One night, Thomas and Marc take Laurent to a brothel, where Laurent loses his virginity to a prostitute, Freda, before they are disrupted by his drunken brothers. Upset, Laurent leaves on a scouting trip, where he catches scarlet fever and is left with a heart murmur. Laurent is bedridden and cared for and entertained by Clara and their maid Augusta. Laurent's teacher at his Catholic school suggests that Laurent's illness has matured him, so that he has made progress in his studies, and urges Clara to treat him more like an adult.
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After constant progress and enhancement regarding medical auscultation, 3M Littmann in the USA made a prominent breakthrough in 2000, namely the first attempt to develop an electronic stethoscope for auscultation. Alongside the ongoing scientific development and improvement, the stethoscope is becoming intelligent, electronic, and mobile. In addition, Bifulco et al. proposed a PVDF sensor that allows simultaneous recording of respiration, Seismocardiogram (SCG), and heart sounds in 2014 [6]. Liu et al. described an epidermal mechano-acoustic sensor based on soft electronics in 2016 [7]. Jain et al. focused on extracting heart sounds from SCG signals, thus demonstrating the possibility of using accelerometers as heart-sound sensors in 2016 [8].Anumukonda, M. et al. put forward a high-density microphone-based heart-sound sensor in 2016 [9]. Afattah et al. invented a cardiac acoustic sensor utilizing a piezoelectric PVDF thin film in 2017 [10]. Moreover, Choudhary et al. devised a method for extracting basic heart sounds (HSs) from SCG signals to achieve a good location of HS waves S1 and S2 in one SCG cycle without the use of a reference ECG cycle in 2018 [11]. Martinek et al. fabricated an advanced interferometric heart-sound sensor in 2018 with the application of optical fiber [12]. Lee et al. proposed a novel skin-compliant device based on triaxial accelerometers with 800 Hz bandwidth, which proved capable of recording various physiological activities, such as respiration, cardiac activity (including heart sounds), swallowing, and vocal-fold vibrations in 2019 [13]. Ha et al. presented an E-tattoo sensor capable of recording ECG, SCG, and heart sounds in 2019 [14]. Gupta et al. developed a monolithic integrated sensor that featured a triaxial accelerometer for monitoring body motion, respiration, and SCG, and a piezoelectric sensor for simultaneous recording of heart and lung sounds in 2020 [15]. A piezoelectric lead zirconate titanate sensor designed by Andreozzi et al. was proposed for use in cardiographic techniques in 2021. It allows simultaneous recording of breathing, infrasound heart vibrations, and heart sounds from a single location in the chest [16]. Centracchio et al. developed a new technique for measuring the local force on the chest wall generated by the mechanical activity of the heart through cardiography in 2022 [17]. Andreozzi et al. recorded heart-induced vibrations in the chest wall through cardiography using a special force sensor, which was shown to be able to simultaneously monitor breathing, heart sounds, and infrasonic heart vibrations from a single point of contact on the chest in 2022 [18]. However, the common piezoelectric thin-film electronic stethoscope cannot obtain much information about the cardiac sound signal because of their poor low-frequency response and the primary distribution of the main components of the cardiac sound signal in the low-frequency range, which makes the investigation of the recognition and feature extraction of heart acoustic signals extremely challenging.
The MEMS cardiac sound sensor acoustic encapsulate matching diagram is shown in Figure 6. The acoustic propagation theory in the 3-layer media holds that there is an enlargement of the reflection coefficient when the sound is input on the boundary between two differing media. Acoustic energy transmission, on the other hand, shows reduction as the impedance difference becomes greater. The reflection between the stethoscope and the skin intensifies as the two are in contact, leading to less sound energy transmission, as well as stronger attenuation [26]. Therefore, in order to maximally perceive and acquire the cardiac sound signal, the cardiac sound transmitted through the human tissue can be transmitted to the MEMS-based sensor for heart sounds without significant attenuation. Additionally, the concave structure of the cilium is parallel to the waterproof and sound-transmitting film (the main material is e-PTFE) to ensure the maximum cilium area for acoustic signal acquisition. Moreover, the medical silicone oil (20 cst) packaging material is selected to match the soft-tissue acoustic impedance traits in humans, so as to match the acoustic impedance of the sensor in the test environment. The velocities of sound and the characteristic acoustic impedances for various media can be found in Table 3.
Probe packaging architecture is designed for the MEMS-based heart sound sensor, with an emphasis on its pickup traits and the method of acoustic matching packaging. Additionally, the sensor probe is mainly composed of a stethoscope shell, waterproof and sound-permeable film, inner support of the film, fixed ear, oil injection hole, and air guide hole. On the premise of sealing the waterproof sound-permeable film, the film internal support structure was added and the film internal support was placed for auscultation, as illustrated in Figure 7a,b. In addition, the inner support of the film can also enhance the stiffness of the sound permeable film, so as to improve the natural frequency of the acoustically permeable film and evade its impact on the cardiac sound auscultation process. The medical silicone oil (20 cst) matches with the acoustic impedance of the sensor, aiming to lower the sound loss during the process of cardiac sound auscultation, improve the auscultation effect, and reduce the loss of cardiac sound distortion and weak cardiac murmur.
Cardiovascular: flushing, hypertension, cardiac murmur, myocardial infarction, angina pectoris, hypotension, syncope, arrhythmic/conduction disorder, cardiorespiratory arrest, heart failure, hypertensive crisis
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