Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff：Implications for noninvasive blood pressure measurement

An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement.However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element（FE） models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

Assessing Malnutrition in Pregnant Women Using the Dietary Diversity Score and the Mid-Upper Arm Circumference: A Cross-Sectional Study, Zambia

The dietary diversity score (DDS) and the mid-upper arm circumference (MUAC) can be used to assess nutritional status. The DDS is a qualitative measure of food consumption reflecting an individual’s access to different food items and therefore a proxy indicator of the nutritional status. The aim of the study was to assess whether the dietary diversity score and MUAC can be used to assess the nutritional status of pregnant women attending antenatal. A cross-sectional survey was conducted at Chilenje level I Hospital in a township located in Lusaka city, Lusaka province. The study employed quantitative methods to collect and analyse data on the dietary patterns of individuals in the previous 24 hours before the survey. Health facilities were randomly selected and systematic sampling was used to select a sample of 299 pregnant women. An interview schedule was used to collect data. Median and interquartile range were used to compare demographic data. Spearman’s Correlation for two continuous variables was used to establish associations between DDS and the MUAC. The median age was 27 years. About 44% of the women were in the lowest dietary diversity category, indicating inadequate nutrient intake, 31% in the medium category and 24% in the high intake. Dietary diversity score was negatively correlated with mid-upper arm circumference (p = 0.1295). However, most of the women in the lower dietary diversity score category (75%) had a high mid-upper arm circumference meaning that their nutritional status was good. Dietary diversity score can be used to predict malnutrition in pregnant women. The mid-upper arm circumference was negatively correlated with the 24hour dietary diversity score implying that we might not rely on this measurement to assess the nutritional status.

Upper arm composition and nutritional status of school children and adolescents in Abeokuta,Southwest Nigeria

Background:Upper arm composition is a reflection of body protein and calorie reserves.However,there is a paucity of data on upper arm composition of children from African countries,including Nigeria.This study aimed to determine the composition of upper arm and nutritional status of school children in Abeokuta,Nigeria and to compare with international reference standards.The sensitivity and specifi city of upper arm muscle area by height(UAMAH)as a nutritional assessment tool was also determined.Methods:Five hundred and seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling.Weight,height,mid-upper arm circumference(MUAC)and triceps skin fold thickness(TSF)were measured.Body mass index,upper arm muscle area(UAMA),upper arm fat area(UAFA),fat percentage and UAMAH were derived.Results:The TSF,UAFA and fat percentage were significantly higher in females than males at each age group.MUAC and UAMA were significantly higher in female children aged 10-14 years,whereas UAMA was significantly higher in male children aged 15-19 years.UAMA and UAFA of the children were lower than those of Americans but similar to those of Zimbabweans,and higher than those of Indians.The sensitivity and specifi city of UAMAH for detecting wasting were 80.8%and 63.9%,respectively,whereas the corresponding values for stunting were 32.2%and 58.2%,respectively.Conclusions:The school children studied have a combination of poor calorie and protein reserve.UAMAH may be a valuable tool for complete evaluation of the nutritional status of school children.

基于ARM的纯电动农用车辆电机矢量控制研究

随着纯电动汽车市场越来越火爆,农业机器也开始采用纯电动电机驱动的方案。为此,介绍了纯电动农用车辆BLDCM电机的结构和数学模型,设计了一套基于ARM的纯电动农用车辆电机矢量控制系统和上位机软件。试验结果表明:上位机界面能够实时显示各个测试量的数值,可为农用车辆电机驱动控制系统测试提供直观结果,也证实了整个系统的稳定性和可靠性。

Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.

A Device Monitoring System Based on ARM Upper Computer and WIFI Transmission

With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitoring system based on ARM upper computer and WIFI transmission, and we tested this system on workshop equipment. The hardware adopts ARM Cortex-A8 processor architecture of TI company as the main control chip, using IAC-335X-Kit development board for system design, external USB camera module and WIFI wireless module for video capture and data transmission. The software is based on embedded Linux as the platform. The system will collect production data accurately and objectively, and the statistical analysis. At the same time, the system uses QT to develop the upper computer software GUI interface. Compared with the traditional system based on the wired network, our design is more convenient and flexible, which reduces the implementation restriction and maintenance cost of traditional network cabling.

腔内心电图技术在肿瘤化疗患者上臂植入式输液港中的运用

目的 探讨腔内心电图技术在肿瘤化疗患者上臂植入式输液港中的应用价值,为后续开展相关临床操作提供参考。方法 选取2021年1月—2022年11月在长沙市某三级甲等医院肿瘤科化疗的患者240例为研究对象,按照组间基线资料均衡可比的原则分为对照组和观察组,每组120例。对照组在超声引导下置入中心静脉导管,根据体外测量法估算导管长度后行X线检测确认导管尖端位置,由医生在上臂皮下埋入输液港。观察组在超声引导下置入中心静脉导管后,应用腔内心电图根据P波的变化确认定位导管尖端位置,由医生在上臂皮下埋入输液港。观察两组患者置港成功时间、维护时间以及置管费用、置港舒适度和置管并发症。结果 观察组患者置港成功时间、维护时间短于对照组,差异有统计学意义(P<0.05);观察组患者置管费用少于对照组,差异有统计学意义(P<0.05);观察组患者在置港过程中对简单活动的影响程度及疼痛程度评分低于对照组,差异有统计学意义(P<0.05);观察组患者置管并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论 相比较X线摄片的优势,腔内心电图技术可有效辅助植入上臂输液港,减少置港成功时间、维护时间及置港费用,提升患者的舒适度,降低并发症发生率,此方法简单易行、治疗成本低、安全性高。

集束化护理模式在肿瘤患者植入式上臂静脉港维护中的应用效果

目的分析集束化护理模式在肿瘤患者植入式上臂静脉港维护中的应用效果。方法收集2021年1月至2022年6月收治的植入式上臂静脉港肿瘤患者76例,根据随机数字表法分为对照组和观察组,每组38例。对照组静脉港维护中给予常规护理,观察组给予集束化护理模式,对比2组患者的并发症发生情况、心理适应能力、生命质量及满意度。结果观察组患者中并发症发生率为5.26%低于对照组的21.05%(P<0.05);观察组患者的简明癌症患者心理适应问卷(Mini-Mac-19)评分低于对照组(P<0.05);观察组患者的中文版癌症患者生命质量通用量表(FACT-G)评分高于对照组(P<0.05);观察组患者对护理工作的满意率是97.37%高于对照组的81.58%(P<0.05)。结论集束化护理模式在肿瘤患者植入式上臂静脉港维护中的应用可取得显著效果,不仅能有效预防并发症,增强患者心理适应能力,而且还能提高其生命质量及满意度,值得临床推广应用。

上臂型输液港肿瘤患者并发CRT的危险因素分析

目的 探讨上臂型输液港肿瘤患者发生导管相关性血栓(CRT)的危险因素,为临床护理方案制定提供一定参考依据。方法 选取医院2021年2月—2022年2月收治120例上臂型输液港肿瘤患者为研究对象,将其中36例发生CRT患者作为病例组,84例未并发CRT患者作为对照组。通过问卷调查的方式收集患者基本资料及导管相关性血栓发生情况;通过单因素分析、多因素Logistic回归分析,探讨上臂型输液港肿瘤患者发生导管相关性血栓的危险因素。结果 现状调查结果显示,本研究36例CRT患者中,症状性血栓9例,无症状性血栓27例。单因素及多因素Logistic回归分析结果显示,患者年龄≥60岁、BMI指数越高、肿瘤分期为Ⅲ~Ⅳ期、TC水平越高、FIB越高、D-二聚体水平越高、上臂输液港肿瘤患者并发CRT风险越高(P<0.05)。结论 CRT为上臂型输液港肿瘤患者常见并发症,其发生将增加患者的治疗成本,并给治疗带来额外的负担,本研究经过调查发现,上臂型输液港肿瘤患者中以无症状性血栓最为多见。且本研究多因素回归分析显示,患者年龄、BMI指数、肿瘤分期、TC水平、FIB水平、D-二聚体水平为上臂输液港肿瘤患者并发CRT的独立危险因素,提示临床应重视以上因素的评估,做好基础性护理干预,包括密切监测患者症状、采取抗凝治疗、保持导管和周围区域的清洁等,并参考相应管理指南制订相应的防护方案,以降低上臂型输液港肿瘤患者CRT发生风险,保障患者治疗有效性和持续性。

研究思维导图式指导模式在乳腺癌患者植入上臂静脉输液港护理中的应用效果

目的研究思维导图式指导模式在乳腺癌患者植入上臂静脉输液港护理中的应用效果。方法自2022年8月至2023年12月期间,选取50例在本院收治的乳腺癌且行上臂静脉输液港患者,随机分为两组,采用常规护理的为对照组,试验组则在此基础上采用思维导图式指导模式进行干预,比较两组护理后的临床效果。结果干预前两组患者焦虑及抑郁评分相比差异无统计学意义(P>0.05),干预后相比对照组,试验组相关知晓优良率高(P<0.05)、试验组焦虑及抑郁评分改善更明显(P<0.05)、并发症发生率更低(P<0.05)、护理总满意度较高(P<0.05);单因素分析显示,负面情绪、并发症、满意度和知晓率与年龄、文化程度、家庭收入有着很大关系(P<0.05);多因素Logistic回归分析得知负面情绪、并发症、满意度和知晓率与高龄、文化程度低、家庭收入低有着很大关系(P<0.05)。结论在乳腺癌患者植入上臂静脉输液港护理中应用思维导图式指导模式进行干预,在一定程度上能提高患者的认知水平与满意度,减少焦虑、抑郁负性情绪及临床并发症的发生,临床应用前景广阔。

基于ARM和Linux的圆纬机上位机软件设计

针对圆纬机上位机软件控制面板单一、整体水平不高的问题,提出一种以ARM和嵌入式Linux为平台的设计方法。详细介绍软件设计要求、功能模块划分、核心模块和辅助模块的设计等。软件通过对花样文件进行解析后获取控制数据,利用并行总线传送给下位机FPGA,同时根据编码器信息控制选针器动作,实现织物的编织,该软件采用多线程编程和多重缓冲的技术保证编织动作实时性的要求。应用结果证明,ARM的处理功能减轻了下位机的负担;与传统的圆纬机上位机软件相比,该软件界面友好、功能完备、实时性强,具有较高的实用价值。

基于ARM Cortex-M3的SysTick解析

SysTick是嵌入式系统中不可缺少的组成部分.本文介绍了SysTick的基本功能和相关寄存器的定义,给出了SysTick的运行机制,并结合SysTick定时实例分析了ARM程序的基本结构、主程序工作流程和产生定时误差的主要原因,程序对设计ARM上位机系统具体一定的借鉴意义.

高频超声检查正常成人上臂肌群及上臂常见疾病声像图表现

在对正常成人上臂肌群以及上臂的常见疾病声像图进行检查的过程中,运用高频超声方法进行检测是非常方便的。选取2018年2月—2019年12月60名正常成人作为研究对象,运用高频超声对64例上臂肌群声像图进行检测,并对其声像图以及检测方法进行分析。对其中18例患有单侧上臂病变的患者声像图进行分析记录,最终以骨骼、血管、神经的解剖作为参考,分析正常成人的上臂肌群与周围骨骼、神经、血管之间的联系,同时对上臂常见的疾病声像图的特征进行详细记录。在对正常成人上臂肌群进行检查的过程中,运用高频超声方法可以更加清楚地看出其中的脉络。因此,在对上臂疾病进行检测的过程中可以把高频超声法作为首选。

A neural network-based electromyography motion classifier for upper limb activities

The objective of the work is to investigate the classifcation of different movements based on the surface electromyogram(SEMG)pattern recognition method.The testing was conducted for four arm movements using several experiments with artificial neural network class fication scheme.Six time domain features were extracted and consequently dlassification was implemented using back propagation neural dassifier(BPNC).Further,the realization of projected network was verified using cross validation(CV)process;hence ANOVA algorithm was carried out.Performance of the network is analyzed by considering mean square error(MSE)value.A comparison was performed between the extracted feat ures and back propagation network results reported in the literature.The concurrent result indicates the significance of proposed network with classification accuracy(CA)of 100%recorded from two channels,while analysis of variance technique helps in investigating the effectiveness of classified sigmal for recognition tasks.

基于ARM的测长称重装置设计

采用ARM9内核的S3C2440A微处理器作为下位机,工业PC机作为上位机,进行测长和称重硬件电路设计和软件编程,设计了高精度的钢管自动在线测长称重装置。下位机完成钢管长度和重量的测量,将测量数据显示在LCD上,并通过串口将测量数据传送至上位机。上位机显示钢管的长度和重量,并将数据存储在数据库中。该装置能在同一工位自动完成测长称重,降低了人工劳动强度,测量效率和精度高。

上回转塔式起重机平衡重计算方法

为进一步提高上回转塔式起重机的抗倾覆能力,提高其工作稳定性,保证起重机平衡重设计的精准性,以更好地满足操作需求和工作需要,该文分析上回转塔式起重机平衡重的作用及影响、平衡重计算方法问题及改进,研究上回转塔式起重机的构造,并重点探究科学的上回转塔式起重机平衡重计算方法,以期为相关工作提供一定帮助。

基于ARM+FPGA的卫星电源控制器通用测试系统

针对传统的卫星电源控制器(PCU)测试系统出现的定制化严重、运行维护困难、成本投入大等问题,该文设计并实现了一种基于ARM+FPGA架构的通用测试系统。该架构通过利用FPGA自身高速和并行处理数据的能力,实现了PCU常用的1553B、CAN和RS422多种总线通信接口整合。利用ARM芯片强大的算法处理和逻辑运算能力,移植并运行了UCOSII嵌入式操作系统,采用以太网芯片将多种通信接口转换成以太网接口,实现与通用测试上位机的数据传输。实际型号应用表明,该测试系统能够稳定适配不同的PCU,成本较低,维护较方便,具有一定的推广价值。

手-臂双侧强化训练联合重复经颅磁刺激对痉挛偏瘫型脑瘫患儿精细运动功能的影响

目的:探讨痉挛偏瘫型脑瘫患儿应用手-臂双侧强化训练(HABIT)联合重复经颅磁刺激(rTMS)对其上肢精细运动功能的影响。方法:回顾性分析2022年1月—2023年3月泉州市妇幼保健院·儿童医院康复科收治的84例痉挛偏瘫型脑瘫患儿的临床资料,按照不同治疗方案分为两组,各42例。两组均予常规康复训练,对照组采用rTMS治疗,观察组在对照组治疗基础上联合HABIT。比较两组治疗前后精细运动功能评估量表(FMFM)评分百分数及Peabody运动发育量表评分。结果:治疗前,两组FMFM评分及Peabody运动发育量表评分比较,差异无统计学意义(P>0.05);治疗后,两组FMFM中A区、B区评分及总分百分数比较,差异无统计学意义(P>0.05);治疗后,观察组FMFM量表中C区、D区、E区评分百分数高于对照组,差异有统计学意义(P<0.05)。治疗后,两组抓握、视觉-运动整合、精细运动商评分均高于治疗前,且观察组明显高于对照组,差异有统计学意义(P<0.05)。结论:痉挛偏瘫型脑瘫患儿应用HABIT联合rTMS治疗能够改善其上肢精细运动功能。

心腔内电图特异性Q波在上臂输液港导管尖端定位中的应用

目的探讨在上臂输液港植入过程中,心腔内电图特异性Q波对导管尖端定位的指导作用。方法将应用心腔内电图定位技术辅助上臂输液港植入的患者124例,根据心腔内电图P波形态的不同分为观察组(非单纯高尖P波)63例和对照组(单纯高尖P波)61例。观察组应用特异性Q波定位法确定导管置入长度,对照组按中华护理学会发布的团体标准《PICC尖端心腔内电图定位技术》确定导管置入长度。通过X线检查,比较两组导管尖端定位精准率,同时比较观察组自身分别应用体表测量法、P/R波振幅50%定位法、双峰P波定位法所对应的导管长度与实际置入长度的差异。结果观察组和对照组导管尖端位于上腔静脉与右心房的交界处及上腔静脉下1/3段的定位精准率分别为98.41%、100%,差异无统计学意义(P>0.05),观察组中体表测量法、P/R波振幅50%定位法所对应的导管长度显著小于实际置入长度(均P<0.05),双峰P波定位法对应的导管长度与实际置入长度差异无统计学意义(P>0.05)。结论对于心腔内电图表现为非单纯高尖P波形态的患者,特异性Q波定位法具有较好的精准度和适用性,可作为心腔内电图定位技术的补充。