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.

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.

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.

Spectral and mathematical evaluation of electromyography signals for clinical use

The surface electromyography （SEMG） is a complicated biomedical signal, generated during voluntary or involuntary muscle activities and these muscle activities are always controlled by the nervous system. In this paper, the processing and analysis of SEMG signals at multiple muscle points for different operations were carried out. Myoelectric signals were detected using designed acquisition setup which consists of an instrumenta- tion amplifier, filter circuit, an amplifier with gain adjustment. Fhrther, Labview^-based data programming code was used to record SEMG signals for independent activities. The whole system consists of bipolar noninvasive electrodes, signal acquisition protocols and signal conditioning at different levels. This work uses recorded SEMG signals generated by biceps and triceps muscles for four different arm activities. Feature extraction was done on the recorded signal for investigating the voluntary muscular contraction relationship for exercising statistic measured index method to evaluate distance between two independent groups by directly addressing the quality of signal in separability class for different arm movements. Thereafter repeated factorial analysis of variance technique was implemented to evaluate the effectiveness of processed signal. From these results, it demonstrates that the proposed method can be used as SEMG feature evaluation index.