is desirable. The systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) of 30 healthy dogs were evaluated with human sphygmomanometer and neonatal cuff. The age, sex, breed, weight, height, weight to height ratio (WTH), of each dog was recorded. The mean and range of ABP values for Alsatians and Boerboels were similar to those of some other breeds. There were no age, breed and sex differences in ABP indices of dogs. The coefficient of variations and ranges of DAP and MAP were significantly higher than SAP measurements. In all dogs, SAP was influenced by breed and interaction of breed and sex when all confounders were controlled. The WTH and sex were found to independently influence SAP in presence of confounders. In Alsatian, WTH and sex interaction influenced all pressures in presence of confounders. The DAP was significantly influenced by heart rate and WTH in presence and absence of confounders respectively. Although age did not influence ABP in all dogs, it influenced SAP and DAP in females and Boerboel. The absence of age, sex, and breed differences in ABP of dogs may be due to multiple interactions between these factors. The human sphygmomanometer has the best precision for SAP measurements and WTH may be used as canine’s body mass index (BMI) because of its influence on ABP.Keywords: Blood pressure, dogs, breed, sex, age, oscillometry

Flow-mediated dilatation to relieve puncture-induced radial artery spasm: A pilot study.

Puncture-induced radial artery spasm (RAS) may extend the duration of coronary an-giography (CAG) or cause transradial access failure. Flow-mediated dilatation (FMD), a widely-used noninvasive approach for assessing endothelial function, was reported to remove the entrapped radial sheath after percutaneous coronary intervention. Herein, the efficacy and safety of FMD in treating puncture-induced RAS before transradial CAG was investigated. Ninety patients with puncture-induced RAS were randomized in a 1:1:1 ratio into three groups: FMD group was immediately treated with blockage of brachial artery blood for 5 min using a sphygmomanometric cuff and then rapid relief; nitroglycerin (NTG) group was administered with 0.5 mg sublingual NTG instantly; and the no-therapy group was treated with a wait-and-watch strategy. The time of radial pulse recovery, and regional and systemic complications were recorded. The rate of radial pulse recovery within 30 min in FMD group was significantly higher than that in no-therapy group (97% vs. 73%, p = 0.026). The median time to return of radial pulse in FMD group and NTG group was significantly shorter than that in no-therapy group (7 [6.5-9] min vs. 15 [12-18] min, 8 [7-9] min vs. 15 [12-18] min, respectively; both p < 0.001). Headache and decreased blood pressure were more prevalent in NTG group than those in FMD and no-therapy groups. FMD is a feasible, noninvasive and nonpharmacological approach to relieve RAS and facilitate radial artery cannulation after an initial failed attempt. (Cardiol J 2018; 25, 1: 1-6).

Correlation between endothelial dysfunction and myocardial damage in acute phase of Tako-Tsubo cardiomyopathy: brachial flow mediated dilation as a potential marker for assessment of patient with Tako-Tsubo.

Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the percentage of dilation after ischemia by comparing it to the basal. These values were measured at admission and on discharge. The obtained values were compared for each patient to explore their variability during hospitalization. Moreover, the correlation between the b-FMD at admission and both the troponin I peak and the LOHS was investigated. There was a statistical significant difference between mean FMD measured at admission and at discharge (respectively 1.54±0.34 and 8.92±2.48%; p<0.001). Moreover, we found a significant negative correlation between troponin I peak and FMD values at admission (r=-0.7645; p<0.001) and a significant inverse correlation between FMD at admission and LOHS (r=-0.7543; p<0.001). There is a significant improvement of b-FMD during hospitalization in patients admitted for Tako-Tsubo Cardiomyopathy. Moreover, for the first time, a direct correlation among b-FMD, troponin I peak and LOHS has been detected.

Comparison of the increase of both muscle strength and hypertrophy of biceps brachii muscle in strengthening exercise with low-intensity resistance training with and without the application of blood flow restriction and high-intensity resistance training

Background: Strengthening exercise is an important component of rehabilitation programs. Recently, it is reported that strengthening exercise with low-intensity resistance training (20-30% of 1 Repetition Maximum) combined with the application of blood flow restriction potentially increases muscle strength and induces muscle hypertrophy as well.Objective: This study aims to compare the increase in muscle strength and hypertrophy among the muscles trained with high-intensity resistance training (HIRT), low-intensity resistance training combined with the application of blood flow restriction using a sphygmomanometer cuff (LIRT+BFR) and low-intensity resistance training (LIRT) alone. Method: The subjects (n=18) are randomly and equally divided into three groups, those are the groups getting the strengthening exercise for left Biceps Brachii muscle with HIRT (70% of 1 RM), LIRT (30% of 1 RM)+BFR and LIRT (30% of 1 RM). Before starting and after getting the resistance training for five weeks, each subject is measured for the left arm circumference. Results: HIRT and LIRT+BFR produce an increase of the left arm circumference significantly greater than LIRT. However, there is no significant difference in the increase of left arm circumference between the HIRT and LIRT+BFR. There is a significant difference in the increase of the peak torque of left flexion elbow joint among the three groups, either at 60o/s or 120o/s or 180o/s angular velocity. At 60o/s angular velocity, LIRT+BFR produces the greatest increasing of the left elbow peak torque among the three groups. At both 120o/s and 180o/s angular velocity, there is no significant difference in the increase of the peak torque of flexion left elbow joint between HIRT and either LIRT+BFR or LIRT. However, at both 120o/s and 180o/s angular velocity, there is a significant difference in the increase of the peak torque of flexion left elbow joint between LIRT+BFR and LIRT.Conclusion: the strengthening exercise for Biceps Brachii muscle with LIRT+BFR induces the Biceps Brachii muscle hypertrophy and increases the muscle strength more than strengthening exercise with LIRT alone. Compared to the HIRT, LIRT+BFR induces an equal muscle hypertrophy and increases more muscle strength for the trained Biceps Brachii muscle.

PREDICTION OF JAMAR GRIP STRENGTH VALUE USING MODIFIED ANEROID SPYHGMOMANOMETER CUFF METHOD

Objective: To examine the prediction of Jamar grip strength value by using aneroid sphygmomanometer cuff method in adults. Methods: This study involved 120 subjects, aged 20–59 years old. The grip strength of subjects were measured using Jamar dynamometer and aneroid sphygmomanometer cuff method. Spearman analysis was used to evaluate the correlation between variables and grip strength. Forward stepwise was used to analyze the regression of Jamar dynamometer using aneroid sphygmomanometer cuff method. Results: There was a weak correlation (r&lt;0.4) between grip strength with age and BMI, moderate correlation (r = 0.4–0.6) for grip circumference, and also strong correlation r= (0.6–0.8) for sex, hand length, and hand width. Jamar grip strength value can be predicted using spyghmomanometer with the formula of (0.1157 x Sphygmomanometer grip strength value) – (5.696 x sex) + (0.0824 x age) (female =1, male= 0). Conclusions: Grip strength correlates with physiological variables. The variables to predict Jamar grip strength using sphygmomanometer are sex and age. Regression analysis shows that spyhgmomanometer can be used as an alternative to measure grip strength and has a valid value to predict the Jamar grip strength value. Keywords: Adult, grip strength, Jamar dynamometer, sphygmomanometer, prediction formula DOI: 10.15850/ijihs.v5n1.958

Adequacy of sphygmomanometer cuff to brachial circumference of people attended in Primary Health Care Centers.

To evaluate the adequacy of sphygmomanometer cuff to brachial circumference (BC) of individuals treated at Primary Health Care Centers. Epidemiological, observational, and quantitative cross-sectional study. A total of 381 blood pressure (BP) readings conducted by nursing professionals were observed at 18 service units selected by drawing, considering two modalities of care centers. The correct use of the cuff was the main outcome variable. The BC was measured using inelastic measuring tape. The tests used for statistical analysis were Student's t-test, χ2, or Fisher's exact test. The measurement of BC ranged from 19.5 to 45.0 cm (mean = 30.4; standard deviation - SD = 4.3). Among the BP measurements, 218 (57.2%) of them were conducted with the appropriately sized cuff, being more frequent in the units with Family Health Teams (59.6 versus 40.4; p < 0.001). Ninety-three (24.2%) BC measurements were < 27 cm and 63 (16.5%) were > 34 cm. The adult cuff was used correctly 209 (59.4%) times and the large adult cuff was used correctly 9 (31.0%) times. The study found an inadequacy in the use of the cuff in 42.8% of blood pressure readings in the Primary Health Care Centers. Similar studies should be performed in other cities and areas to estimate the effect of this problem in the diagnosis and monitoring of systemic arterial hypertension (SAH).

A new approach for detecting sudden hypotension in hemodialysis by using dual-channel optical system

Dialysis hypotension is one of the most prevalence symptoms of dialysis and occurs in 40% of treatment sessions. Detection and prediction of hypotension is important for the well-being of the patient and for optimizing treatment. The aim of this study was to construct optical system to monitor blood pressure (BP) continuously and without cuff in hemodialysis based on pulse transit time (PTT) method. To measure the BP changes, dual-channel optical system were developed. In this study, individuals were classified into two groups of normal and hemodialysis. In both groups, BP and consequently PTT were earned three times in different positions. After the initial calibration, the regression equation was drawn for each subject. In normal group, each subject was placed in the supine position and BP was measured both by designed system and sphygmomanometer cuff. During BP measurements, in addition to BP, blood pressure decline was also monitored by optical system. For hemodialysis group, the same measurement setup was adopted. In both groups, the error between cuff method and PTT was calculated. Correlation coefficients for BPcuff vs BPPTT were calculated and Bland–Altman plot was performed for the normal and hemodialysis groups. In this study 16 subjects participated. The results for normal group showed that maximum difference between cuff method and the present method was 14[Formula: see text]mmHg and for dialysis group was 16[Formula: see text]mmHg. Bland–Altman plot in normal group revealed limits of agreement from [Formula: see text]13.98 to 13.18[Formula: see text]mmHg. Considering hemodialysis group, limits of agreement were from [Formula: see text]15.94 to 13.88[Formula: see text]mmHg. The correlation coefficient was 0.74 for normal group and was 0.72 for hemodialysis group. The proposed system can monitor BP continuously and diagnose sudden hypotension. So it can be recommended as a useful method to indicate hypotension and can be used for dialysis unit.

Sonographic Evaluation of Endothelial Function in Brachial Arteries of Adult Stroke Patients.

Brachial artery flow-mediated dilatation on sonography is used to evaluate endothelial dysfunction, which is a key event in the development of atherosclerosis and predates structural atherosclerotic lesions by many years. Atherosclerosis has been implicated in the pathophysiologic mechanisms of ischemic stroke. The aim of this study was to determine the association between brachial flow-mediated dilatation, the presence of cardiovascular risk factors, and acute stroke. We evaluated right brachial arteries of 150 participants (50 stroke patients, 50 patients with cardiovascular risk factors, and 50 healthy control individuals) with B-mode sonography before and 5 minutes after sphygmomanometer cuff application to their forearms. Analysis of variance for multiple comparisons was used between each group. Mean ages of the stroke, risk factor, and control groups ± SD were 57.5 ± 14.8, 52.4 ± 16.0, and 56.1 ± 14.9 years, respectively (P = .235). Flow-mediated dilatation rates were 4.37% ± 1.50%, 5.62% ± 1.23%, and 10.33% ± 1.96% in the stroke, risk factor, and control groups (P ≤ .001). Dilatation was 3.79% ± 0.92% in ischemic stroke compared with 6.02% ± 1.62% in intracerebral hemorrhage (P < .001), but there was no significant difference in dilatation between ischemic stroke subtypes according to the Trial of ORG 10172 in Acute Stroke Treatment classification (P = .301). Brachial flow-mediated dilatation was significantly lower in patients with acute stroke compared with controls matched for vascular risk factors and healthy controls. Decreased vascular endothelial function in stroke patients was particularly related to cerebral infarction compared with intracerebral hemorrhage. Brachial flow-mediated dilatation did not differentiate ischemic stroke subtypes by the Trial of ORG 10172 in Acute Stroke Treatment classification. Flow-mediated dilatation was therefore found to be a marker of cardiovascular risk and a probable reactant in the acute phase of stroke.

Evaluation of the acceptability of a sphygmomanometer device in knee extension training following surgical procedures of the knee

BackgroundThe postoperative treatment after a standard surgical intervention such as knee arthroplasty, proximal tibial osteotomy or supracondylar osteotomy, can have an important impact on the overall treatment outcome. In most cases, outcomes are positively effected by patients receiving physiotherapy and occupational therapy. Basic movements and range of motion need to be learnt. Self-responsible behaviour, which is similar to exercise programs in sports, needs to be supported. However, in most cases the transfer of training techniques into successful and desired postoperative care is not simple. A training technique needs to be developed which is self-explanatory, effective, encouraging for and accessible to the patient. ObjectivesThe purpose of this study was to describe and evaluate an easy and effective technique to support regular physiotherapy in early postoperative rehabilitation using a sphygmomanometer device. Measurements were undertaken relating to handling, training results and motivation. DesignThis was a descriptive study. MethodsForty one patients were instructed to undertake extension exercises of the knee in the early postoperative phase. A sphygmomanometer cuff was rolled out and placed just below the popliteal fossa, and inflated to 20 mmHg. In this position the patients were prompted to push the knee down with the maximum available power. The quadriceps muscle of the leg is activated when patients extend the knee using two thirds of their maximum power, and then followed by one third of their maximum power. This exercise sequence was carried out three times for 5 seconds. The results were documented by using a patient questionnaire. ResultsThirteen patients indicated that they felt highly motivated while undertaking the training program. One patient reported poor motivation due to inconvenient handling (preparing the cuff by closing the valve screw or calculating the target value) and six patients reported that the method of handwritten recording of training sessions needed to be improved. There were no technical problems. The training results were rated as being predominantly good. Due to the variation in individual ability in extending the knee, comparison of the overall values obtained could not be done. ConclusionThe use of a sphygmomanometer device is cheap and feasible technique in postoperative independent knee extension training.

Assessment of the endothelial function with changed volume of brachial artery by menstrual cycle.

BackgroundThe endothelial function has been proven to be an important factor in the pathogenesis of atherosclerosis, hypertension and heart failure. The flow-mediated vasodilation (FMD) of the peripheral artery is an endothelium-dependent function. Brachial-artery ultrasound scanning is the popular method for evaluating FMD. However, good technical training on ultrasonography is required for the user to obtain high-quality data. Therefore, the goal of this study was to propose a new method which only used a sphygmomanometer cuff to occlude the blood flow and record the vascular volume waveform (Vwave).ResultsWe used this method to assess the FMD in the menstrual cycle for 26 volunteer females. All female subjects were evaluated two times (M: menstrual phase; F: luteal phase) in one menstrual cycle and for two cycles. In the first cycle, the FMD volume ratio in M was 101.9 ± 45.5 % and was higher in L, at 137.5 ± 62.1 % (p = 0.0032 versus M). In the second cycle, the FMD volume ratios in M and L were 91.4 ± 37.0 % and 124.0 ± 56.4 %, respectively (p < 0.001 vs. M).ConclusionsOur results have confirmed those results in the study of Hametner et al. Blood pressure measurement and FMD assessment all used the same mechanic of digital blood pressure monitor, which makes our method suitable using at home.

Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers.

Background: There are very little scientific data on occlusion pressure for superficial lymphatic collectors. Given its importance in determining the transport capacity of lymphatic vessels, it is crucial to know its value. The novel method of near-infrared fluorescence lymphatic imaging (NIRFLI) can be used to visualize lymphatic flow in real time. The goal of this study was to see if this method could be used to measure the lymphatic occlusion pressure.Methods: We observed and recorded lymph flow in the upper limb of healthy volunteers through a transparent cuff using near-infrared fluorescence lymphatic imaging. After obtaining a baseline of the lymph flow without pressure inside the cuff, the cuff was inflated by increments of 10 mm Hg starting at 30 mm Hg. A NIRFLI guided manual lymphatic drainage technique named “Fill & Flush Drainage Method” was performed during the measurement to promote lymph flow. Lymphatic occlusion pressure was determined by observing when lymph flow stopped under the cuff.Results: We measured the lymphatic occlusion pressure on 30 healthy volunteers (11 men and 19 women). Mean lymphatic occlusion pressure in the upper limb was 86 mm Hg (CI ±3.7 mm Hg, α = 0.5%). No significant differences were found between age groups (p = 0.18), gender (p = 0.12), or limb side (p = 0.85).Conclusions: NIRFLI, a transparent sphygmomanometer cuff and the “Fill and Flush” manual lymphatic drainage method were used to measure the lymphatic occlusion pressure in 30 healthy humans. That combination of these techniques allows the visualization of the lymph flow in real time, while ensuring the continuous filling of the lymph collectors during the measurement session, reducing false negative observations. The measured occlusion pressures are much higher than previously described in the medical literature.

Validation of simple and inexpensive algometry using sphygmomanometer cuff and neuromuscular junction monitor with standardized laboratory algometer.

Background and Aims:The availability, ergonomics and economics prohibit the routine use of algometers in clinical practice and research by the anesthesiologists. A simple bedside technique of quantitative pain measurement would enable the routine use of algometry. We proposed to validate simple pain provocation using sphygmomanometer cuff and the electric stimulation of neuromuscular junction monitor (TOF-guard, Organon Teknika) to measure pain against a standardized laboratory pressure algometer.Material and Methods:Pain detection threshold (Pdt) and pain tolerance threshold (Ptt) were measured in forty healthy volunteers of both genders, using the above three techniques. All measurements were repeated three times. The co-efficient of inter-rater reliability (or consistency) between three independent measurements obtained from each of the techniques was determined by Cronbach's co-efficient alpha (α C). The correlation between the mean Pdt and Ptt values recorded by standardized algometer and the sphygmomanometer technique and nerve stimulator technique was performed using Pearson Correlation. An r >0.5 and a two-tailed significance of <0.05 were considered as good correlation between the standardized algometer and the tested techniques.Results:There was a good inter-rater reliability (α C > 0.7) for the three techniques. There was a good correlation with r >0.65 (P < 0.001) between the measurements of standardized pressure algometer and the two techniques being tested as alternatives for algometer to measure pain.Conclusion:The sphygmomanometer cuff technique and electrical stimulation with the peripheral nerve stimulator to measure pain threshold and tolerance provide a simple, efficient, repeatable measure of pain intensity and can be used as suitable alternatives to standard algometers.

Using Korotkoff Sounds to Detect the Degree of Vascular Compliance in Different Age Groups.

The principle behind the generation of the Korotkoff sounds is the turbulence of blood flowing through a partially occluded area in the artery. With increasing age, the vascular wall compliance is expected to decrease, which is due to the thickening of the vessel wall, due to which the amplitude of the transmitted Korotkoff sounds is decreased. There is also an accompanying rise in the systolic B.P. and pulse pressure. To record and compare the amplitudes of the intermediate Korotkoff sounds and the blood pressures in individuals of the two age groups, and calculate the pulse pressure and determine whether they vary in relation to the amplitude of the intermediate Korotkoff sounds recorded. The cross-sectional study was conducted on 50 young subjects (15-25 years) and 50 older subjects (50-70 years). The mid arm circumference was measured using a tape. A phonoarteriogram was placed over the left brachial artery and the sphygmomanometer cuff was tied 2cm above the cubital fossa of the left arm. The blood pressure was recorded using the Lab Tutor software. The Korotkoff sounds picked up and transmitted by the phonoarteriogram are represented as distinct lines on the graphical recording. Independent samples t-test to look for significant mean amplitude differences and for correlating mean amplitude and pulse pressure. Null hypothesis rejected at p<0.05. Data analysed using the SPSS software version 20.0 (SPSS Inc.). There was a significant difference in the mean amplitudes of Korotkoff sounds among the different age groups (p=0.001) and subject categories (p=0.043 among males, p=0.037 among females). A significant difference in pulse pressures was also seen among different age groups and subject categories. The decrease in the amplitudes of Korotkoff sounds in the older age group accompanies the increase in pulse pressures seen in this group and the same was seen among the different age groups within each sex (r=-0.574, p=0.001 among males) and (r=-0.449, p=0.002 among females). Measuring the amplitude of Korotkoff sounds can give us an idea of the nature of the arterial wall as shown by a decrease in amplitude in older individuals when compared to the younger individuals and of the volume of blood flowing through the artery as shown by the higher amplitudes observed in males when compared to females.

The Impact of Remote Ischemic Pre-Conditioning on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and Angioplasty: A Double-Blind Randomized Clinical Trial.

Background and objectiveContrast-induced nephropathy (CIN) is an acute major complication following intravascular administration of iodinated contrast agents; however, the best approach for preventing CIN is not clear. Remote ischemic pre-conditioning (RIPC) is a new, non-pharmacological method that has been considered for the prevention of CIN following coronary angiography. This study assessed the effects of RIPC with four brief episodes of upper limb ischemia and reperfusion in the prevention of contrast-induced nephropathy (CIN) after coronary angiography and/or angioplasty.MethodsIn this double-blind randomized clinical trial, we enrolled 51 patients with chronic stable angina and non-ST elevation acute coronary syndrome (NSTE.ACS), and they underwent coronary angiography and/or angioplasty. Standard fluid therapy with normal saline was prescribed for all patients before and after the procedure. The patients were divided into two groups, i.e., a study group of patients who had undergone RIPC intervention and a control group of patients who had not undergone RIPC. One hour before the procedure, a sphygmomanometer cuff was placed around one arm and inflated up to 50 mmHg above the systolic pressure for five minutes; then, the cuff was deflated for another five minutes, and this cycle was repeated four times. The patients’ serum creatinine levels were measured at baseline and 48 hours after the procedure, and the incidence of CIN was calculated.ResultsTwenty-one males and 30 females were studied in two groups, i.e., an RIPC intervention group (n = 25) and a control group (n = 26) that were homogenous considering baseline characteristics. No significant difference was observed in the mean level of serum creatinine between the two groups at a post-intervention time of 48 hours (RICP: 1.74 ± 0.70 mg/dL vs. Control: 1.75 ± 0.87 mg/dL; P = 0.64). However, a lower incidence rate of CIN was observed 48 hours after the administration of the contrast medium in the RIPC group, but it was not statistically significant (RIPC: 23.1% vs. Control: 12.0%; P = 0.30).ConclusionIt seems that adequate fluid therapy is still the most effective strategy for preventing CIN and that RIPC might have additional protective effects in very high risk patients, such as those with severe renal insufficiency and heart failure.

Effects of changing skin mechanics on the differential sensitivity to surface compliance by tactile afferents in the human finger pad.

It is not known how changes in skin mechanics affect the responses of cutaneous mechanoreceptors in the finger pads to compression forces. We used venous occlusion to change the stiffness of the fingers and investigated whether this influenced the firing of low-threshold mechanoreceptors to surfaces of differing stiffness. Unitary recordings were made from 10 slowly adapting type I (SAI), 10 fast adapting type I (FAI) and 9 slowly adapting type II (SAII) units via tungsten microelectrodes inserted into the median nerve at the wrist. A servo-controlled stimulator applied ramp-and-hold forces (1, 2, and 4 N) at a constant loading and unloading rate (2 N/s) via a flat 2.5-cm-diameter silicone disk over the center of the finger pad. Nine silicone disks (objects), varying in compliance, were used. Venous occlusion, produced by inflating a sphygmomanometer cuff around the upper arm to 40 ± 5 mmHg, was used to induce swelling of the fingers and increase the compliance of the finger pulp. Venous occlusion had no effect on the firing rates of the SAI afferents, nor on the slopes of the relationship between mean firing rate and object compliance at each amplitude, but did significantly reduce the slopes for the FAI afferents. Although the SAII afferents possess a poor capacity to encode changes in object compliance, mean firing rates were significantly lower during venous occlusion. The finding that venous occlusion had no effect on the firing properties of SAI afferents indicates that these afferents preserve their capacity to encode changes in object compliance, despite changes in skin mechanics.

The Evaluation of Digital Rectal Examination for Assessment of Anal Tone in Suspected Cauda Equina Syndrome.

Seventy-five doctors completed a questionnaire documenting their grade, specialty, and experience in performing digital rectal examination (DRE). A model anus, using a pressure transducer surrounding an artificial canal, was assembled and calibrated. Participants performed 4 DREs on the model (with a break between attempts) and predicted tone as "reduced" or "normal" (35 and 60 mm Hg, respectively), followed by a "squeeze" test. Thirty health care assistants partook as a control group with no training in DRE. Our main objective was to investigate the validity of digital rectal examination (DRE) for assessment of anal tone. Cauda equina syndrome represents the constellation of symptoms and signs resulting from compression of lumbrosacral nerve routes. Combined with subjective neurological findings, a reduction in anal tone is an important sign, deeming further imaging necessary. DRE is an invasive procedure used to assess anal tone despite debated accuracy. A total of 75 doctors from various specialties were asked to fill in a questionnaire detailing their grade, age, and area of expertise. In addition, information was gathered with regard to prior training in performing DRE to assess anal tone and the importance placed on any findings. Thirty hospital health care assistants (HCAs) were used as a control group. HCAs were selected as a control group because they receive no training on the technique and would never be required to perform it in their clinical practice. A model anus was assembled using a modified pediatric sphygmomanometer cuff to act as a sphincter. The cuff could be inflated to simulate a full range of anal tone. The cuff was incorporated into an artificial anal canal, which was, in turn, placed into a model buttock created from plaster of Paris. The apparatus was calibrated across a range of pressures. In each attempt, 60%, 61%, 63%, and 67% of doctors correctly identified the anal tone, respectively (average accuracy: 64%). HCAs had an identical average accuracy of 64%. All participants (100%) were able to correctly identify the squeeze test. For doctors, no correlation was found between confidence in assessing anal tone using DRE and a correct result. Seventy-one percent had received previous training in DRE, with 64% of these taught how to assess anal tone. Forty-three percent of doctors thought that further training would be beneficial. The results demonstrate that accuracy in assessing anal tone using DRE is limited, with overall correctness of 64%. Poor correlation exists between perceived level of skill and study result. Doctors were not significantly more able than HCAs to detect correct tone. Therefore, DRE for the assessment of anal tone is not a wholly accurate tool. A squeeze test may be of greater value if interpreted correctly. 4.

Interprofessional Participation in a Statewide Collaborative to Recognize and Treat Hypertension in Pregnancy

Poster Presentation Objective To standardize the identification and treatment pregnant/postpartum women presenting with blood pressures ≥ 160 and/or ≥ 105 within 30 minutes of validated elevated blood pressure. Design Plan‐do‐study‐act cycles (PDSA) were used to implement the evidence‐based guidelines from the California Maternal Quality Care Collaborative (CMQCC) Preeclampsia Toolkit. Physician, pharmacy, and nursing staffs were educated on the guidelines and the acute hypertensive order set developed by the Memorial Care Women's Best Practice Team. The team actively participated in the CMQCC Preeclampsia Collaborative. Sample All pregnant/postpartum women presenting perinatal care areas with elevated blood pressures. Methods Initial elevated blood pressures are reevaluated within 15 minutes using a manual sphygmomanometer and appropriate size cuff. Physicians are contacted, the acute hypertensive order set is initiated, and labetalol or hydralazine are immediately administered. Blood pressures are reassessed every 15 to 20 minutes and medication treatment is continued until blood pressures reach values less than threshold. Upon event completion, a debrief is conducted. Implementation Strategies Perinatal nursing staff were educated on the use of a manual sphygmomanometer and choice of appropriate cuff. A self‐learning module with competency evaluation was required. Postpartum nurses were taught to administer intravenous hydralazine. Physicians were provided written communication of the new protocol and order set. The pharmacist assured that the necessary level of drugs was in stock. Rolling manual blood pressure kits with assorted cuffs and guidelines were distributed. Electronic message boards were used to continually educate staff. Debrief forms provided feedback to the implementation team to complete PDSA cycles, enhance adherence to the guidelines, and improve feedback to staff. Results The baseline data from April 2013 indicate that 14.3% of women with blood pressures meeting the criteria were treated. By June 2014, 84.2% were treated within 30 minutes and 89.5% were treated within 60 minutes. Conclusion/Implications for Nursing Practice Understanding the potential for maternal morbidity and mortality has increased the recognition of care providers and enhanced the treatment of acute hypertension. Methodology and implementation strategies were effective in achieving the standardized identification and treatment of pregnant/postpartum women presenting with hypertension. Unanticipated challenges included providing training in the basic fundamentals of blood pressure measurement and obtaining institutional approval for intravenous hydralazine to become standard practice for postpartum nurses. Next steps in nursing practice include evaluation of hypertensive patient within one week of hospital discharge and implementation in the emergency department.

Fatigue-related firing of muscle nociceptors reduces voluntary activation of ipsilateral but not contralateral lower limb muscles.

During fatiguing upper limb exercise, maintained firing of group III/IV muscle afferents can limit voluntary drive to muscles within the same limb. It is not known if this effect occurs in the lower limb. We investigated the effects of group III/IV muscle afferent firing from fatigued ipsilateral and contralateral extensor muscles and ipsilateral flexor muscles of the knee on voluntary activation of the knee extensors. In three experiments, we examined voluntary activation of the knee extensors by measuring changes in superimposed twitches evoked by femoral nerve stimulation. Subjects attended on 2 days for each experiment. On one day a sphygmomanometer cuff occluded blood flow of the fatigued muscles to maintain firing of group III/IV muscle afferents. After a 2-min extensor contraction (experiment 1; n = 9), mean voluntary activation was lower with than without maintained ischemia (47 ± 19% vs. 87 ± 8%, respectively; P < 0.001). After a 2-min knee flexor maximal voluntary contraction (MVC) (experiment 2; n = 8), mean voluntary activation was also lower with than without ischemia (59 ± 21% vs. 79 ± 9%; P < 0.01). After the contralateral (left) MVC (experiment 3; n = 8), mean voluntary activation of the right leg was similar with or without ischemia (92 ± 6% vs. 93 ± 4%; P = 0.65). After fatiguing exercise, activity in group III/IV muscle afferents reduces voluntary activation of the fatigued muscle and nonfatigued antagonist muscles in the same leg. However, group III/IV muscle afferents from the fatigued left leg had no effect on the unfatigued right leg. This suggests that any "crossover" of central fatigue in the lower limbs is not mediated by group III/IV muscle afferents.