Neuromuscular blockade management in patients with COVID-19

Chaves-Cardona Harold,Hernandez-Torres Vivian,Kiley Sean,Renew Johnathan 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.4

This narrative review evaluates the evidence for using neuromuscular blocking agents (NMBA) in patients being treated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While large prospective randomized-controlled trials (RCTs) are lacking at this point in time, smaller observational studies and case series are reviewed to ascertain the indications and utility of NMBAs. Additionally, large RCTs that address similar clinical scenarios are reviewed and the authors translate these findings to patients with COVID-19. Specifically, NMBAs can be helpful during endotracheal intubation to minimize the risk of patient coughing and possibly infecting healthcare personnel. NMBAs can also be used in patients to promote patient-ventilator synchrony while reducing the driving pressure needed with mechanical ventilation (MV), particularly in patients with the severe clinical presentation (Type H phenotype). Prone positioning has also become a cornerstone in managing refractory hypoxemia in patients with SARS-CoV-2 acute respiratory distress syndrome (ARDS), and NMBAs can be useful in facilitating this maneuver. In the perioperative setting, deep levels of neuromuscular blockade can improve patient outcomes during laparoscopic operations and may theoretically reduce the risk of aerosolization as lower insufflation pressures may be utilized. Regardless of the indication, quantitative neuromuscular monitoring remains the only reliable method to confirm adequate recovery following cessation of neuromuscular blockade. Such monitors may serve a unique purpose in patients with COVID-19 as automation of measurements can reduce healthcare personnel-patient contact that would occur during periodic subjective evaluation with a peripheral nerve stimulator.

A Method for Computing Maximum Throughput at the User Interface of FDDI Stations

Mario Cardona,Tadashi Satake,Shigeo Tsujii 한국통신학회 1993 Asia-Pacific Conference on Communications Vol.2 No.1

Metabolic, cardiorespiratory, and neuromuscular fitness performance in children with cerebral palsy : A comparison with healthy youth

Claudia Cardona García,Alberto Alcocer-Gamboa,Margarita Pérez Ruiz,Ignacio Martínez Caballero,Avery D. Faigenbaum,Jonathan Esteve-Lanao,Beatriz Moral Saiz,Teresa Martín Lorenzo,Sergio Lerma Lara 한국운동재활학회 2016 JER Vol.12 No.2

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

Carlos Eduardo Montes Cardona,Herney Andrés García-Perdomo 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.2

Purpose: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi. Materials and Methods: A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin. Results: Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15–0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin. Conclusions: Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

Residual Vibration Reduction in Mechanical Systems: A Time-domain Approach

Joaquim Maria Veciana,Salvador Cardona 한국정밀공학회 2012 International Journal of Precision Engineering and Vol. No.

This paper presents a time-domain technique to generate command inputs for the reduction of residual vibrations in mechanical systems. The technique is based on the generation of motion profiles with zero-crossing points in their frequency spectra at the system resonances in the same way as the zero-vibration (ZV) command generation methods. By including an appropriate negative exponential time function, which contains the system natural frequency and the damping ratio, the resultant input can be applied to damped systems with a result of zero residual vibration. The signals synthesized can be used as a generic physical magnitude in vibratory systems. However, they were particularized for mechanical systems and engineering metrics were used. Compared to other ZV methods, for a short duration input range, the signals obtained have better performance in terms of minimum-acceleration-switch shape which is translated to a smoother motion profile. The development includes the application to single-mode and multiple-mode mechanical systems and the possibility of handling two functional requirements or constraints in the desired application. The analyzed systems are those that can be modeled as discrete linear ones with several vibratory degrees of freedom and can be described with constant parameter motion equations. Experimental results show the efficacy of the method developed with its application to a damped pendulum test platform.

Parameter selection in the design of displacement and motion functions by means of B-splines

Enrique Zayas,Salvador Cardona-Foix,Lluïsa Jordi-Nebot 대한기계학회 2018 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.32 No.5

This work analyses the incidence of the parameter selection of B-spline curves, used in the design of displacement and motion functions, on its degree of freedom and shape. A complete design process based on the use of non-parametric B-spline curves and the convenience of selecting the curve parameters from the point of view of its practical application is shown. In order to make easy the design and use of the displacement function, the algorithms for derivation and integration of the B-splines used are presented. Three case studies validate the proposed design process and the selection of the adequate parameters. The first case presents the design of a displacement function of a roller follower driven by a disk cam; the corresponding cam profile and its prototype are shown. The second case presents the design of the motion function corresponding to the cutting unit of a manufacturing cardboard tube machine. The third case exposes the design of the displacement function of the bar feeding mechanism in a single-spindle automatic lathe, to produce a partial thread screw of hexagonal head.

Minimizing Residual Vibrations for Non-Zero Initial States:Application to an Emergency Stop of a Crane

Joaquim Maria Veciana,Salvador Cardona-Foix,Pau Català 한국정밀공학회 2013 International Journal of Precision Engineering and Vol. No.

This paper presents an approach to design command inputs for the reduction of residual vibrations in mechanical systems for nonzero initial states. The technique starts with the development of a standard input shaper in a second order oscillator, and adds the initial states of the system to the formulation. However, it is proven that the obtained input shaper does not guarantee a null residual vibration when it is convolved with any unshaped command. To obtain an analytically proven zero-vibration response, it is required to include the parameters that characterize the response of the system to a selected normalized unshaped command in the formulation. By introducing an appropriate processing time delay and by measuring the initial states using a feedback sensor, the proposed method has been applied in a real time scenario where an emergency stop of a crane is required, assuming that initially the payload is swaying. The analyzed systems are those that can be modeled as discrete linear ones and can be described with constant parameter motion equations. Experimental results show the efficacy of the developed method with its application to a scaled crane test platform.

Modified Adaptive Input Shaping for Maneuvering Cranes Using a Feedback MEM Gyroscope with Null Drift

Joaquim Maria Veciana,Salvador Cardona-Foix,Pau Català 한국정밀공학회 2015 International Journal of Precision Engineering and Vol. No.

This paper presents an adaptive algorithm to reduce residual vibrations when the feedback sensor used has null drift along the time. The adaptive approaches are useful to deal with large variations of the system parameters at each maneuver, such as it occurs in cranes. For the feedback sensor, the use of inertial measurement units such as Micro-Electro-Mechanical Systems (MEMS) is increasingly extended because of their cost, size, robustness and power consumption. However, the effectiveness of the adaptive input shaping algorithms is compromised because of this drift, which is a commonly raised issue in this kind of devices. The study presented in this manuscript focuses on the development of an automatic compensation of this drift to obviate frequent calibrations. It is based on a non-asymptotic algebraic identification technique, which does not require initial conditions and has a short convergence time. This study uses the Zero-Vibration (ZV) input shaper technique, and the null drift is added to the algorithm as a parameter to be identified. The proposed method is particularized for single maneuvers of cranes with a gyroscope as feedback sensor, in a real time scenario. Experimental results show the efficacy of the method on a scaled crane test platform.

Order reduction in time integration caused by velocity projection

Martin Arnold,Alberto Cardona,Olivier Brüls 대한기계학회 2015 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.29 No.7

Holonomic constraints restrict the configuration of a multibody system to a subset of the configuration space. They imply so calledhidden constraints at the level of velocity coordinates that may formally be obtained from time derivatives of the original holonomicconstraints. A numerical solution that satisfies hidden constraints as well as the original constraint equations may be obtained consideringboth types of constraints simultaneously in each time step (Stabilized index-2 formulation) or using projection techniques. Both approachesare well established in the time integration of differential-algebraic equations. Recently, we have introduced a generalized-α Liegroup time integration method for the stabilized index-2 formulation that achieves second order convergence for all solution components. In the present paper, we show that a separate velocity projection would be less favourable since it may result in an order reduction and inlarge transient errors after each projection step. This undesired numerical behaviour is analysed by a one-step error recursion that considersthe coupled error propagation in differential and algebraic solution components. This one-step error recursion has been used before toprove second order convergence for the application of generalized-α methods to constrained systems.

Bio-structural monitoring of bone mineral alterations through electromechanical impedance measurements of a Piezo-device joined to a tooth

Tinoco Hector A.,Cardona Carlos I.,Marín-Berrio Maribel L. F.,García-Grisales Juliana,Gomez Juan P.,Roldan Samuel I.,Peña Fabio M.,Brinek Adam,Kalasová Dominika,Kaiser Jozef,Zikmund Tomas 대한의용생체공학회 2020 Biomedical Engineering Letters (BMEL) Vol.10 No.4

Bone presents different systemic functionalities as calcium phosphate reservoir, organ protection, among others. For that reason, the bone health conditions are essential to keep in equilibrium the metabolism of several body systems. Different technologies exist to diagnose bone conditions with invasive methods based on ionizing radiation. Therefore, there is a challenge to develop new ways to evaluate bone alterations in a noninvasive form. This study shows the assessment of a piezo-actuated device acting on a human tooth for the bio-monitoring of bone alterations. The bone diagnosis is performed by applying the electromechanical impedance technique (EMI), commonly used in structural health monitoring. For the experimental tests, five bone samples were prepared, and one was chosen as the monitoring. All samples were put in a decalcifying substance (TBD1 acid–base) at different times to emulate localized bone mineral alterations. Bone reductions were computed by using X-ray micro-computed tomography analyzing the morphometry. Electrical resistance measurements (piezo-device) were taken for the monitoring specimen meanwhile it was partially decalcified during 8520 seconds. In the frequency spectrum, several observation windows showed that the bone alterations gradually changed the electrical resistance signals which were quantified statistically. Results evidenced that the bone density changes are correlated with the electrical resistance measurements; these changes presented an exponential behavior as much as in the calculated index, and bone mineral reduction. The results demonstrated that bone alterations exhibit linear dependence with the computed statistical indexes. This result confirms that it is possible to observe the bone changes from the teeth as a future application.