Experimental Assessment of a Variable Orifice Flowmeter for Respiratory Monitoring

Accurate measurement of gas exchanges is essential in mechanical ventilation and in respiratory monitoring. Among the large number of commercial flowmeters, only few kinds of sensors are used in these fields. Among them, variable orifice meters (VOMs) show some valuable characteristics, such as linearity, good dynamic response, and low cost. This paper presents the characterization of a commercial VOM intended for application in respiratory monitoring. Firstly, two nominally identical VOMs were calibrated within ±10 L·min−1, to assess their metrological properties. Furthermore, experiments were performed by humidifying the air, to evaluate the influence of vapor condensation on sensor’s performances. The condensation influence was investigated during two long lasting trials (i.e., 4 hours) by delivering 4 L·min−1 and 8 L·min−1. Data show that the two VOMs’ responses are linear and their response is comparable (sensitivity difference of 1.4%, RMSE of 1.50 Pa); their discrimination threshold is <0.5 L·min−1, and the settling time is about 66 ms. The condensation within the VOM causes a negligible change in sensor sensitivity and a very slight deterioration of precision. The good static and dynamic properties and the low influence of condensation on sensor’s response make this VOM suitable for applications in respiratory function monitoring

Cardio-respiratory monitoring in archery using a smart textile based on flexible fiber bragg grating sensors

In precision sports, the control of breathing and heart rate is crucial to help the body to remain stable in the shooting position. To improve stability, archers try to adopt similar breathing patterns and to have a low heartbeat during each shot. We proposed an easy-to-use and unobtrusive smart textile (ST) which is able to detect chest wall excursions due to breathing and heart beating. The sensing part is based on two FBGs housed into a soft polymer matrix to optimize the adherence to the chest wall and the system robustness. The ST was assessed on volunteers to figure out its performance in the estimation of respiratory frequency (fR) and heart rate (HR). Then, the system was tested on two archers during four shooting sessions. This is the first study to monitor cardio-respiratory activity on archers during shooting. The good performance of the ST is supported by the low mean absolute percentage error for fR and HR estimation (≤1.97% and ≤5.74%, respectively), calculated with respect to reference signals (flow sensor for fR, photopletismography sensor for HR). Moreover, results showed the capability of the ST to estimate fR and HR during different phases of shooting action. The promising results motivate future investigations to speculate about the influence of fR and HR on archers’ performance

Multipoint temperature monitoring of microwave thermal ablation in bones through fiber bragg grating sensor arrays

Bones are a frequent site of metastases that cause intolerable cancer-related pain in 90% of patients, making their quality of life poor. In this scenario, being able to treat bone oncology patients by means of minimally invasive techniques can be crucial to avoid surgery-related risks and decrease hospitalization times. The use of microwave ablation (MWA) is gaining broad clinical acceptance to treat bone tumors. It is worth investigating temperature variations in bone tissue undergoing MWA because the clinical outcomes can be inferred from this parameter. Several feasibility studies have been performed, but an experimental analysis of the temperature trends reached into the bone during the MWA has not yet been assessed. In this work, a multi-point temperature study along the bone structure during such treatment is presented. The study has been carried out on ex vivo bovine femur and tibia, subjected to MWA. An overall of 40 measurement points covering a large sensing area was obtained for each configuration. Temperature monitoring was performed by using 40 fiber Bragg grating (FBGs) sensors (four arrays each housing 10 FBGs), inserted into the bones at specific distances to the microwave antenna. As result, the ability of this experimental multi-point monitoring approach in tracking temperature variations within bone tissue during MWA treatments was shown. This study lays the foundations for the design of a novel approach to study the effects of MWA on bone tumors. As consequence, the MWA treatment settings could be optimized in order to maximize the treatment effects of such a promising clinical application, but also customized for the specific tumor and patient

Fiber bragg gratings for medical applications and future challenges: A review

In the last decades, fiber Bragg gratings (FBGs) have become increasingly attractive to medical applications due to their unique properties such as small size, biocompatibility, immunity to electromagnetic interferences, high sensitivity and multiplexing capability. FBGs have been employed in the development of surgical tools, assistive devices, wearables, and biosensors, showing great potentialities for medical uses. This paper reviews the FBG-based measuring systems, their principle of work, and their applications in medicine and healthcare. Particular attention is given to sensing solutions for biomechanics, minimally invasive surgery, physiological monitoring, and medical biosensing. Strengths, weaknesses, open challenges, and future trends are also discussed to highlight how FBGs can meet the demands of next-generation medical devices and healthcare system

Smart Textile Based on Fiber Bragg Grating Sensors for Respiratory Monitoring: Design and Preliminary Trials.

Continuous respiratory monitoring is important to assess adequate ventilation. We present a fiber optic-based smart textile for respiratory monitoring able to work during Magnetic Resonance (MR) examinations. The system is based on the conversion of chest wall movements into strain of two fiber Bragg grating (FBG) sensors, placed on the upper thorax (UT). FBGs are glued on the textile by an adhesive silicon rubber. To increase the system sensitivity, the FBGs positioning was led by preliminary experiments performed using an optoelectronic system: FBGs placed on the chest surface experienced the largest strain during breathing. System performances, in terms of respiratory period (TR), duration of inspiratory (TI) and expiratory (TE) phases, as well as left and right UT volumes, were assessed on four healthy volunteers. The comparison of results obtained by the proposed system and an optoelectronic plethysmography highlights the high accuracy in the estimation of TR, TI, and TE: Bland-Altman analysis shows mean of difference values lower than 0.045 s, 0.33 s, and 0.35 s for TR, TI, and TE, respectively. The mean difference of UT volumes between the two systems is about 8.3%. The promising results foster further development of the system to allow routine use during MR examinations.Continuous respiratory monitoring is important to assess adequate ventilation. We present a fiber optic-based smart textile for respiratory monitoring able to work during Magnetic Resonance (MR) examinations. The system is based on the conversion of chest wall movements into strain of two fiber Bragg grating (FBG) sensors, placed on the upper thorax (UT). FBGs are glued on the textile by an adhesive silicon rubber. To increase the system sensitivity, the FBGs positioning was led by preliminary experiments performed using an optoelectronic system: FBGs placed on the chest surface experienced the largest strain during breathing. System performances, in terms of respiratory period (TR), duration of inspiratory (TI) and expiratory (TE) phases, as well as left and right UT volumes, were assessed on four healthy volunteers. The comparison of results obtained by the proposed system and an optoelectronic plethysmography highlights the high accuracy in the estimation of TR, TI, and TE: Bland-Altman analysis shows mean of difference values lower than 0.045 s, 0.33 s, and 0.35 s for TR, TI, and TE, respectively. The mean difference of UT volumes between the two systems is about 8.3%. The promising results foster further development of the system to allow routine use during MR examinations

Psychopathological profile in COVID-19 patients including healthcare workers: the implications

OBJECTIVE: The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19.PATIENTS AND METHODS: We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews.RESULTS: At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p&lt;0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p&lt;0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this. at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000). and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients.CONCLUSIONS: We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being

A subgroup analysis of the ODYSSEY APPRISE study: Safety and efficacy of alirocumab in the Italian cohort.

Background and aims: ODYSSEY APPRISE trial evaluated efficacy and safety of alirocumab in 994 patients with hypercholesterolemia and high CV risk in a real-life setting. The aim of the present report is to detail on the Italian cohort enrolled and treated in the trial. Methods and results: The methodology of the of the multinational, single-arm, Phase 3b open-label ODYSSEY APPRISE (Clinicaltrials.gov: NCT02476006) has been previously reported. 255 Italian patients were enrolled and treated according to the trial protocol. Overall mean exposure to alirocumab was 83.3 ± 27.7 weeks. At week 12, LDL-C decreased by 51.3 ± 23.1% and this reduction was overall maintained for the duration of the study. A similar reduction was observed in patients with and without heterozygous familial hypercholesterolemia (HeFH 50.7% ± 23.9 vs. non-FH, 53.6% ± 19.6). LDL-C was reduced below 1.8 mmol/L and/or by ≥ 50% reduction from baseline in 62% of patients overall (61% in HeFH and 67% in non-FH). Alirocumab was similarly well tolerated in the Italian cohort as in the entire study population and the more common treatment emergent adverse events (TEAEs) were influenza, myalgia and nasopharyngitis. The incidence LDL-C levels &lt;25 mg/dl and &lt;15 mg/dl, was 8.2% and 2.9% respectively. Conclusion: The efficacy and safety of alirocumab in a real-life setting, in the Italian subgroup of patients are consistent with findings in the entire study population and confirm that alirocumab is a beneficial approach to further reduce LDL-C levels in patients at high CV risk on maximally tolerated conventional lipid lowering treatment

A multi-parametric wearable system to monitor neck movements and respiratory frequency of computer workers

Musculoskeletal disorders are the most common form of occupational ill-health. Neck pain is one of the most prevalent musculoskeletal disorders experienced by computer workers. Wrong postural habits and non-compliance of the workstation to ergonomics guidelines are the leading causes of neck pain. These factors may also alter respiratory functions. Health and safety interventions can reduce neck pain and, more generally, the symptoms of musculoskeletal disorders and reduce the consequent economic burden. In this work, a multi-parametric wearable system based on two fiber Bragg grating sensors is proposed for monitoring neck movements and breathing activity of computer workers. The sensing elements were positioned on the neck, in the frontal and sagittal planes, to monitor: (i) flexion-extension and axial rotation repetitions, and (ii) respiratory frequency. In this pilot study, five volunteers were enrolled and performed five repetitions of both flexion-extension and axial rotation, and ten breaths of both quite breathing and tachypnea. Results showed the good performances of the proposed system in monitoring the aforementioned parameters when compared to optical reference systems. The wearable system is able to well-match the trend in time of the neck movements (both flexion-extension and axial rotation) and to estimate mean and breath-by-breath respiratory frequency values with percentage errors ≤6.09% and ≤1.90%, during quiet breathing and tachypnea, respectively

Living with chronic spontaneous urticaria in italy. a narrative medicine project to improve the pathway of patient care

Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness