Reliability of Blood Pressure Measurements: An Analysis of the White Coat Effect and Its Fluctuations

In this paper, we evaluate the difference between the first and second measurements of blood pressure (BP) when BP is measured twice using the results of 17,775 medical checkups. The two measurements for both systolic BP (SBP) and the diastolic BP (DBP) fluctuated a large amount even though they were measured at a short interval. The first measurements were 6.7 and 2.4 mmHg higher than the second ones for SBP and DBP, suggesting a white coat effect. Then, the factors that might affect the differences between the two measurements were analyzed by the regression models. For both SBP and DBP, the difference increased as the first measurement increased. Age, gender, BMI and alcohol consumption were other important factors affecting the difference. In the case of a typical male individual, the typical criteria for hypertension of 140/90, 160/100 and 180/110 mmHg criteria in the first measurement would correspond to 135/86, 150/94 and 165/102 mmHg in the second measurement. The necessity of developing accurate and cost-efficient BP measurement methods is strongly suggested.

The Evaluation of Measurement Uncertainty and Its Application in the Vacuum Pressure Measurement

In order to accurately measure the pressure and the pressure difference between two points in the vacuum chamber, a large number of experimental data were used to research the performance of the three capacitance diaphragm gauge and analysis the main influences of the uncertainly degree of pressure in the process. In this paper, three kind of uncertainty, such as the single uncertainty, the synthesis uncertainty and the expanded uncertainty of the three capacitance diaphragm gauges are introduced in detail in pressure measurement. The results show that the performance difference of capacitance diaphragm gauge can be very influential to the accuracy of the pressure difference measurement and the uncertainty of different pressure can be very influential to pressure measurement. That for accurately measuring pressure and pressure difference has certain reference significance.

Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Clinical and Therapeutic Evaluation of Hypertensives According to the Practice of Ambulatory Blood Pressure Measurement (ABPM) at the Bel Air International Clinic in Conakry from January 1, 2019 to November 30, 2022

Introduction: Ambulatory Blood Pressure Measurement (ABPM) is a non- invasive examination recommended for subjects at high cardiovascular risk, and those requiring a nocturnal drop in BP such as elderly and obese subjects, those with secondary hypertension or resistant, diabetics, subjects with metabolic syndrome or sleep apnea syndrome. The objective of this study was to evaluate the contribution of ABPM in the diagnosis and evaluation of the level of control of hypertension under treatment at the Bel Air international clinic. Materials and Methods: This is a retrospective, cross-sectional and descriptive study, carried out at the Bel Air International Clinic in Conakry (Guinea) between January 2019 and November 30, 2022. It included a consecutive series of 180 consenting patients recruited through an ambulatory measurement of 24-hour blood pressure from a FUGADA brand device. Results: We collected 180 patients, with a male predominance (sex-ratio M/F = 2.46). The mean age of the patients was 48.48 ± 14.23 years. The most represented age group was that of 32 to 42 years with 50 cases (27.8%) followed by that of 43 to 52 years with 42 cases or 23.3%. The indication was for diagnostic purposes in 106 cases 58.9%, the therapeutic evaluation in 58 patients (32.2%). The examination was prescribed by a cardiologist in 98 cases (54.4%), a general practitioner in 71 cases (39.4%), a neurologist in 11 cases (6.1%). In the therapeutic evaluation, high blood pressure was controlled in 24 patients (13.3%) and uncontrolled in 34 cases (18.9%). In the diagnostic indication, high blood pressure was confirmed in 79 cases (43.9%) with a statistically significant link (Chi2 = 4.57 and p-value = 0.032). The nycthemeral mean was 187.27 ± 26.22 mmHg for systolic blood pressure (SBP) and 110.37 ± 19.06 mmHg for diastolic blood pressure (DBP), during the day, 151.64 ± 21.45 mmHg for SBP and 71.59 ± 8.67 mmHg for diastolic blood pressure. During the study 65 patients (36.1%) were identified as dippers and 115 patients (63.9%) were no-dipping. The antihypertensive protocol used was monotherapy in 68 cases (37.8%), dual therapy in 46 cases (25.6%), triple therapy in 17 cases (9.4%). However 39 patients or 21.7% were not taking any antihypertensive. Conclusion: This preliminary study, despite the modest sample size, showed the importance of ABPM as a tool for diagnosis, monitoring of hypertensive patients and therapeutic adaptation. A large-scale national study would be necessary for the rational use of ambulatory blood pressure measurement in our context in order to improve the management of hypertensive patients.

Hydraulic Fracturing Stress Measurements and Their Implication for the Design of the First Concrete Lined Pressure Shaft in Sri Lanka

The Urea Oya Multipurpose Development Project （UMDP） is a water transfer, hydropower and irrigation in the south-eastern part of the central highland region of Sri Lanka. During geotechnical site investigation program 42 hydraulic fracture tests and 42 impression packer tests were carried out in 3 boreholes to about 840 m depth. Based on the stress measurements the minimum and maximum horizontal stress ratios were calculated. In situ stress computations at all the tests were based on the assumption that the principal stress components were vertical （σv） and horizontal （σH and σh, the maximum and minimum, respectively）. The results of the measurements had a direct impact on the design of the major openings bearing a high overburden--the underground powerhouse and the transformer cavern--and revealed a significant optimization potential concerning the selection of the lining system of the pressure shaft.

Design and theoretical analysis of test system for propellants' gas pressure in warhead

Aiming at harsh environment of cluster bombs center tube explosion dispersion and difficulties in installation of traditional test systems,a storage test system based on 16-bit ultra-low power microcontroller MSP430 is designed in order to acquire gas pressure during cluster bombs dispersion.To meet the requirement of low power consumption,the working states of system＇s modules during data acquisition are elaborated and the equation to calculate the gas pressure change during cylindrical center tube opening the hatch is deduced.The field test is conducted and good test results are obtained.

Value of negative pressure sealing drainage on wound healing of Gustilo IIIB and IIIC open fractures

BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has positive value in improving patient prognosis.AIM To explore the clinical value of the negative pressure sealing drainage technique in wound healing of Gustilo IIIB and IIIC open fractures.METHODS Eighty patients with Gustilo IIIB and IIIC open fractures with skin and soft tissue injuries who were treated in the Second People’s Hospital of Dalian from March 2019 to December 2021 were selected as the research subjects.They were divided into a study group(n=40,healed with negative pressure closed drainage)and a control group(n=40,healed with conventional dressing changes)according to the variation in the healing they received.The efficacy of the clinical interventions,the variations in the regression indicators(time to wound healing,time to fracture healing,time to hospitalization),and the conversion and healing of bacterial wounds were compared 1-3 mo after the intervention.RESULTS The total effective rate of patients among the study group was 95.00%(38/40),which was notably higher than 75.00%(30/40)among the control group(P<0.05).The wound healing time,fracture healing time,and hospital stay of the patients in the study group was shorter than the control group(P<0.05).After the intervention,the negative bacterial culture at the wound site rate and wound healing rate of the patients among the study group increased compared to the control group(P<0.05).CONCLUSION Negative pressure sealing and drainage technology has a good therapeutic effect on patients with Gustilo IIIB and IIIC open fracture wounds with skin and soft tissue injury.It can notably enhance the wound healing rate and the negative rate of bacteria on the wound surface and help to speed up the recovery process of patients.

Prediction Model of Coal Reservoir Pressure and its Implication for the Law of Coal Reservoir Depressurization

The main methods of coalbed methane(CBM)development are drainage and depressurization,and a precise prediction of coal reservoir pressure is thus crucial for the evaluation of reservoir potentials and the formulation of reasonable development plans.This work established a new reservoir pressure prediction model based on the material balance equation(MBE)of coal reservoir,which considers the self-regulating effects of coal reservoirs and the dynamic change of equivalent drainage area(EDA).According to the proposed model,the reservoir pressure can be predicted based on reservoir condition data and the actual production data of a single well.Compared with traditional reservoir pressure prediction models which regard EDA as a fixed value,the proposed model can better predict the average pressure of reservoirs.Moreover,orthogonal experiments were designed to evaluate the sensitivity of reservoir parameters on the reservoir pressure prediction results of this proposed model.The results show that the saturation of irreducible water is the most sensitive parameter,followed by Langmuir volume and reservoir porosity,and Langmuir pressure is the least sensitive parameter.In addition,the pressure drop of reservoirs is negatively correlated with the saturation of irreducible water and the Langmuir volume,while it is positively correlated with porosity.This work analyzed the reservoir pressure drop characteristics of the CBM wells in the Shizhuangnan Block of the Qinshui Basin,and the results show that the CBM reservoir depressurization can be divided into three types,i.e.,rapidly drop type,medium-term stability type,and slowly drop type.The drainage features of wells were reasonably interpreted based on the comprehensive analysis of the reservoir depressurization type;the latter was coupled to the corresponding permeability dynamic change characteristics,eventually proving the applicability of the proposed model.

Investigation on the relationship between overpressure and sub-harmonic response from encapsulated microbubbles

Sub-harmonic component generated from microbubbles is proven to be potentially used in noninvasive blood pressure measurement. Both theoretical and experimental studies are performed in the present work to investigate the dependence of the sub-harmonic generation on the overpressure with different excitation pressure amplitudes and pulse lengths. With 4-MHz ultrasound excitation at an applied acoustic pressure amplitude of 0.24 MPa, the measured sub-harmonic amplitude exhibits a decreasing change as overpressure increases; while non-monotonic change is observed for the applied acoustic pressures of 0.36 MPa and 0.48 MPa, and the peak position in the curve of the sub-harmonic response versus the overpres- sure shifts toward higher overpressure as the excitation pressure amplitude increases. Furthermore, the exciting pulse with long duration could lead to a better sensitivity of the sub-harmonic response to overpressure. The measured results are ex- plained by the numerical simulations based on the Marmottant model. The numerical simulations qualitatively accord with the measured results. This work might provide a preliminary proof for the optimization of the noninvasive blood pressure measurement through using sub-harmonic generation from microbubbles.

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.

Reliability of gas holdup measurements using the differential pressure method in a cyclone-static micro-bubble flotation column

Gas holdup is one of the key parameters in flotation process. Gas holdup as measured by a differential pressure method was investigated and the relative errors compared to the average gas holdup from the volume expansion method. The errors were used to establish optimum measurement positions. The results show that the measurement position should be in the middle of the column and in the region half way from the center to the wall (the half-radius). The gas holdup along the axial direction is lower at the bottom and higher at the top of the floatation column. The gas holdup along the radial direction is lower near the wall and higher near the center of the flotation column. The average gas holdup measure- ment can be replaced by regional gas holdup values.

A pilot study of the precision of digital intraocular pressure measurement during vitrectomy

AIM:To evaluate the precision of digital intraocular pressure(IOP)measurement in silicone oil(SO)filled eyes during vitrectomy.METHODS:This is a retrospective,single-blind study.Patients who were diagnosed with retinal detachment and scheduled for vitrectomy with SO injection were consecutively enrolled.During the vitrectomy,IOP was digitally measured and then by a rebound tonometer(Icare PRO).The rebound tonometer readings were masked to the surgeons.The digitally measured IOP and that of rebound tonometer were compared,and the inter-methods agreement was assessed.The absolute deviation in IOP values between these two methods(△IOP)was also calculated,and correlations between△IOP and refractive status,lens status and levels of surgeons’experience were analyzed.RESULTS:A total of 131 patients(131 eyes)were recruited,with a mean age of 51.0±16.1 y.There was no significant difference in IOPs between digital measurement and the rebound tonometer(15.6±4.3 vs 15.7±5.1 mm Hg;t=0.406,P=0.686).Intraclass correlation coefficients(ICC)analysis indicated a strong correlation between these two measurements(ICC=0.830,P<0.001).The mean△IOP was 2.0±1.9 mm Hg(range:0-12.8 mm Hg),with 98 eyes(74.8%)had the△IOP within 3 mm Hg.△IOP was found to be negatively correlated with levels of surgeons’experience(r=-0.183;P=0.037),but not with the refractive status or lens status of the patients(both P>0.05).CONCLUSION:For experienced surgeons,the digital IOP measurement may be an acceptable technique for IOP measurement in SO filled eyes during vitrectomy.However,its use by inexperienced surgeons should be taken with caution.

A blood pressure measurement method based on synergetics theory

The principle for blood pressure measurement using pulse transit time is introduced in this paper.And the math model of synergetics theory is studied in detail.The synergetics theory is applied in the analysis of blood pressure measurement data.The simulation results show that the application of synergetics theory is helpful to judge the normal blood pressure,and the accuracy is up to 80%.

Hygienic and Dietary Measures in Cameroonian Hypertensive Patients Followed at the Douala General Hospital: Knowledge, Compliance and Effect on Blood Pressure Control

Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hypertensive patients led us to study the knowledge, compliance and effect of HDMs among Cameroonian hypertensive patients. Methods: This was a cross-sectional study carried out at the Douala General Hospital;the census of patients was carried out from 05 March to 10 May 2018. The data evaluated were knowledge and compliance with HDMs with an inference of their effect on blood pressure control. Results: We recruited 330 participants at mean age of 60 ± 11 years, 37.9% men;57.3% with blood pressure (BP) controlled. Out of 330 subjects, 308 (93.3%) who had been educated about dietary health measures for hypertension were assessed on knowledge, compliance and effect of these measures against 22 (6.7%) who had never heard about them. Around 85.7% of participants had good knowledge of HDMs and 78.9% had good compliance with them. There was no statistically significant influence of knowledge and compliance with HDMs on blood pressure control. Conclusion: The level of knowledge and adherence to HDMs of hypertensive patients at the Douala General Hospital was appreciable. It is however appropriate for physicians to intensify patient education on HDMs and BP control.

THE INTERACTION BETWEEN SHOCK WAVES AND SOLID SPHERES ARRAYS IN A SHOCK TUBE

When a shock wave interacts with a group of solid spheres,non-linear aerodynamic behaviors come into effect.The complicated wave reflections such as the Mach reflection occur in the wave propagation process.The wave interactions with vortices behind each sphere's wake cause fluctuation in the pressure profiles of shock waves.This paper reports an experimental study for the aerodynamic processes involved in the interaction between shock waves and solid spheres.A schlieren photography was applied to visualize the various shock waves passing through solid spheres.Pressure measurements were performed along different downstream positions.The experiments were conducted in both rectangular and circular shock tubes.The data with respect to the effect of the sphere array, size,interval distance,incident Mach number,etc.,on the shock wave attenuation were obtained.

Measuring the Internal Velocity of Debris Flows Using Impact Pressure Detecting in the Flume Experiment

Measuring the internal velocity of debris flows is very important for debris flow dynamics research and designing debris flow control works. However, there is no appropriate method for measuring the internal velocity because of the destructive power of debris flow process. In this paper, we address this problem by using the relationship between velocity and kinetic pressure, as described by surface velocity and surface kinetic pressure data. Kinetic pressure is the difference of impact pressure and static pressure. The former is detected by force sensors installed in the flow direction at the sampling section. Observations show that static pressure can be computed using the formula for static water pressure by simply substituting water density for debris flow density. We describe the relationship between surface velocity and surface kinetic pressure using data from seven laboratory flume experiments. It is consistent with the relationship for single phase flow, which is the measurement principle of the Pitot tube.

CFD simulation of pressure fluctuation characteristics in the gas-solid fluidized bed:Comparisons with experiments

A simple hydrodynamic model based on two-fluid theory, taking into account the effect of discrete particles on both the gas- and solid-phase momentum equations, was used to numerically investigate the pressure fluctuation characteristics in a gas-solid fluidized bed with the aid of CFX 4.4, a commercial CFD software package, by adding user-defined Fortran subroutines. Numerical simulations together with typical experimental measurements show that pressure fluctuations originate above the distributor when a gas pulse is injected into the fluidized bed. The pressure above the bubble gradually increases due to the presence of a rising bubble. When the bubble passes through the bed surface, the pressure near the bed surface gradually decreases to a lower value. Moreover, the pressure signals in the bubbling fluidized beds show obviously periodic characteristics. The major frequency of pressure fluctuations at the same vertical position is affected slightly by the operating gas velocity, and the amplitude of pressure fluctuations is related to both the operating gas velocity and the vertical height. In this study, the influence of the operating gas velocity on the pressure wave propagation velocity can be ignored, and only two peak frequencies in the power spectrum of the pressure fluctuations are observed which are associated with the bubble formation above the distributor and its eruption at the bed surface.

Revisiting the methods for gas permeability measurement in tight porous medium

Permeability is a key parameter to describe fluid transport properties of porous medium; however, the permeability measurement is extremely difficult for tight porous medium, e.g. fine-grained rock or dense soil. In this paper, three methods for gas permeability measurement, i.e. steady state method, pulse decay method(PDM) and pressure oscillation method(POM), are first reviewed and then their advantages and drawbacks are discussed. Both analytical and numerical solutions of gas permeability are presented for the tight porous medium. The results show that the analytical method is relatively simple but only valid under certain conditions, whilst the numerical method is more robust and generic, which can take into account several factors such as porosity, saturation, gas leakage, and unconventional boundary conditions. The influence of the effective porosity on the permeability determination is further analyzed using the proposed numerical method. In this study, new pressure data interpretation procedures for PDM and POM are proposed, and the obtained results can serve as a guidance to define a proper method for permeability measurement of the tight porous medium.

Pressure relief, gas drainage and deformation effects on an overlying coal seam induced by drilling an extra-thin protective coal seam

Numerical simulations and field tests were used to investigate the changes in ground stress and deformation of, and gas flow from, a protected coal seam under which an extra-thin coal seam was drilled. The geological conditions were: 0.5 meter mining height, 18.5 meter coal seam spacing and a hard limestone/fine sandstone inter-stratum. For these conditions we conclude: 1) the overlying coal-rock mass bends and sinks without the appearance of a caving zone, and 2) the protected coal seam is in the bending zone and undergoes expansion deformation in the stress-relaxed area. The deformation was 12 mm and the relative defor- mation was 0.15%. As mining proceeds, deformation in the protected layer begins as compression, then becomes a rapid expansion and, finally, reaches a stable value. A large number of bed separation crannies are created in the stress-relaxed area and the permeability coefficient of the coal seam was increased 403 fold. Grid penetration boreholes were evenly drilled toward the protected coal seam to affect pressure relief and gas drainage. This made the gas pressure decrease from 0.75 to 0.15 MPa, the gas content decrease from 13 to 4.66 m3/t and the gas drainage reach 64%.

Principle and engineering application of pressure relief gas drainage in low permeability outburst coal seam

With the increase in mining depth, the danger of coal and gas outbursts increases.In order to drain coal gas effectively and to eliminate the risk of coal and gas outbursts, we used a specific number of penetration boreholes for draining of pressure relief gas.Based on the principle of overlying strata movement, deformation and pressure relief, a good effect of gas drainage was obtained.The practice in the Panyi coal mine has shown that, after mining the C11coal seam as the protective layer, the relative expansion deformation value of the protected layer C13 reached 2.63%, The permeability coefficient increased 2880 times, the gas drainage rate of the C13 coal seam increased to more than 60%, the amount of gas was reduced from 13.0 to 5.2 m3/t and the gas pressure declined from 4.4 to 0.4 MPa, which caused the danger the outbursts in the coal seams to be eliminated.The result was that we achieved a safe and highly efficient mining operation of the C13 coal seam.