scholarly journals An active approach of pressure waveform matching for stress‐based testing of arteries

2021 ◽  
Author(s):  
Emmanouil Agrafiotis ◽  
Markus A. Geith ◽  
Mohammad A. Golkani ◽  
Vera Hergesell ◽  
Gerhard Sommer ◽  
...  
2019 ◽  
Vol 62 (5) ◽  
pp. 1326-1337 ◽  
Author(s):  
Brittany L. Perrine ◽  
Ronald C. Scherer ◽  
Jason A. Whitfield

Purpose Oral air pressure measurements during lip occlusion for /pVpV/ syllable strings are used to estimate subglottal pressure during the vowel. Accuracy of this method relies on smoothly produced syllable repetitions. The purpose of this study was to investigate the oral air pressure waveform during the /p/ lip occlusions and propose physiological explanations for nonflat shapes. Method Ten adult participants were trained to produce the “standard condition” and were instructed to produce nonstandard tasks. Results from 8 participants are included. The standard condition required participants to produce /pːiːpːiː.../ syllables smoothly at approximately 1.5 syllables/s. The nonstandard tasks included an air leak between the lips, faster syllable repetition rates, an initial voiced consonant, and 2-syllable word productions. Results Eleven oral air pressure waveform shapes were identified during the lip occlusions, and plausible physiological explanations for each shape are provided based on the tasks in which they occurred. Training the use of the standard condition, the initial voice consonant condition, and the 2-syllable word production increased the likelihood of rectangular oral air pressure waveform shapes. Increasing the rate beyond 1.5 syllables/s improved the probability of producing rectangular oral air pressure signal shapes in some participants. Conclusions Visual and verbal feedback improved the likelihood of producing rectangular oral air pressure signal shapes. The physiological explanations of variations in the oral air pressure waveform shape may provide direction to the clinician or researcher when providing feedback to increase the accuracy of estimating subglottal pressure from oral air pressure.


2018 ◽  
Author(s):  
Penny Perlepe ◽  
Rodolphe Clérac ◽  
Itziar Oyarzabal ◽  
Corine Mathonière

Author(s):  
Angela Thompson

Advance care planning (ACP) in paediatrics applies from the diagnosis of a life-limiting/life-threatening condition onwards. It encompasses the management of intermittent potentially reversible episodes through to end-of-life care in keeping with the child’s best interest. It is an active approach to managing care and acknowledges the child’s and family’s broader social, emotional, and spiritual needs and keeps the child central and paramount to all planning. It requires transparent discussions and effectively documented agreements that are well communicated, readily accessible, and immediately identifiable. It is essential to regularly review and amend as necessary. They describe the care agreed at that point in time in the child’s best interest, in line with RCPCH guidance. Challenges may particularly occur at the time of transition to adult services.


2008 ◽  
Vol 294 (6) ◽  
pp. H2535-H2539 ◽  
Author(s):  
David G. Edwards ◽  
Matthew S. Roy ◽  
Raju Y. Prasad

Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.


Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 671
Author(s):  
Ana Osuna ◽  
Anna Ulldemolins ◽  
Hector Sanz-Fraile ◽  
Jorge Otero ◽  
Núria Farré ◽  
...  

This paper describes the design, construction and testing of an experimental setting, making it possible to study the endothelium under different pathophysiological conditions. This novel experimental approach allows the application of the following stimuli to an ex vivo vessel in a physiological bath: (a) a realistic intravascular pressure waveform defined by the user; (b) shear stress in the endothelial layer since, in addition to the pressure waveform, the flow through the vessel can be independently controlled by the user; (c) conditions of hypo/hyperoxia and hypo/hypercapnia in an intravascular circulating medium. These stimuli can be applied alone or in different combinations to study possible synergistic or antagonistic effects. The setting performance is illustrated by a proof of concept in an ex vivo rabbit aorta. The experimental setting is easy to build by using very low-cost materials widely available. Online Supplement files provide all the technical information (e.g., circuits, codes, 3D printer drivers) following an open-source hardware approach for free replication.


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