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Annual International Conference of the... Jul 2023Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the...
Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure. Experiments were carried out on 15 participants, (14 males, 64.3 ± 10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional occluding cuff, with a microphone for Korotkoff sounds, was placed on the upper arm (on the brachial artery). Intra-arterial blood pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness. The brachial artery closed at a CP of 132.0 ± 17.1 mmHg. Systolic and diastolic blood pressure (SBP and DBP) were 147.6 ± 14.3 and 72.7 ± 10.1 mmHg; mean pressure (MP, 100.1 ± 10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5 ± 13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 19.0 ± 8.3 (range 2-29) mmHg, DBP: 4.0 ± 4.3 (range 2-12) mmHg. SBP derived from the onset of Korotkoff sounds can underestimate IABP by up to 19 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods.
Topics: Male; Humans; Female; Blood Pressure; Pulse Wave Analysis; Blood Pressure Determination; Sphygmomanometers; Auscultation
PubMed: 38082761
DOI: 10.1109/EMBC40787.2023.10340757 -
Scientific Reports Jan 2023Neural decoding models can be used to decode neural representations of visual, acoustic, or semantic information. Recent studies have demonstrated neural decoders that...
Neural decoding models can be used to decode neural representations of visual, acoustic, or semantic information. Recent studies have demonstrated neural decoders that are able to decode accoustic information from a variety of neural signal types including electrocortiography (ECoG) and the electroencephalogram (EEG). In this study we explore how functional magnetic resonance imaging (fMRI) can be combined with EEG to develop an accoustic decoder. Specifically, we first used a joint EEG-fMRI paradigm to record brain activity while participants listened to music. We then used fMRI-informed EEG source localisation and a bi-directional long-term short term deep learning network to first extract neural information from the EEG related to music listening and then to decode and reconstruct the individual pieces of music an individual was listening to. We further validated our decoding model by evaluating its performance on a separate dataset of EEG-only recordings. We were able to reconstruct music, via our fMRI-informed EEG source analysis approach, with a mean rank accuracy of 71.8% ([Formula: see text], [Formula: see text]). Using only EEG data, without participant specific fMRI-informed source analysis, we were able to identify the music a participant was listening to with a mean rank accuracy of 59.2% ([Formula: see text], [Formula: see text]). This demonstrates that our decoding model may use fMRI-informed source analysis to aid EEG based decoding and reconstruction of acoustic information from brain activity and makes a step towards building EEG-based neural decoders for other complex information domains such as other acoustic, visual, or semantic information.
Topics: Humans; Brain Mapping; Music; Electroencephalography; Auditory Perception; Auscultation
PubMed: 36635340
DOI: 10.1038/s41598-022-27361-x -
Respiration; International Review of... 2020Effective auscultations are often hard to implement in isolation wards. To date, little is known about the characteristics of pulmonary auscultation in novel coronavirus... (Observational Study)
Observational Study
BACKGROUND
Effective auscultations are often hard to implement in isolation wards. To date, little is known about the characteristics of pulmonary auscultation in novel coronavirus (COVID-19) pneumonia.
OBJECTIVES
The aim of this study was to explore the features and clinical significance of pulmonary auscultation in COVID-19 pneumonia using an electronic stethoscope in isolation wards.
METHODS
This cross-sectional, observational study was conducted among patients with laboratory-confirmed COVID-19 at Wuhan Red-Cross Hospital during the period from January 27, 2020, to February 12, 2020. Standard auscultation with an electronic stethoscope was performed and electronic recordings of breath sounds were analyzed.
RESULTS
Fifty-seven patients with average age of 60.6 years were enrolled. The most common symptoms were cough (73.7%) during auscultation. Most cases had bilateral lesions (96.4%) such as multiple ground-glass opacities (69.1%) and fibrous stripes (21.8%). High-quality auscultation recordings (98.8%) were obtained, and coarse breath sounds, wheezes, coarse crackles, fine crackles, and Velcro crackles were identified. Most cases had normal breath sounds in upper lungs, but the proportions of abnormal breath sounds increased in the basal fields where Velcro crackles were more commonly identified at the posterior chest. The presence of fine and coarse crackles detected 33/39 patients with ground-glass opacities (sensitivity 84.6% and specificity 12.5%) and 8/9 patients with consolidation (sensitivity 88.9% and specificity 15.2%), while the presence of Velcro crackles identified 16/39 patients with ground-glass opacities (sensitivity 41% and specificity 81.3%).
CONCLUSIONS
The abnormal breath sounds in COVID-19 pneumonia had some consistent distributive characteristics and to some extent correlated with the radiologic features. Such evidence suggests that electronic auscultation is useful to aid diagnosis and timely management of the disease. Further studies are indicated to validate the accuracy and potential clinical benefit of auscultation in detecting pulmonary abnormalities in COVID-19 infection.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antiviral Agents; Auscultation; COVID-19; China; Cough; Cross-Sectional Studies; Electrical Equipment and Supplies; Female; Glucocorticoids; Humans; Lung; Male; Middle Aged; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Sounds; SARS-CoV-2; Sensitivity and Specificity; Severity of Illness Index; Smartphone; Sound Spectrography; Sputum; Stethoscopes; Tomography, X-Ray Computed; Young Adult; COVID-19 Drug Treatment
PubMed: 33147584
DOI: 10.1159/000509610 -
Asian Pacific Journal of Cancer... Nov 2022The Objective of this study was estimation of Temporomandibular joint dysfunction in oral cancer survivors.
BACKGROUND
The Objective of this study was estimation of Temporomandibular joint dysfunction in oral cancer survivors.
METHODS
The hundred patients with oral cancer who had undergone radiotherapy or chemotherapy were randomly selected as per inclusion criteria. Range of motion of temporomandibular joint(TMJ), visual analogue scale (VAS), Manual muscle testing (MMT), Auscultation test, Chvostek test and swelling over orofacial muscles were used as the Outcome measures.
RESULTS
The findings of this study revealed that the Temporomandibular joint was significantly dysfunctional. The group analysis demonstrated statistically significant impairments in all the Outcome measures. VAS (p<0.0001), ROM for all four motions (p<0.0001), Manual muscle testing (p<0.0001), Provocation test (52%), Auscultation test (92%), Chvostek Test (4%), and swelling (56%) were all shown significant dysfunction of TMJ.
CONCLUSION
This study showed that pain was increased during activity than at rest based on the findings of VAS pain rating scale. It was found that the range of motion of TMJ was significantly reduced; however muscular strength was minimally affected. Majority of survivors were tested positive for the provocation test and auscultation test and few for Chvostek test which indicated the involvement of facial nerve.
Topics: Humans; Cancer Survivors; Mouth Neoplasms; Pain; Survivors; Temporomandibular Joint; Temporomandibular Joint Disorders; Male; Adult
PubMed: 36444581
DOI: 10.31557/APJCP.2022.23.11.3685 -
IEEE Transactions on Biomedical... Dec 2019Heart-sound auscultation is a rapid and fundamental technique used for examining the cardiovascular system. The main components of heart sounds are the first and second...
Heart-sound auscultation is a rapid and fundamental technique used for examining the cardiovascular system. The main components of heart sounds are the first and second heart sounds. Discriminating these heart sounds under the presence of additional heart sounds and murmurs will be difficult. To recognize these signals efficiently, this study proposes a monitoring system with phonocardiogram and electrocardiogram. This system has two key points. The first is chip implementation, including capacitor coupled amplifier, transimpedance amplifier, high-pass sigma-delta modulator, and digital signal processing block. The chip in the system is fabricated in 0.18 μm standard complementary metal-oxide-semiconductor process. The second is a software application on smartphones for heart-related physiological signal recording, display, and identification. A wavelet-based QRS complex detection algorithm verified by MIT/BIH Arrhythmia Database is also proposed. The overall measured positive prediction, sensitivity, and error rate of the proposed algorithm are 99.90%, 99.82%, and 0.28%, respectively. During auscultation, doctors may refer to these physiological signals displayed on the smartphone and simultaneously listen to the heart sounds to diagnose the potential heart disease. By taking advantage of signal visualization and keeping the original diagnosis procedure, the uncertainty existing in heart sounds can be eliminated, and the training period to acquire auscultation skills can be reduced.
Topics: Algorithms; Amplifiers, Electronic; Cardiovascular Diseases; Electrocardiography; Heart Auscultation; Humans; Phonocardiography; Semiconductors; Signal Processing, Computer-Assisted; Wearable Electronic Devices
PubMed: 31634841
DOI: 10.1109/TBCAS.2019.2947694 -
MedEdPORTAL : the Journal of Teaching... 2022Physicians need adequate physical exam skills. Unfortunately, interns have variable physical exam skills, and teaching is often limited to rounds, an inconsistent...
INTRODUCTION
Physicians need adequate physical exam skills. Unfortunately, interns have variable physical exam skills, and teaching is often limited to rounds, an inconsistent setting. Physical exam skills, particularly those involving auscultation, require practice. Our goal was to create a cardiac physical exam workshop for pediatric interns that would improve their performance on an interactive assessment of their ability and understanding in physical exam and murmur interpretation.
METHODS
We completed a targeted needs assessment and then developed a 2-hour workshop on the pediatric cardiac physical exam targeted to pediatrics residents. The workshop included didactics, group discussion, and practice interpreting common pediatric murmurs. Pediatrics residents completed the assessment as a pretest and then participated in the workshop. At the end of the workshop, the assessment was administered as a posttest, followed by a reassessment 3 months later. Nonparametric statistical analysis was conducted. Pre- and posttest scores were compared using the Wilcoxon signed rank test.
RESULTS
Twenty-five residents completed the workshop, including 22 pediatrics residents, one pediatrics/anesthesia combined resident, one pediatric neurology resident, and one resident completing a preliminary year in pediatrics prior to dermatology residency. There was a significant increase in the mean score on the assessment from pre- to posttest (pretest = 54%, posttest = 71%, < .001). This increase was sustained at the 3-month reassessment ( = 67%).
DISCUSSION
This cardiac physical exam workshop demonstrated improvement in physical exam knowledge and interpretation ability as measured by an online pre-/posttest.
Topics: Child; Humans; Internship and Residency; Clinical Competence; Physical Examination; Heart Murmurs; Auscultation
PubMed: 36605544
DOI: 10.15766/mep_2374-8265.11289 -
Computer Methods and Programs in... Dec 2023Aimed at the shortcomings of using time interval ( [Formula: see text] ) between the sounds produced by the aortic valve closure (A) and the pulmonary valve closure (P)... (Review)
Review
BACKGROUND AND OBJECTIVE
Aimed at the shortcomings of using time interval ( [Formula: see text] ) between the sounds produced by the aortic valve closure (A) and the pulmonary valve closure (P) to detect the wide splitting of the second heart sound (S), which are the [Formula: see text] easily influenced by the heartbeat and not easily distinguished from the fixed splitting of S without considering the entire respiratory phase, and from the third heart sound (S), this study proposes a novel methodology to detect the wide splitting of S using an estimated split coefficient of S ( [Formula: see text] ) combined with an adaptive number (N) of S.
METHODOLOGY
The methodology is orderly summarized as follows: Stage 1 describes the segmentation-based S automatic location and extraction. A Gaussian mixture model (GMM)-based regression model for S is proposed to estimate the positions of A and P, then an overlapping rate (OLR)-based [Formula: see text] and the [Formula: see text] are estimated, and finally, a N-S is automatically determined to calculate the statistics of [Formula: see text] and [Formula: see text] . In stage 3, based on the combination of estimated features, the detection of wide splitting of S is determined.
RESULTS
The performance is evaluated using a total of 3350-period heart sounds from 72 patients, with an overall accuracy of 100%, F=1 and a Cohen's kappa value (κ) of 1.
DISCUSSION
The significant contributions are highlighted: A novel GMM-based efficient methodology is proposed for estimating the characteristics of A and P. A novel OLR-based [Formula: see text] is defined to replace the current state-of-the-art criterion for evaluating the split degree of S. Considering respiration phases combined with CR are proposed for the high-precision diagnosis of S wide split.
Topics: Humans; Heart Sounds; Heart Auscultation; Aortic Valve; Heart Rate; Thorax
PubMed: 37714021
DOI: 10.1016/j.cmpb.2023.107777 -
Scientific Reports Jan 2022A novel intelligent diagnostic system is proposed to diagnose heart sounds (HSs). The innovations of this system are primarily reflected in the automatic segmentation... (Comparative Study)
Comparative Study
A novel intelligent diagnostic system is proposed to diagnose heart sounds (HSs). The innovations of this system are primarily reflected in the automatic segmentation and extraction of the first complex sound [Formula: see text] and second complex sound [Formula: see text]; the automatic extraction of the secondary envelope-based diagnostic features [Formula: see text], [Formula: see text], and [Formula: see text] from [Formula: see text] and [Formula: see text]; and the adjustable classifier models that correspond to the confidence bounds of the Chi-square ([Formula: see text]) distribution and are adjusted by the given confidence levels (denoted as [Formula: see text]). The three stages of the proposed system are summarized as follows. In stage 1, the short time modified Hilbert transform (STMHT)-based curve is used to segment and extract [Formula: see text] and [Formula: see text]. In stage 2, the envelopes [Formula: see text] and [Formula: see text] for periods [Formula: see text] and [Formula: see text] are obtained via a novel method, and the frequency features are automatically extracted from [Formula: see text] and [Formula: see text] by setting different threshold value ([Formula: see text]) lines. Finally, the first three principal components determined based on principal component analysis (PCA) are used as the diagnostic features. In stage 3, a Gaussian mixture model (GMM)-based component objective function [Formula: see text] is generated. Then, the [Formula: see text] distribution for component k is determined by calculating the Mahalanobis distance from [Formula: see text] to the class mean [Formula: see text] for component k, and the confidence region of component k is determined by adjusting the optimal confidence level [Formula: see text] and used as the criterion to diagnose HSs. The performance evaluation was validated by sounds from online HS databases and clinical heart databases. The accuracy of the proposed method was compared to the accuracies of other state-of-the-art methods, and the highest classification accuracies of [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], 99.67[Formula: see text] and 99.91[Formula: see text] in the detection of MR, MS, ASD, NM, AS, AR and VSD sounds were achieved by setting [Formula: see text] to 0.87,0.65,0.67,0.65,0.67,0.79 and 0.87, respectively.
Topics: Algorithms; Databases, Factual; Heart Auscultation; Heart Diseases; Heart Sounds; Humans; Principal Component Analysis
PubMed: 35079025
DOI: 10.1038/s41598-021-04136-4 -
BMJ Open Respiratory Research Mar 2021The significance of pulmonary crackles, by their timing during inspiration, was described by Nath and Capel in 1974, with early crackles associated with bronchial...
BACKGROUND
The significance of pulmonary crackles, by their timing during inspiration, was described by Nath and Capel in 1974, with early crackles associated with bronchial obstruction and late crackles with restrictive defects. Crackles are also described as 'fine' or 'coarse'. We aimed to evaluate the usefulness of crackle characteristics in the diagnosis of chronic obstructive pulmonary disease (COPD).
METHODS
In a population-based study, lung sounds were recorded at six auscultation sites and classified in participants aged 40 years or older. Inspiratory crackles were classified as 'early' or 'late and into the types' 'coarse' and 'fine' by two observers. A diagnosis of COPD was based on respiratory symptoms and forced expiratory volume in 1 s/forced inspiratory vital capacity below lower limit of normal, based on Global Lung Function Initiative 2012 reference. Associations between crackle characteristics and COPD were analysed by logistic regression. Kappa statistics was applied for evaluating interobserver agreement.
RESULTS
Of 3684 subjects included in the analysis, 52.9% were female, 50.1% were ≥65 years and 204 (5.5%) had COPD. Basal inspiratory crackles were heard in 306 participants by observer 1 and in 323 by observer 2. When heard bilaterally COPD could be predicted with ORs of 2.59 (95% CI 1.36 to 4.91) and 3.20 (95% CI 1.71 to 5.98), annotated by observer 1 and 2, respectively, adjusted for sex and age. If bilateral crackles were coarse the corresponding ORs were 2.65 (95% CI 1.28 to 5.49) and 3.67 (95% CI 1.58 to 8.52) and when heard early during inspiration the ORs were 6.88 (95% CI 2.59 to 18.29) and 7.63 (95%CI 3.73 to 15.62). The positive predictive value for COPD was 23% when early crackles were heard over one or both lungs. We observed higher kappa values when classifying timing than type.
CONCLUSIONS
'Early' inspiratory crackles predicted COPD more strongly than 'coarse' inspiratory crackles. Identification of early crackles at the lung bases should imply a strong attention to the possibility of COPD.
Topics: Auscultation; Female; Forced Expiratory Volume; Humans; Lung; Pulmonary Disease, Chronic Obstructive; Respiratory Sounds
PubMed: 33674283
DOI: 10.1136/bmjresp-2020-000852 -
International Journal of Nursing... Apr 2022To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically...
AIM
To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically ill patients.
BACKGROUND
Incorrect nasogastric tube placement causes serious complications.
DESIGN
This was a methodological and comparative study.
METHODS
The study sample consisted of 88 new insertions of nasogastric feeding tubes between April 2018-2019. Results from the 'auscultatory', 'pH' and 'colorimetric capnometry' methods were compared with the location of the nasogastric tube as determined through radiography. Descriptive statistics, Eta analysis and the Cohen kappa compliance test as well as sensitivity and specificity were conducted.
RESULTS
There was a weak agreement (26.3%) between the auscultation and radiological evaluation for confirming nasogastric tube placement. The pH measurement and colorimetric capnometry methods were not correlated with radiological evaluation. Stomach pH increased as patient age increased and use of the colorimetric capnometry method failed to confirm the oesophageal and duodenal location. The specificity of the auscultation was low, and both the specificity and sensitivity pH methods were low.
CONCLUSION
It was determined that auscultation, measuring pH and colorimetric capnometry were unreliable methods for confirming placement of nasogastric tubes. It is recommended to confirm initial placement of the nasogastric tube with radiography and to develop effective and reliable non-radiological measurement methods that can be performed at the bedside.
Topics: Auscultation; Capnography; Colorimetry; Humans; Hydrogen-Ion Concentration; Intubation, Gastrointestinal
PubMed: 35285146
DOI: 10.1111/ijn.13049