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Biomedical subjects

J M Walsh

Publications and source records attributed to J M Walsh.

At least 37 records · Page 2Linked to original sources

Muscle fatigue and muscle length interaction: effect on the EMG frequency components.

Muscle fatigue can be identified by a decrease in the frequency components of the EMG signal, typically represented by a fall in the center frequency (fc). In addition, changes in muscle length have been demonstrated to independently alter the EMG fc. What remains unknown is the interaction between muscle fatigue and muscle length changes on the EMG fc. To address this question, a human biceps model of muscle fatigue, consisting of repetitive non-isometric contractions until task failure was studied. EMG signals from the biceps brachii were acquired via surface electrodes, and muscle length was determined by recording elbow angle. Five subjects developed biceps fatigue by repeating contractions of 50% maximal force until task failure. Fatigue produced a decrease in EMG fc at all muscle lengths. For the first three quarters of fatigue development there was a similar degree of reduction in EMG fc at all muscle lengths. But as task failure approached, there was a greater reduction in EMG fc at the shortest muscle length relative to the longest muscle length (41% reduction from baseline versus 30% reduction from baseline, respectively). The effect of muscle length independent of fatigue was such that a 20% increase in length would result in approximately an 18% fall in EMG fc. In conclusion, during fatigue development muscle length significantly influences the EMG fc, and it may be an important factor to consider when utilizing the EMG fc to detect muscle fatigue.

Adult↗

Comparison of diaphragmatic EMG power spectra: spontaneous contractions vs. evoked compound action potentials.

The electromyogram (EMG) power spectrum from spontaneous diaphragm contractions has been used to identify the development of fatigue. However, power spectral analysis of the spontaneous diaphragmatic EMG signal is limited and subject to error. In contrast, power spectral analysis of the compound diaphragm action potential (CDAP) may be superior. The aim of the present study was to determine whether the EMG power spectra of evoked CDAPs correlate with those of spontaneous diaphragm contractions. Four anesthetized mechanically ventilated dogs with spontaneous isometric diaphragm contractions were studied using a mechanically isolated in situ diaphragm preparation. CDAPs were elicited via phrenic nerve stimulation, and intramuscular wire electrodes recorded EMG. Diaphragm temperature was changed from 40 to 30 degrees C to elicit changes in the EMG power spectra. The EMG signal from 10 spontaneous contractions and 10 CDAPs were acquired at 1 degrees C intervals. Fast Fourier transform was applied to both spontaneous and CDAP data yielding the power spectra, which were represented by their center frequencies (fc). The CDAP fc correlated well with the EMG fc obtained from spontaneous contractions (r = 0.99). We conclude that evoked CDAPs may provide an accurate alternative to spontaneous contractions for EMG power spectral analysis of the diaphragm.

Animals↗

Magnesium sulfate potentiates several cardiovascular and metabolic actions of terbutaline.

beta-Adrenergic agonists are useful for the emergency treatment of asthma. Recently, magnesium sulfate (MgSO4) has also been shown to be efficacious in this situation. beta-Agonists have unwanted cardiovascular and metabolic actions: increased systolic blood pressure, corrected QT interval (QTc), serum glucose and insulin, and decreased RR interval, diastolic blood pressure, serum potassium, phosphate, and calcium. As beta-agonists and MgSO4 quite possibly will be used in combination, we sought to determine how MgSO4 would affect these actions. Healthy young male adults were administered two doses of terbutaline sulfate, 0.25 mg subcutaneously, 30 min apart on two separate occasions, in a randomized, double-blind fashion. On one occasion, 4 g of MgSO4 was administered intravenously over the same 30-min period. On the other, normal saline solution was given as a placebo. Cardiovascular and metabolic variables were measured sequentially for 2 h. Data at 60 min with p values given for a summation of all time points are as follows: MgSO4 increased terbutaline's effects on the RR interval by 0.09 s, p < 0.0001; QTc interval by 0.01 s, p < 0.0007; diastolic blood pressure by 8 mm Hg, p = 0.0001; serum calcium by 0.13 mg/dl, p = 0.01; and glucose by 9 mg/dl, p < 0.0001. MgSO4 also mitigated the systolic blood pressure elevating the effect of terbutaline by 5 mm Hg (p = 0.007). The magnitude of the response potentiations was modest. We conclude that combining terbutaline and MgSO4 is unlikely to result in serious short-term adverse events, if used acutely in patients with relatively normal cardiac and metabolic function. MgSO4 may act by potentiating the effect of beta-agonists on magnesium requiring enzymes such as adenyl cyclase.

Adult↗

Muscle temperature alters the EMG power spectrum of the canine diaphragm.

Electromyogram (EMG) power spectral analysis has been widely used to detect muscle fatigue. Non-fatigue factors that influence the EMG power spectrum must be well understood to ensure accurate interpretation. We explored the effect of muscle temperature on the EMG power spectrum in an isolated canine diaphragm preparation with intact neuro-vascular supply. In 5 animals, diaphragm temperature was continuously recorded with an intramuscular thermocouple, and the EMG signal was recorded with intramuscular wire electrodes. Data were obtained from spontaneous isometric diaphragm contractions while the diaphragm underwent passive cooling from 40 to 30 degrees C. The EMG power spectrum was determined using fast Fourier transform and each spectrum was characterized by its center frequency (fc). A direct linear relationship was found between diaphragm temperature and the EMG fc. The mean slope of the temperature-EMG fc relationship was 2.9% fc.degree C-1. In conclusion, diaphragm temperature is a major determinant of the diaphragmatic EMG power spectrum, and should be controlled when this index is employed in the investigation of muscle fatigue.

Action Potentials↗

The prevalence of drugs and alcohol in fatally injured truck drivers.

To assess the impact of alcohol and other drug use in the trucking industry, the National Transportation Safety Board, in collaboration with The National Institute on Drug Abuse investigated fatal-to-the-driver trucking accidents in eight states over a one year period. Comprehensive drug screens were performed on blood specimens collected from 168 fatally injured drivers. One or more drugs were detected in 67% of the drivers and 33% of the drivers had detectable blood concentrations of psychoactive drugs or alcohol. The most prevalent drugs were cannabinoids and ethanol, each found in 13% of the drivers. Cocaine or benzoylecgonine was found in 8% of the cases. Seven percent of the driver's blood specimens contained amphetamine or methamphetamine and 7% contained phenylpropanolamine, ephedrine, or pseudoephedrine. A panel of toxicologists reviewed the accident investigation report and the toxicology findings for each case and determined that impairment due to marijuana use was a factor in all cases where the delta-9-tetrahydrocannabinol concentration exceeded 1.0 ng/mL and that alcohol impairment contributed to all accidents where the blood alcohol concentration was 0.04% wt/vol or greater. In 50 of 56 cases where psychoactive drugs or alcohol were found, impairment due to substance use contributed to the fatal accident.

Accidents, Traffic↗

Predictors of screening for hypercholesterolemia in a general internal medicine practice.

We compared current practice with the National Cholesterol Education Program (NCEP) guidelines for the detection and evaluation of hypercholesterolemia and analyzed the association of various patient and provider factors with screening. Using a retrospective medical records review of 1,000 randomly selected patients between the ages of 18 and 70 in a university-based general internal medicine practice--faculty, residents (categorical and primary care), and nurse practitioners--we found that 80% of patients were screened for hypercholesterolemia. Patients older than 35 were more likely to be screened than younger patients (87% versus 77%; P = .001), and, among younger patients, nonwhites were less likely to be screened than whites (58% versus 77%; P = .0001). Lipoprotein analysis was done in 60% of the 235 patients in whom it was indicated; older patients were significantly more likely to have these measurements. Among patients taking medications for hypercholesterolemia, 92% had lipoprotein analyses done beforehand. No differences were detected in screening by provider characteristics. We conclude that providers in our practice are appropriately aggressive in screening high-risk patients for hypercholesterolemia. The finding that young whites are screened much more often than nonwhites was surprising. Finally, although there is a high rate of screening overall, many patients with elevated cholesterol levels are not appropriately classified as to their low-density-lipoprotein levels.

Adolescent↗

Death certification and coding for ischaemic heart disease in Tasmania.

Official records show that the rates of mortality from ischaemic heart disease (IHD) in Tasmania have been the highest of all the Australian states for most of the past decade. This study assesses the accuracy of the official Tasmanian mortality data for IHD in 1987 and 1988 for males aged 25 to 74 years using routinely available clinical and pathological data supplemented by information from the attending doctor. Our findings show that a death officially coded to ICD 9 rubrics 410-414 (IHD) in Tasmania has 94% sensitivity and a positive predictive value of 90% for fatal definite acute myocardial infarction or possible coronary death as defined by the WHO. Comparison of our results with those of two earlier studies undertaken in Australian mainland centres indicates that differences in the official statistics for coronary mortality between Tasmania and the mainland states reflect true differences in the risk of coronary death. While the results from three Australian studies suggest that the routine system of death certification is reasonably accurate, careful monitoring of death certification and coding practices need to be undertaken regularly in all states of Australia if secular changes in regional patterns of coronary mortality are to be regarded as credible.

Adult↗

Structural change of the thorax in chronic obstructive pulmonary disease.

This study examines structural changes of the thorax in hyperinflated subjects with chronic obstructive pulmonary disease (COPD). Age-matched normal subjects were used for comparison. Thoracic dimensions were determined using anteroposterior and lateral chest radiographs performed at total lung capacity, functional residual capacity, and residual volume. Rib cage dimensions (lateral diameter, rib angle, anteroposterior diameter) and diaphragm position were determined at each lung volume. There were no significant differences in rib cage dimension between the COPD and normal subjects for all lung volumes. In contrast, the diaphragm was significantly lower in the COPD subjects. The change of rib cage dimensions in the COPD subjects (for a similar volume change) was not different from that in normal subjects, whereas the change of diaphragm position in the COPD subjects (for a similar volume change) was reduced. In conclusion, the primary structural change of the thorax in COPD with chronic hyperinflation is confined to the diaphragm, with no appreciable structural change in the rib cage.

Aged↗

A systems model of clinical preventive care: an analysis of factors influencing patient and physician.

An ideal model for clinical preventive care must consider the physician, the patient and the many factors which influence each of them. In this paper, we review existing models, examining their strengths and weaknesses. We then propose a new model, the Systems Model of Clinical Preventive Care. This model is unique in its focus on the patient-physician interaction and details the factors impinging on each that promote or inhibit the completion of preventive care activities. These factors include patient and physician predisposing factors, such as health beliefs and attitudes; enabling factors, such as skills and resources; and reinforcing factors, such as social support. Additional factors include health care system organizational factors, such as access or availability; characteristics of the preventive activity, such as cost; and cues to action, such as symptoms or reminders. The proposed model contains components of behavioral, communication, health education and psychosocial theories. We then apply our model to mammography as an example of a screening activity. Finally, we describe the strengths and weaknesses of the proposed model, and identify areas for future research.

Delivery of Health Care↗

Cancer screening in older adults.

Adults aged 65 and older represent an increasingly important segment of the US population. Cancer is an important cause of death in this group. Screening for cancer can significantly reduce cancer incidence and mortality. In this review I address screening for breast, cervical, prostate, lung, colorectal, and ovarian cancer in older Americans. Decisions about screening for cancer must consider the effects of screening, diagnostic evaluations, and treatments on the quality of life of each person.

Aged↗

Production of recombinant human erythropoietin in Bowes melanoma cells in suspension culture.

Recombinant DNA technology was used to insert a fetal liver genomic library ApaI fragment encoding for human erythropoietin (Epo) into Bowes melanoma cells. The cells expressed the erythropoietin gene, and Epo was secreted into the culture medium together with the normally-secreted tissue plasminogen activator. Attempts to grow the cells in glass spinners in Dulbecco's medium supplemented with fetal bovine serum produced cell aggregates growing in suspension. When calcium-free suspension culture media (Joklik, DME-S, McCoy 5A-S) were used, single cell suspension cultures were obtained and high Epo production observed. When attempts were made to scale up the small glass spinners, poor growth or Epo production occurred unless the vessels were aerated. This was shown to be because of the drop in pH, possibly due to CO2 accumulation, rather than due to oxygen depletion. It was shown that a semi-continuous operation could be achieved in aerated 8-1 spinners fitted with either a conventional stirrer or a vibromixer agitator. The system was scaled up to a 100-1 stainless steel vessel fitted with a vibromixer agitator. This system was operated for over 4 months with weekly harvests producing over 100 million units of Epo in about 1000-1 of culture fluid. Interference by the serum proteins with downstream purification of the hormone from the culture fluid made the use of serum-free media highly desirable. Studies showed that the Epo was produced in serum-free systems containing peptones.

DNA, Recombinant↗

Unsuspected hemodynamic alterations during endotracheal suctioning.

Endotracheal suctioning of intubated patients is associated with hemodynamic complications including arterial hypoxemia, cardiac arrhythmias, hypotension and even death. Prior investigations of this subject focus primarily on arterial hypoxemia. Our observations of ETS revealed significant falls in the mixed SvO2 and we postulated that alterations in VO2 or CO must be occurring. This study was then designed to determine the alterations in CO, VO2, SaO2 and the resulting effect on SvO2 during ETS. Ten critically ill intubated patients with pulmonary artery catheters in place, were studied during routine ETS by the nursing staff. We found that ETS produced a significant decrease in SvO2 which was predominantly due to an increased VO2 accompanied by an inadequate rise or even fall in CO. Alterations in SaO2 appeared to be modest and were insensitive indicators of alterations in SvO2.

Adult↗

NIH drug tests.

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Employment↗