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Ji-yun Shin - One of the best experts on this subject based on the ideXlab platform.
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Heart sounds analysis via Esophageal Stethoscope system in beagles
Journal of Clinical Monitoring and Computing, 2013Co-Authors: Sang Hi Park, Young Duck Shin, Eun Jung Kwon, Ji-yun ShinAbstract:Esophageal Stethoscope is less invasive and easy to handling. And it gives a lot of information. The purpose of this study is to investigate the correlation of blood pressure and heart sound as measured by Esophageal Stethoscope. Four male beagles weighing 10 to 12 kg were selected as experimental subjects. After general anesthesia, the Esophageal Stethoscope was inserted. After connecting the microphone, the heart sounds were visualized and recorded through a self-developed equipment and program. The amplitudes of S1 and S2 were monitored real-time to examine changes as the blood pressure increased and decreased. The relationship between the ratios of S1 to S2 (S1/S2) and changes in blood pressure due to ephedrine was evaluated. The same experiment was performed with different concentration of isoflurane. From S1 and S2 in the inotropics experiment, a high correlation appeared with change in blood pressure in S1. The relationship between S1/S2 and change in blood pressure showed a positive correlation in each experimental subject. In the volatile anesthetics experiment, the heart sounds decreased as MAC increased. Heart sounds were analyzed successfully with the Esophageal Stethoscope through the self-developed program and equipment. A proportional change in heart sounds was confirmed when blood pressure was changed using inotropics or volatile anesthetics. The Esophageal Stethoscope can achieve the closest proximity to the heart to hear sounds in a non-invasive manner.
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correlation of blood pressure and the ratio of s1 to s2 as measured by Esophageal Stethoscope and wireless bluetooth transmission
Pakistan Journal of Medical Sciences, 2013Co-Authors: Young Duck Shin, Sang Hi Park, Ji-yun Shin, Youngjin ChoiAbstract:UNLABELLED: Objective : Esophageal Stethoscope has the advantage of being non-invasive, easily placed and capability to monitor the heart sound. This study was designed to determine whether the ratio of S1 to S2 analyzed by Esophageal Stethoscope and wireless bluetooth transmission can be accurate indicator that express the correlation with blood pressure. METHODS: Total 33 adult male and female without cardiac disorder and with normal heart rhythm were selected randomly as the subjects of this Study. Two microphones were used with one for acquisition of heart sound by connecting it to the Esophageal Stethoscope while the other was used to measure the background noise in the operating room. After having transmitted the heart sound measured with the Esophageal Stethoscope to the receiver by using bluetooth module, it was saved in PC and outputted, following removal of noise in the operating room and the respiratory sound. S1 and S2 were measured with computation of the ratio of S1 to S2. Correlations between the systolic blood pressure with each of the S1, S2 and ratio of S1 to S2 were examined by using correlation analysis. RESULTS: The ratio of S1 to S2 displayed the highest correlation with the systolic blood pressure, with S1 and S2 also displaying positive correlation with the systolic blood pressure. CONCLUSION: As the result of analysis of the heart sound and the systolic blood pressure measured by using the Esophageal Stethoscope, the radio of S1 to S2 displayed greater correlation with the systolic blood pressure in comparison to the S1.
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a digital Esophageal Stethoscope system for monitoring anesthetized patients cardiovascular system
Biomedical Engineering Letters, 2012Co-Authors: Ji-yun Shin, Young Duck ShinAbstract:Purpose Esophageal Stethoscope is a device to measure heart sound or respiratory sound by inserting a catheter into the patients’ esophagus during operation. It is easy to use, noninvasive, and not influenced by ambient noise, but does not provide the quantitative information about cardiovascular system. Thus, in this study, we tried to develop a digital Esophageal Stethoscope system (DESS) that can be used to monitor the heart sounds of anesthetized patients during operation.
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A digital Esophageal Stethoscope system for monitoring anesthetized patients’ cardiovascular system
Biomedical Engineering Letters, 2012Co-Authors: Ji-yun Shin, Young Duck ShinAbstract:Purpose Esophageal Stethoscope is a device to measure heart sound or respiratory sound by inserting a catheter into the patients’ esophagus during operation. It is easy to use, noninvasive, and not influenced by ambient noise, but does not provide the quantitative information about cardiovascular system. Thus, in this study, we tried to develop a digital Esophageal Stethoscope system (DESS) that can be used to monitor the heart sounds of anesthetized patients during operation. Methods It consists of the wireless sensor module and the base station. The wireless sensor module acquires and amplifies heart sound data with microphone connected to Esophageal catheter and transmits the data to the base station through Bluetooth. The base station is composed of a receiver and a PC. The receiver processes and forwards the heart sound data to a PC, where MatLab based software (Cardiac Sound Analyzer) records and displays the heart sound as phonocardiogram and spectrogram in time and frequency domain in real time. Besides, it can quantify and objectify heart sound information by calculating its intervals, heart rates, and intensity values in dB. Results We performed a pilot experiment with patients under general anesthetic surgery and evaluated the performance of the developed system. Conclusions This system is so simple and useful for anesthesiologist to evaluate the included information on cardiac condition without being disturbed by ambient noise and is helpful for comparing a patient’s states before and after surgery.
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Design technology in portable digital Esophageal Stethoscope
7th International Conference on Networked Computing, 2011Co-Authors: Ji-yun ShinAbstract:Auscultation of heart sound and breathing sound in anesthesia is very important, because it can provide the information of patient's cardiorespiratory system. In operating room, anesthesiologists use Esophageal Stethoscope, which is a device to measure heart sound or respiratory sound by inserting a catheter into the esophagus close to heart. It is not only low cost and very simple to use for anesthesiologists, but provides the clinical data such as heart sound, breathing sound, core temperature. But it cannot not quantize and analyze the various data objectively. For this reason, we designed portable digital Esophageal Stethoscope system(PDES). PDES is a device that can acquire the data of heart sound and breathing sound by connecting microphone to the end of Esophageal catheter. Besides, it can transmit the wireless data to a PC using Bluetooth technology and display on its screen. It displays the magnitude of heart sound, heart sound waveform, core temperature by using Heart Sound 1.0, that is developed for this purpose.
J.y. Shin - One of the best experts on this subject based on the ideXlab platform.
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electronic Esophageal Stethoscope system and its heart sound analysis program
2013Co-Authors: J.y. ShinAbstract:Esophageal Stethoscope is a device to measure heart sound or respiratory sound during operation by inserting a catheter into the esophagus close to the heart. It is simple, low cost, affected less by noise from external environment. In this paper, we developed heart sound analysis program for Electronic Esophageal Stethoscope System (EESS) that can acquire the heart sound data and display and analyze them simultaneously. The hardware consists of a transmitter and a receiver. The former transmits the heart sound data acquired from the Esophageal catheter to the later through Bluetooth. The receiver amplifies and delivers the received data from the transmitter to the PC through 3.5 mm aux cable. Heart Sound Analyzer (HSA) that can display the heart sound waveform and analysis heart rate and amplitude(RMS) value, is developed using MatLab. In the preliminary test of simulated operating environment, heart sound was successfully recorded and displayed in HSA program. In addition, heart rate and RMS value was detected in real time. Therefore, This system can prevent the possible accidents in operating room by monitoring anesthetized patients’ cardiac condition continuously.
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Portable digital Esophageal Stethoscope system
2010 Annual International Conference of the IEEE Engineering in Medicine and Biology, 2010Co-Authors: J.y. ShinAbstract:Heart sound occurs when the heart contracts and expands. It provides information on myocardial contractility and blood vessels, which is not obtainable from ECG. For this reason, stethoscopy of heart sound in anesthesiology is a very crucial means for acquiring cardiac information and preventing intraoperative medical accidents, and it requires a system for precise objective measurement and analysis of heart sound and murmur. Thus, this study purposed to develop portable digital Esophageal Stethoscope (PDES) that can objectify and quantify heart sound and murmur. In this study, we designed PDES for precise measurement and analysis of heart sound and murmur data. Heart sound information obtained by inserting the sensor of the PDES into the patient's esophagus can be transmitted to a terminal or a PC and displayed on the screen The amplitude and waveform of heart sound are displayed using self-developed software Heart Sound 1.0. The results of experiment with the developed PDES showed that data on the amplitude and waveform of heart sound and murmur were produced stably in real-time. In addition, when heart sound was heard using a headphone, the sound was clear without external murmur. The PDES developed in this study, which complements the disadvantages of traditional Esophageal Stethoscope while preserving its advantages, could not only examine heart sound and murmur using an Esophageal catheter but also display the amplitude and waveform of heart sound and murmur and measure the patient's body temperature. Accordingly, the developed PDES is expected to be useful in the continuous stethoscopy of heart sound during operation and to contribute to research on heart sound by providing heart sound data.
Jonathan V Roth - One of the best experts on this subject based on the ideXlab platform.
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Nasal Temperature can be used as a Reliable Surrogate Measure of Core Temperature
Journal of Clinical Monitoring and Computing, 2008Co-Authors: Jonathan V Roth, Leonard E. BraitmanAbstract:Background All current methods of core temperature monitoring have limitations. There is at least one skin temperature probe that can be modified to a nasal temperature probe (NP). This study was conducted to validate this modified skin temperature probe as an accurate surrogate measure of core temperature by comparing the temperature measurements obtained from NP to those from the Esophageal Stethoscope (ES).
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Nasal Temperature can be used as a Reliable Surrogate Measure of Core Temperature
Journal of Clinical Monitoring and Computing, 2008Co-Authors: Jonathan V Roth, Leonard E. BraitmanAbstract:Background All current methods of core temperature monitoring have limitations. There is at least one skin temperature probe that can be modified to a nasal temperature probe (NP). This study was conducted to validate this modified skin temperature probe as an accurate surrogate measure of core temperature by comparing the temperature measurements obtained from NP to those from the Esophageal Stethoscope (ES). Methods In 45 adult patients undergoing general anesthesia, one pair of simultaneous temperature measurements were obtained from the ES ( E _temp) and the NP ( N _temp). Results The NP was easily inserted in all patients. No patient developed epistaxis. The magnitudes of the differences between N _temp and E _temp measurements were 0.2°C or less in 43 out of 45 patients (95.6%); 0.1°C or less in 33 patients (73.3%). On average, the E _temp was 0.05°C higher than the N _temp. The 95% prediction interval for the E _temp− N _temp difference was −0.2°C to +0.3°C. Thus we expect the magnitude of the temperature difference to be less than 1/3°C in the next future individual patient. Conclusion In adults, the NP readings closely match the core temperature readings obtained by ES and thus can be used as a reliable surrogate measure of core temperature. This technique may be useful and advantageous in various situations, particularly when other methods of core temperature monitoring are not available or reliable.
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Evaluation of transEsophageal atrial pacing in the prone and lateral positions.
Journal of Cardiothoracic and Vascular Anesthesia, 2001Co-Authors: Nanette M. Schwann, Jonathan V Roth, David P. Maguire, Stephen E Mcnulty, Anthony SaouafAbstract:Abstract Objective: To develop recommendations for positioning the second-generation pacing Esophageal Stethoscope for transEsophageal atrial pacing in patients positioned prone (P), right lateral decubitus (RLD), and left lateral decubitus (LLD). Design: Prospective; patients assigned consecutively. Setting: Tertiary and university hospitals. Participants: Thirty (10 in each position group) adult patients undergoing surgery. Interventions: The optimal depths of insertions (DOI) where pacing current threshold was minimal (THmin) were determined first when supine, then after positioning. Measurements and Main Results: TransEsophageal atrial pacing was successful in all patients supine and after positioning. The optimal DOI varied from 2 cm less deep to 4 cm deeper in positioned patients compared with supine patients. Patients positioned P required equal or up to 8 mA greater current outputs to achieve transEsophageal atrial pacing; LLD and RLD patients may require up to 8 mA greater or lesser current compared with supine patients. Conclusion: TransEsophageal atrial pacing can be used safely and effectively in patients positioned P, RLD, and LLD. Recommendations are presented for positioning the pacing Esophageal Stethoscope. Emphasis is given to using the lowest DOIs and smallest currents to reduce the chance of transEsophageal ventricular pacing. Copyright © 2001 by W.B. Saunders Company
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positioning the pacing Esophageal Stethoscope for transEsophageal atrial pacing without p wave recording implications for transEsophageal ventricular pacing
Anesthesia & Analgesia, 1996Co-Authors: Jonathan V Roth, J D Brody, E J DenhamAbstract:: This study determined guidelines for positioning a new pacing Esophageal Stethoscope (PES) used for transEsophageal atrial pacing (TEAP) without having to record Esophageal P waves. In 44 patients with heights ranging from 142 cm (4'8") to 193 cm (6'4"), the PES was inserted to a depth of insertion (DOI) of 43 cm. As the PES was withdrawn, TEAP thresholds were determined at every DOI in 1-cm intervals between 43 and 25 cm DOI inclusive. TEAP was accomplished in all 44 patients. The minimum TEAP threshold (mean +/- SD 10.8 +/- 4.0 mA) was < or = 17 mA in 43 of 44 patients (98%). Except for one patient, TEAP could be accomplished over a 9- to 19-cm (mean +/- SD, 13.7 +/- 2.8 cm) wide range of DOI. Unintentional transEsophageal ventricular pacing (TEVP) occurred in 15 of 44 (34%) of patients. TEVP occurred over a 1- to 7-cm (mean +/- SD, 3.7 +/- 1.7 cm) wide range of DOI; the minimum TEVP threshold averaged 30.4 +/- 6.4 mA. TEAP was consistently accomplished at DOIs more proximal than where TEVP could occur and with lower currents than that required for TEVP. An insertion depth, in centimeters, equal to half of the patient's height, in inches, produced successful TEAP in all 44 patients; the minimum TEAP threshold occurred on average at a DOI 2.6 cm more proximal. Asynchronous TEVP can be avoided by using lower currents at shallow DOIs.
Young Duck Shin - One of the best experts on this subject based on the ideXlab platform.
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the correlation between the first heart sound and cardiac output as measured by using digital Esophageal Stethoscope under anaesthesia
Pakistan Journal of Medical Sciences, 2014Co-Authors: Young Duck Shin, Sang Hi Park, Yongwook Jeon, Youngjin ChoiAbstract:OBJECTIVE: The use of an Esophageal Stethoscope is a basic heart sounds monitoring procedure performed in patients under general anesthesia. As the size of the first heart sound can express the left ventricle function, its correlation with cardiac output should be investigated. The aim of this study was to investigate the effects of cardiac output (CO) on the first heart sound (S1) amplitude. Methods : Six male beagles were chosen. The S1 was obtained with the newly developed Esophageal Stethoscope system. CO was measured using NICOM, a non-invasive CO measuring device. Ephedrine and beta blockers were administered to the subjects to compare changes in figures, and the change from using an inhalation anesthetic was also compared. RESULTS: The S1 amplitude displayed positive correlation with the change rate of CO (r = 0.935, p < 0.001). The heart rate measured using the Esophageal Stethoscope and ECG showed considerably close figures through the Bland-Altman plot and showed a high positive correlation (r = 0.988, p < 0,001). CONCLUSION: In beagles, the amplitude of S1 had a significant correlation with changes in CO in a variety of situations.
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Heart sounds analysis via Esophageal Stethoscope system in beagles
Journal of Clinical Monitoring and Computing, 2013Co-Authors: Sang Hi Park, Young Duck Shin, Eun Jung Kwon, Ji-yun ShinAbstract:Esophageal Stethoscope is less invasive and easy to handling. And it gives a lot of information. The purpose of this study is to investigate the correlation of blood pressure and heart sound as measured by Esophageal Stethoscope. Four male beagles weighing 10 to 12 kg were selected as experimental subjects. After general anesthesia, the Esophageal Stethoscope was inserted. After connecting the microphone, the heart sounds were visualized and recorded through a self-developed equipment and program. The amplitudes of S1 and S2 were monitored real-time to examine changes as the blood pressure increased and decreased. The relationship between the ratios of S1 to S2 (S1/S2) and changes in blood pressure due to ephedrine was evaluated. The same experiment was performed with different concentration of isoflurane. From S1 and S2 in the inotropics experiment, a high correlation appeared with change in blood pressure in S1. The relationship between S1/S2 and change in blood pressure showed a positive correlation in each experimental subject. In the volatile anesthetics experiment, the heart sounds decreased as MAC increased. Heart sounds were analyzed successfully with the Esophageal Stethoscope through the self-developed program and equipment. A proportional change in heart sounds was confirmed when blood pressure was changed using inotropics or volatile anesthetics. The Esophageal Stethoscope can achieve the closest proximity to the heart to hear sounds in a non-invasive manner.
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an improved electronic Esophageal Stethoscope using sound and pressure sensors
The Transactions of the Korean Institute of Electrical Engineers, 2013Co-Authors: Young Duck Shin, Yongwook JeonAbstract:Esophageal Stethoscope is used for monitoring the heart sounds and breath sounds of patients during surgery under a general anesthesia. Recently, an electronic Esophageal Stethoscope (EES)(1) has been developed for the purpose of real-time monitoring these information visually. This system uses only a microphone as the sound sensor. A drawback of the EES system is that it may be difficult to distinguish the first sound ( ) and the second sound ( ) of heart, because their periods are irregular depending on patients. In this paper, we propose an improved EES system in which the infrasound is measured by adding a pressure sensor as well as a sound sensor. We investigate some correlations between the infrasound and characteristics of the heart sound. The proposed system has been tested on 15 patients. The results show that the new system is capable of detecting the first sound more reliably and easily determining the heart rate and breathing period.
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correlation of blood pressure and the ratio of s1 to s2 as measured by Esophageal Stethoscope and wireless bluetooth transmission
Pakistan Journal of Medical Sciences, 2013Co-Authors: Young Duck Shin, Sang Hi Park, Ji-yun Shin, Youngjin ChoiAbstract:UNLABELLED: Objective : Esophageal Stethoscope has the advantage of being non-invasive, easily placed and capability to monitor the heart sound. This study was designed to determine whether the ratio of S1 to S2 analyzed by Esophageal Stethoscope and wireless bluetooth transmission can be accurate indicator that express the correlation with blood pressure. METHODS: Total 33 adult male and female without cardiac disorder and with normal heart rhythm were selected randomly as the subjects of this Study. Two microphones were used with one for acquisition of heart sound by connecting it to the Esophageal Stethoscope while the other was used to measure the background noise in the operating room. After having transmitted the heart sound measured with the Esophageal Stethoscope to the receiver by using bluetooth module, it was saved in PC and outputted, following removal of noise in the operating room and the respiratory sound. S1 and S2 were measured with computation of the ratio of S1 to S2. Correlations between the systolic blood pressure with each of the S1, S2 and ratio of S1 to S2 were examined by using correlation analysis. RESULTS: The ratio of S1 to S2 displayed the highest correlation with the systolic blood pressure, with S1 and S2 also displaying positive correlation with the systolic blood pressure. CONCLUSION: As the result of analysis of the heart sound and the systolic blood pressure measured by using the Esophageal Stethoscope, the radio of S1 to S2 displayed greater correlation with the systolic blood pressure in comparison to the S1.
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a digital Esophageal Stethoscope system for monitoring anesthetized patients cardiovascular system
Biomedical Engineering Letters, 2012Co-Authors: Ji-yun Shin, Young Duck ShinAbstract:Purpose Esophageal Stethoscope is a device to measure heart sound or respiratory sound by inserting a catheter into the patients’ esophagus during operation. It is easy to use, noninvasive, and not influenced by ambient noise, but does not provide the quantitative information about cardiovascular system. Thus, in this study, we tried to develop a digital Esophageal Stethoscope system (DESS) that can be used to monitor the heart sounds of anesthetized patients during operation.
J J Entress - One of the best experts on this subject based on the ideXlab platform.
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atrial pacing thresholds measured in anesthetized patients with the use of an Esophageal Stethoscope modified for pacing
Anesthesiology, 1991Co-Authors: Christine Z Pattison, John L Atlee, Edwin L Mathews, N Buljubasic, J J EntressAbstract:TransEsophageal atrial pacing (TAP) with the use of standard, thermistor-equipped, Esophageal Stethoscopes, modified for pacing by incorporation of a 4-French, bipolar TAP probe (pacing Esophageal Stethoscope [PES]), was evaluated in 100 adult patients under general anesthesia. A commercially available TAP pulse generator supplied 10-ms pulses with current variable between 0 and 40 mA. Pacing distances (in centimeters) were measured from the infraal-veolar ridge to midway between PES electrodes (1.5-cm interelectrode distance). Pacing thresholds (milliamperes) were measured at the point of a maximum-amplitude P-wave (PMAX) in the bipolar Esophageal electrogram and points 1 cm proximal or 1, 2, or 3 cm distal to PMAX TAP (70–100 beats per min) was used for sinus bradycardia ≤ 60 beats per min (36 patients) or atrioventricular (AV) junctional rhythm (2 patients) and blood pressure changes with TAP documented. In male patients (n = 49), PMAX was 32.7 ± 0.3 cm (mean ± SE) and minimum pacing threshold 5.1 ± 0.4 mA (range, 1–13 mA) at 33.6 ± 0.3 cm (range, 30–37 cm). In female patients (n = 51), PMAX was 30.4 ± 0.4 cm and minimum pacing threshold 4.4 ± 0.4 mA (range, 2–14 mA) at 31.1 ± 0.4 cm (range, 26–40 cm). TAP produced an average 13–16 mmHg increase in systolic, diastolic, or mean-arterial pressure in patients with sinus bradycardia or AV junctional rhythm. There were no subjective patient complaints (epigastric discomfort, dysphagia) that could be attributed to TAP; objective evaluation (esophagoscopy) was not performed. It is concluded that TAP is widely applicable to anesthetized adults; low TAP thresholds can be obtained by first determining PMAX and positioning the PES electrode 1 cm or less distal to PMAX; and TAP can be used to increase blood pressure in patients with sinus bradycardia or AV junctional rhythm.