OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

The processing mechanism of the human brain for speech information is a significant source of inspiration for the study of speech enhancement technology. Attention and lateral inhibition are key mechanisms in auditory information processing that can selectively enhance specific information. Building on this, the study introduces a dual-branch U-Net that integrates lateral inhibition and feedback-driven attention mechanisms. Noisy speech signals input into the first branch of the U-Net led to the selective feedback of time-frequency units with high confidence. The generated activation layer gradients, in conjunction with the lateral inhibition mechanism, were utilized to calculate attention maps. These maps were then concatenated to the second branch of the U-Net, directing the network's focus and achieving selective enhancement of auditory speech signals. The evaluation of the speech enhancement effect was conducted by utilising five metrics, including perceptual evaluation of speech quality. This method was compared horizontally with five other methods: Wiener, SEGAN, PHASEN, Demucs and GRN. The experimental results demonstrated that the proposed method improved speech signal enhancement capabilities in various noise scenarios by 18% to 21% compared to the baseline network across multiple performance metrics. This improvement was particularly notable in low signal-to-noise ratio conditions, where the proposed method exhibited a significant performance advantage over other methods. The speech enhancement technique based on lateral inhibition and feedback-driven attention mechanisms holds significant potential in auditory speech enhancement, making it suitable for clinical practices related to artificial cochleae and hearing aids.
Humans ; Attention/physiology* ; Speech Perception/physiology* ; Neural Networks, Computer ; Speech ; Noise ; Feedback

In order to meet the need of autonomous control of patients with severe limb disorders, this paper designs a nursing bed control system based on motor imagery-brain computer interface (MI-BCI). In view of the low decoding performance of cross-subjects and the dynamic fluctuation of cognitive state in the existing MI-BCI technology, the neural network structure optimization and user interaction feedback enhancement are improved. Firstly, the optimized dual-branch graph convolution multi-scale neural network integrates dynamic graph convolution and multi-scale convolution. The average classification accuracy is higher than that of multi-scale attention temporal convolution network, Gram angle field combined with convolution long short term memory hybrid network, Transformer-based graph convolution network and other existing methods. Secondly, a dual visual feedback mechanism is constructed, in which electroencephalogram (EEG) topographic map feedback can improve the discrimination of spatial patterns, and attention state feedback can enhance the temporal stability of signals. Compared with the single EEG topographic map feedback and non-feedback system, the average classification accuracy of the proposed method is also greatly improved. Finally, in the four classification control task of nursing bed, the average control accuracy of the system is 90.84%, and the information transmission rate is 84.78 bits/min. In summary, this paper provides a reliable technical solution for improving the autonomous interaction ability of patients with severe limb disorders, which has important theoretical significance and application value.
Humans ; Brain-Computer Interfaces ; Deep Learning ; Electroencephalography ; Feedback, Sensory ; Neural Networks, Computer ; Beds

BACKGROUND

Recovery is essential for high-intensity intermittent sports athletes to achieve optimal performance. Heart rate variability (HRV) serves as a marker of the autonomic nervous system, which also measures the parasympathetic regulation that facilitates recovery. Neurofeedback (NBF) intervention, combined with deep breathing and mental imagery, presented positive results in facilitating parasympathetic reactivation. However, limited studies exist in investigating the influence of the NBF intervention on HRV parameters and recovery, specifically in high-intensity intermittent sports athletes.

OBJECTIVE

This pilot study aims to investigate the effects and influence of neurobiofeedback intervention on recovery via the use of HRV of UAAP Collegiate Basketball and Football Athletes.

STUDY DESIGN

The research will be done with a Quasi-experimental onegroup pretest-posttest study design.

METHODOLOGY

Participants will undergo a neurobiofeedback intervention following neuromuscular and metabolic training. Data is collected with a Polar H10 HRM Chest Strap connected to an Elite HRV monitoring application and will be analyzed by Kubios HRV software.

STATISTICAL ANALYSIS

Descriptive statistics will be computed for participant characteristics. Kolmogorov-Smirnov test (p >0.05) will assess normality. Two-way repeated-measures ANOVAs will examine NBF effects across exercise types, with Bonferroni-corrected pairwise comparisons and trend analysis for the main effects and non-significant but clinically relevant patterns. All analyses will be done using SPSS v25.

EXPECTED RESULTS

It is expected that the neurobiofeedback intervention will have an effect and influence by eliciting a lower LF/HF ratio and SD1/SD2, suggesting a facilitated reactivation of the parasympathetic nervous system, promoting recovery after undergoing neuromuscular or metabolic training.

Human ; Neurofeedback

OBJECTIVES: Pyroptosis plays a critical role in tubulointerstitial lesions of diabetic kidney disease (DKD). Annexin A2 (ANXA2) is involved in cell proliferation, apoptosis, and adhesion and may be closely related to DKD, but its specific mechanism remains unclear. This study aims to investigate the role and molecular mechanism of ANXA2 in high glucose-induced pyroptosis of renal tubular epithelial cells, providing new targets for DKD prevention and treatment. METHODS: Human renal tubular epithelial HK-2 cells were divided into a normal glucose group (5.5 mmol/L), a high glucose group (30.0 mmol/L), and a osmotic control group (24.5 mmol/L mannitol+5.5 mmol/L glucose). ANXA2 expression was modulated by overexpression of plasmids and small interfering RNA (siRNA). Cell proliferation was measured by 5-ethynyl-2'-deoxyuridine (EdU) assay, apoptosis by flow cytometry, and ANXA2, p50, and p65 subcellular localization by immunofluorescence. Western blotting was employed to detect α-smooth muscle actin (α-SMA), fibronectin (FN), and collagen type IV (Col-IV). Real-time fluorescence quantitative PCR (RT-qPCR) and Western blotting were used to analyze nuclear factor-κB (NF-κB) subunits p50/p65 and the pyroptosis pathway factors NLR family Pyrin domain containing 3 (NLRP3), caspase-1, inferleukin (IL)-1β, and IL-18. Protein interactions between ANXA2 and p50/p65 were examined by co-immunoprecipitation, while chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assays were used to examine NF-κB binding to the ANXA2 promoter. RESULTS: High glucose upregulated ANXA2 expression and promoted its nuclear translocation (P<0.01). High glucose reduced cell proliferation, increased apoptosis, and elevated α-SMA, FN, and Col-IV expression (all P<0.05); ANXA2 overexpression aggravated these effects (all P<0.05), while ANXA2 knockdown reversed them (all P<0.05). High glucose activated NF-κB and increased NLRP3, caspase-1, L-1β, and IL-18 mRNA and protein expression (all P<0.05); ANXA2 overexpression further enhanced this, whereas knockdown suppressed NF-κB activation and downstream factors (all P<0.05). Co-immunoprecipitation confirmed ANXA2 directly binds the NF-κB subunit p65. ChIP assays revealed p65 binds specifically to ANXA2 promoter regions (ChIP-2, ChIP-4, and ChIP-6), and luciferase activity in corresponding mutant constructs (M2, M4, and M6) was significantly increased versus controls (all P<0.05), confirming positive transcriptional regulation of ANXA2 by p65. CONCLUSIONS ANXA2 and NF-κB form a positive feedback loop that sustains NLRP3 inflammasome activation, promotes pyroptosis pathway activation, and aggravates high glucose-induced renal tubular epithelial cell injury. Targeting ANXA2 or blocking its interaction with p65 may be a novel strategy to slow DKD progression.
Humans ; Pyroptosis/drug effects* ; Annexin A2/physiology* ; Epithelial Cells/cytology* ; Kidney Tubules/cytology* ; Glucose/pharmacology* ; Diabetic Nephropathies/metabolism* ; NF-kappa B/metabolism* ; Cell Line ; Cell Proliferation ; Transcription Factor RelA/metabolism* ; Feedback, Physiological

During long-duration manned space missions, the complex and extreme space environment exerts significant impacts on astronauts' physiological, psychological, and cognitive functions, thereby posing direct risks to mission safety and operational efficiency. As a key bridge between the brain and external devices, brain-computer interface (BCI) technology enables precise acquisition and interpretation of neural signals, offering a novel paradigm for human-machine collaboration in manned spaceflight. Non-invasive BCI technology shows broad application prospects across astronaut selection, mission training, in-orbit task execution, and post-mission rehabilitation. During mission preparation, multimodal signal assessment and neurofeedback training based on BCI can effectively enhance cognitive performance and psychological resilience. During mission execution, BCI can provide real-time monitoring of physiological and psychological states and enable intention-based device control, thereby improving operational efficiency and safety. In the post-mission rehabilitation phase, non-invasive BCI combined with neuromodulation may improve emotional and cognitive functions, support motor and cognitive recovery, and contribute to long-term health management. However, the application of BCI in space still faces challenges, including insufficient signal robustness, limited system adaptability, and suboptimal data processing efficiency. Looking forward, integrating multimodal physiological sensors with deep learning algorithms to achieve accurate monitoring and individualized intervention, and combining BCI with virtual reality and robotics to develop intelligent human-machine collaboration models, will provide more efficient support for space missions.
Brain-Computer Interfaces ; Humans ; Space Flight ; Astronauts/psychology* ; Neurofeedback ; Cognition ; Electroencephalography ; Man-Machine Systems

OBJECTIVES: Stress urinary incontinence (SUI) is a common condition among women that severely impairs quality of life. Pelvic floor proprioceptive training (PFPT) has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms. This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture, electrical stimulation, and biofeedback therapy versus conventional therapy consisting of electroacupuncture, electrical stimulation, and biofeedback alone in women with SUI, and to explore the role of PFPT in improving symptom and functional outcomes. METHODS: In this randomized controlled trial, 72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital, Central South University, between December 2021 and October 2023. Participants were randomly assigned to an experimental group (n=36) or a control group (n=36). Both groups received health education. The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy, while the experimental group additionally received PFPT 3 times per week for 4 weeks. The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included pelvic floor muscle strength, bladder neck mobility, and balance ability. The ICIQ-SF was reassessed at 1, 3, 6, and 12 months post-treatment. RESULTS: Both groups showed statistically significant improvements in all parameters after treatment (all P<0.05). However, there were no statistically significant differences between groups in most measures (all P>0.05). The experimental group demonstrated longer single-leg stance duration with eyes closed than the control group (left leg: P=0.026; right leg: P=0.006), with a significant increase from baseline (P<0.001). At 6 months post-treatment, the cure rate in the experimental group was significantly higher than that in the control group (P=0.037). CONCLUSIONS Conventional therapy effectively improves SUI symptoms, but adding PFPT provides notable additional benefits, including enhanced balance ability and sustained mid-term cure rates. These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.
Humans ; Female ; Urinary Incontinence, Stress/physiopathology* ; Pelvic Floor/physiopathology* ; Middle Aged ; Biofeedback, Psychology ; Adult ; Exercise Therapy/methods* ; Proprioception ; Electroacupuncture/methods* ; Quality of Life ; Electric Stimulation Therapy/methods* ; Treatment Outcome ; Combined Modality Therapy

OBJECTIVE: To approach the evaluation of relative α variant score monitored by bedside continuous electroencephalography and optic nerve sheath diameter (ONSD) evaluated by ultrasound in patients with ischemic hypoxic encephalopathy, and to observe the effect of neurofeedback training on brain function. METHODS: A prospective observational study was conducted. The patients admitted to the emergency and intensive care department of Shanghai Pudong New Area People's Hospital from January 2021 to December 2023, who meet the diagnostic criteria of ischemic hypoxic encephalopathy with the Glasgow coma score (GCS) ≤ 8 at admission receiving neurofeedback training were enrolled as the study object (observation group), and the patients without neurofeedback training and GCS score ≤ 8 at admission were enrolled as the controls (control group). Both groups received intravenous neurotrophic therapy combining ganglioside and cerebrolysin for 10 days as one course of treatment. On this basis, the observation group additionally received continuous neurofeedback training including visual feedback, auditory feedback, meditation and relaxation for 14 days. Bedside continuous electroencephalography was used for monitoring relative α variation score, and ultrasound was used to determine ONSD. The average power and slow wave power [expressed as delta-theta ratio (DTR)] of five channels in electroencephalography before and 14 days after neurofeedback training were examined. The differences in peripheral blood neutrophil/lymphocyte ratio (NLR), Hamilton depression scale (HAMD) score, National Institutes of Health stroke scale (NIHSS) score, plasma levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF). RESULTS: A total of 60 patients were enrolled in the observation group and 50 patients in the control group finally. There was no significant difference in gender, age or course of disease between the two groups. The ONSD and relative α variant score in the observation group were significantly higher than those in the control group [ONDS (mm): 5.59±0.42 vs. 3.23±0.34, relative α variant score: 2.28±0.39 vs. 0.83±0.28, both P < 0.01]. After neurofeedback training for 14 days, the mean power and DTR in five channels of electroencephalography in the observation group were significantly lower than those before treatment [mean power (μV²/Hz): 95.35±3.61 vs. 102.58±4.23 in frontal pole 1 (Fp1), 38.56±4.73 vs. 46.13±2.36 in frontal 3 (F3), 34.33±5.87 vs. 51.71±4.65 in central 3 (C3), 58.37±4.45 vs. 62.95±3.22 in F7, 45.23±2.41 vs. 54.14±2.45 in temporal 3 (T3); DTR (μV²/Hz): 75.21±11.34 vs. 84.12±11.35 in ground electrode (GND), 72.31±21.67 vs. 88.23±10.25 in reference electrode (REF), 81.34±8.57 vs. 92.41±8.56 in F4, 71.25±5.42 vs. 87.23±5.64 in parietal 3 (P3), 70.12±5.88 vs. 85.67±6.12 in P4; all P < 0.05]. However, there was no significant difference in the mean power of five channels before and after treatment in the control group. There was no significant difference in the HAMD score or NIHSS score before treatment between the two groups. The above scores at 14 days after treatment were significantly lower than before, and the decrease was more significant in the observation group (HAMD score: 4.59±1.06 vs. 10.69±0.97, NIHSS score: 6.81±0.66 vs. 8.45±0.87, both P < 0.01). There was no significant difference in the plasma 5-HT, BDNF or peripheral blood NLR before treatment between the two groups. The above parameters at 14 days after treatment were improved as compared with before, and the levels in the observation group were superior to control group [5-HT (mg/L): 150.25±17.37 vs. 123.34±16.18, BDNF (mg/L): 19.37±2.35 vs. 12.48±2.18, NLR: 4.78±0.83 vs. 5.81±1.17, all P < 0.01]. CONCLUSIONS Both ONDS determined by ultrasound and relative α variation score monitored by electroencephalography changed significantly in the patients with ischemic hypoxic encephalopathy. Neurofeedback training can effectively improve brain function in patients with ischemic hypoxic encephalopathy.
Humans ; Electroencephalography ; Prospective Studies ; Neurofeedback ; Optic Nerve/diagnostic imaging* ; Ultrasonography ; Hypoxia-Ischemia, Brain/physiopathology* ; Male ; Female ; Middle Aged

OBJECTIVES: To determine the impact of scenario-based lecture and personalized video feedback on anesthesia residents' communication skills during preoperative visits. METHODS: A total of 24 anesthesia residents were randomly divided into a video group and a control group. Residents in both groups took part in a simulated interview and received a scenario-based lecture on how to communicate with patients during preoperative visits. Afterwards, residents in the video group received personalized video feedback recorded during the simulated interview. One week later all the residents undertook another simulated interview. The communication skills of all the residents were assessed using the Consultation and Relational Empathy measure (CARE) scale by two examiners and one standardized patient (SP), both of whom were blinded to the group allocation. RESULTS: CARE scores were comparable between the two groups before training, and significantly improved after training in both groups (all P < 0.05). The video group showed significantly greater increase in CARE score after the training than the control group, especially assessed by the SP (t = 6.980, P <0.001). There were significant correlations between the examiner-assessed scores and SP-assessed scores (both P = 0.001). CONCLUSIONS Scenario-based lectures with simulated interviews provide a good method for training communication skills of anesthesia residents, and personalized video feedback can enhance their performance on showing empathy during preoperative interview.
Humans ; Internship and Residency ; Empathy ; Communication ; Anesthesiology/education* ; Male ; Female ; Adult ; Video Recording ; Feedback ; Clinical Competence

Pelvic floor biofeedback is a major non-surgical treatment for anorectal dysfunction and has been recommended in several foreign guidelines. There is no consensus on the clinical practice of pelvic floor biofeedback in China currently. There are controversies in indications, contraindications and formulation of protocols. Launched by Pelvic Floor Medicine Specialty Committee of World Federation of Chinese Medicine Societies and Anorectal Branch of Chinese Medical Doctor Association, Chinese experts on this field were convened to write the Chinese expert consensus on pelvic floor biofeedback for anorectal dysfunction based on relevant references and combined the latest evidence and experts' clinical experience. This consensus recommends that before the use of pelvic floor biofeedback therapy, the patient's condition and pelvic floor function should be fully evaluated, and the guiding role of doctors and pelvic floor therapists should be emphasized to guide the standardized use of pelvic floor biofeedback therapy.
Humans ; Pelvic Floor/physiopathology* ; Biofeedback, Psychology/methods* ; China ; Consensus ; Fecal Incontinence/therapy* ; Pelvic Floor Disorders/therapy*