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An empirical note on tonic neck reflexes: control of the upper limb's proprioceptive sensation.

The effect of asymmetrical tonic reflexes on the upper limb in man was studied by analyzing errors in reproducing a targeted movement in right elbow extension following head rotation and vibration of the neck muscles. Overshoot of reproduction was observed only when the head was rotated to the left in contrast to no rotation or with rotation to the right. However, there was no influence on errors of reproduction after vibration of the neck muscles. These observations suggest that the proprioception in the rotated head controls the kinesthetic input by peripheral sensory receptors, namely, vestibular input plays a greater role in the accurate positioning of the upper limb, especially in inhibiting sensory input from the opposite side of the rotated head.

Adult↗

[Paroxysmal ventricular tachycardia with retrograde Wenckebach block and reciprocal beats (author's transl)].

A case of recurrent paroxysmal ventricular tachycardia with retrograde Wenckebach block and reciprocal beats was studied with His bundle electrogram and right ventricular stimulation. Reentry was reproduced whenever retrograde ventriculo-atrial conduction time reached a critical value. Concealed reentry was also demonstrated and shown to be responsible for the dropped beats of the Wenckebach sequence.

Bundle of His↗

Evaluation of radionuclide angiography in diagnosis of arrhythmogenic right ventricular cardiomyopathy.

OBJECTIVES: The accuracy of Fourier analysis of radionuclide angiography for the diagnosis of arrhythmogenic right ventricular cardiomyopathy was assessed versus X-ray right ventricular angiography. BACKGROUND: In patients with recurrent right ventricular tachycardia, the diagnosis of arrhythmogenic right ventricular cardiomyopathy is based on the presence of right ventricular wall motion abnormalities on conventional X-ray angiography without evidence of other heart disease. METHODS: X-ray and radionuclide angiography were prospectively compared in 73 patients with ventricular tachycardia. We analyzed the presence of a right ventricular enlargement, global hypokinesia and segmental wall motion abnormalities, using visual analysis for both techniques and Fourier analysis for radionuclide angiography. Disease was noted as absent or present and as diffuse or localized. The interobserver reproducibility of both techniques for the diagnosis of right ventricular wall motion abnormalities was tested in 27 randomly selected patients. RESULTS: According to X-ray angiography, 53 patients were considered to have arrhythmogenic right ventricular cardiomyopathy (22 diffuse, 31 localized forms) and 20 patients a normal right ventricle. The sensitivity of radionuclide angiography was 94.3%, specificity 90% and positive and negative predictive values 96% and 85.7%, respectively. Agreement for the location of the wall motion abnormalities was 60% for the apex, 76% for the outflow tract, 82% for the inferior wall and 74% for the free wall. The diagnostic interobserver reproducibility of X-ray and radionuclide angiography was 74% and 96.2%, respectively. CONCLUSIONS: In a selected cohort, Fourier analysis of radionuclide angiography is an accurate and reproducible tool for the diagnosis of arrhythmogenic right ventricular cardiomyopathy.

Adult↗

Measurement of macular pigment: Raman spectroscopy versus heterochromatic flicker photometry.

PURPOSE: There are several techniques for measuring macular pigment (MP) in vivo, of which Raman spectroscopy (RS) is a recently developed objective METHOD: This study reports the reproducibility, test-retest variability, and validity of RS MP readings, by comparing them with heterochromatic flicker photometry (HFP). METHODS: MP was measured with HFP and RS in 120 healthy subjects, and the latter technique was also used on two separate occasions in a sample of 20 subjects to investigate the intersessional variability of readings. Intrasessional reproducibility of RS MP measurements was also calculated. In addition, serum concentrations of lutein (L) and zeaxanthin (Z) were measured and correlated with both RS and HFP MP readings. RESULTS: Mean (+/-SD) MP in the right eye was 0.279 +/- 0.145 and 0.319 +/- 0.155 with RS and HFP, respectively. The differences between corresponding MP readings taken on RS and HFP lay within the Bland-Altman 95% limits of agreement for the two instruments in 93.6% and 94.4% of cases in the right and left eyes, respectively. Intrasessional reproducibility of RS readings, expressed as the coefficient of variation, was 8.42% +/- 7.12%. Ninety-five percent of MP readings taken with RS on two separate occasions lay within the 95% limits of agreement for the two sessions. A positive, but insignificant, relationship was observed between RS and HFP MP readings and serum concentrations of L and Z (RS, P = 0.356; HFP, P = 0.540). CONCLUSIONS: RS, an objective method of measuring MP levels in vivo, exhibits acceptable reproducibility and test-retest variability. The results demonstrated good correlation between RS and HFP measurements of MP, thus authenticating RS against a validated psychophysical technique of measuring MP. However, investigators should use only one of these instruments for the duration of any given study because of differences in the scientific rationale, and the factors that influence RS and HFP measurements of MP.

Adult↗

Bedside evaluation of right ventricular performance using a rapid computerized thermodilution method.

In 34 patients, we assessed the reproducibility and accuracy of a new, computerized, thermodilution method that determines right ventricular ejection fraction (RVEF). We compared the results from this new algorithm with simultaneous results from the conventional plateau thermodilution method and from both first-pass and gated nuclear techniques. Using this new method improved the reproducibility of thermal determinations of RVEF. Although the thermal values were lower, the correlations between thermal and nuclear measurements were close [r = .92 (first-pass technique), r = .81 (gated technique)]. This new method seems particularly appropriate for serial monitoring of RV performance.

Adult↗

[Non-invasive assessment of coronary flow reserve with transthoracic echocardiography: physiopathology, methodology and clinical value].

The assessment of coronary flow reserve with transthoracic Doppler echocardiography, measured as the ratio between hyperemic and baseline coronary flow velocities, is a new tool for the evaluation of coronary artery disease and coronary microcirculation. Color-guided pulsed Doppler allows almost optimal identification of flow velocities at the middle and distal left anterior descending artery and good visualization of the right coronary artery. The development of ultrasound technology (second harmonic, contrast agents, dedicated softwares) is responsible for great feasibility (until 98% for the left anterior descending artery and 40-50% for the right coronary artery) and very good reproducibility of this tool. Doppler-derived coronary flow reserve has excellent concordance with that obtainable with intravascular Doppler flow wire. Diagnosis of stenosis and restenosis after stent implantation in the middle and/or proximal left anterior descending artery and of stenosis of the right coronary artery is very accurate. In the absence of stenosis of epicardial coronary arteries, the reduction in coronary flow reserve implies a damage of coronary microcirculation, which can be a determinant of angina pectoris and signs of myocardial ischemia in arterial hypertension, diabetes mellitus and coronary X syndrome. Further progress may be expected by using myocardial contrast agents for quantitation of regional myocardial coronary flow reserve.

Blood Flow Velocity↗

Clinical use of ultrashort-lived radionuclide krypton-81m for noninvasive analysis of right ventricular performance in normal subjects and patients with right ventricular dysfunction.

The ultrashort-lived radionuclide krypton-81m, eluted in 5% dextrose from a bedside rubidium-81m generator, was intravenously infused for rapid imaging of the right-sided heart chambers in the right anterior oblique projection adjusted for optimal right atrioventricular separation. Left-sided heart and lung background was minimized by rapid decay and efficient exhalation of krypton-81m, requiring no algorithm for background correction. A double region of interest method decreased the variability in the assessment of ejection fraction to 5%. In 10 normal subjects, 11 patients with pulmonary hypertension, 4 patients with right ventricular outflow tract obstruction and 4 patients with right ventricular infarction, right ventricular ejection fraction determined by krypton-81m equilibrium blood pool imaging ranged from 14 to 76%. The correlation between these values and those determined by cineangiography according to Simpson's rule was close: r = 0.93 for all data points (p less than 0.001), r = 0.92 for studies at rest (p less than 0.001) and r = 0.93 for exercise studies (p less than 0.001). Exercise-related changes in right ventricular function revealed a disturbed functional reserve with pulmonary hypertension and right ventricular infarction, whereas in compensated right ventricular outflow tract obstruction there was a physiologic increase in ejection fraction with exercise (p less than 0.001). Thus, equilibrium-gated right ventricular imaging using ultrashort-lived krypton-81m is a simple, accurate and reproducible method with potential for serial assessment of right ventricular ejection fraction in a variety of right ventricular anatomic and functional abnormalities, both at rest and during exercise. Advantages of this method include an extremely low radiation dose to patients and clear right atrioventricular separation without the need to correct for background activity.

Adult↗

A simplified technique for measuring right ventricular ejection fraction using the equilibrium radionuclide angiocardiogram and the slant-hole collimator.

The authors developed and tested a simplified technique for measuring the right ventricular ejection fraction (RVEF). Following in vivo 99mTc red cell labeling, equilibrium (ECG-gated) radionuclide angiocardiography was performed in the modified left-anterior-oblique projection using a 30 degree slant-hold collimator. A single region-of-interest was defined from the ejection fraction image, and background was corrected. In 11 normal patients, the mean RVEF was 0.59 +/- 0.08 (SD). In 20 patients with suspected disease, who had RVEF measured by both equilibrium and first-pass techniques, the correlation between the two methods was excellent (r = 0.95; RVEF [first-pass] = 0.74 RVEF [equilibrium] + 0.03; Sy,x = 0.05). Interobserver correlation was also excellent (r = 0.98; Sy,x = 0.03), as was the correlation between RVEFs measured at least 60 minutes apart (r = 0.98; Sy,x = 0.03). This method was more accurate than alternative techniques, using either a background region-of-interest adjacent to the right ventricle or a fixed right ventricular region-of-interest which included the infundibulum. This simplified technique provides a reproducible method for the sequential quantitative assessment of right ventricular performance.

Cardiac Output↗

Ventricular dimensions and wall motion assessed by echocardiography in patients with arrhythmogenic right ventricular dysplasia.

Twenty patients with arrhythmogenic right ventricular dysplasia (ARVD) and 20 healthy volunteers underwent cross-sectional echocardiographic examination for the assessment of ventricular dimensions and wall motion. Right ventricular cavity diameters and wall segments were selected from the inflow and outflow tracts and the right ventricular body. The measurement error for measuring cavity dimensions was low throughout and the reproducibility of wall motion scoring was high in both the normal subjects and the patients. All except one patient had increased dimensions and/or abnormal wall motion in the right ventricle. The right ventricular inflow tract was dilated in nine patients, the outflow tract in 11 patients and the short- or long-axis diameters of the right ventricular body were increased in seven patients. Right ventricular wall motion abnormalities, being the most frequent finding, ranged from mild hypokinesia only to dyskinesia or sacculations, and were fairly evenly distributed among the segments studied. Left ventricular abnormalities, found in eight patients, were generally mild. Cross-sectional echocardiography thus provides highly reproducible measurements of right ventricular size and contraction patterns even in patients with wall shape deformities, and is therefore a feasible non-invasive method for the evaluation of right-sided myocardial abnormalities in patients with ARVD. The diagnostic accuracy of this technique warrants further clarification.

Adolescent↗

Ultrasonographic assessment of regional radial and longitudinal systolic function in healthy awake dogs.

BACKGROUND: Strain (St) and strain rate (SR) imaging are new ultrasound modalities based on tissue Doppler imaging (TDI) that allow quantitative assessment of segmental myocardial contraction or stretching and rate of deformation, respectively. HYPOTHESIS: Regional peak systolic St and SR could allow repeatable and reproducible assessment of systolic function of the right (RVW) and left (LVFW) myocardial walls in dogs. ANIMALS: Six healthy Beagle dogs were used to determine the repeatability and reproducibility of regional peak systolic St and SR in the RVW and LVFW (Study 1). These variables were also assessed in 30 healthy dogs of several breeds (Study 2). METHODS: Longitudinal peak systolic St and SR were recorded in 2 segments (basal and apical) of the RVW and LVFW. Radial peak systolic St and SR of the LVFW were also assessed. RESULTS: All within- and most (7/10) between-day coefficients of variation were <15%. Absolute values of the longitudinal deformation indices were significantly higher (P < .001) in the RVW (St = -39.5 +/- 5.5% and SR = -5.2 +/- 0.8 s(-1) at the base; St = -36.3 +/- 4.3% and SR = -4.7 +/- 1.1 s(-1) at the apex) than in the LVFW. Absolute values were also higher for the radial (St = 62.9 +/- 10.4% and SR = 5.8 +/- 1.1 s(-1), P < .001) than for the longitudinal LFVW motions. CONCLUSIONS AND CLINICAL IMPORTANCE: St and SR imaging is a repeatable and reproducible method for assessing systolic myocardial function. The combination of these indices with conventional echocardiographic variables may be useful for screening canine myocardial diseases.

Animals↗

Fourier amplitude ratio: a new way to assess valvular regurgitation.

The stroke-volume ratio determined from the equilibrium gated blood-pool study has been utilized to assess valvular regurgitation, but it is difficult to get reproducible results using generally available equipment. We have developed a new approach utilizing the Fourier amplitude ratio of the left and right ventricles, which is easily implemented and reproducible. Initial clinical experience shows that 17 patients with valvular regurgitation were clearly distinguished from 30 patients without valve disease.

Aortic Valve Insufficiency↗

Measurement of right and left ventricular volumes in healthy individuals with cine MR imaging.

Cine magnetic resonance (MR) imaging is a new, rapid MR pulse sequence that acquires up to 32 images per cardiac cycle at up to four levels of the heart within 4 minutes. In this study, the whole heart was encompassed by contiguous 10-mm transverse sections. Ventricular volumes were calculated by adding luminal areas determined in each section at end-diastole and end-systole. The left ventricular volume index was 57 ml/m2 +/- 9 at end-diastole and 17 ml/m2 +/- 4 at end-systole. The right ventricular volume index was 63 ml/m2 +/- 9 at end-diastole and 22 ml/m2 +/- 6 at end-systole. The left to right ventricular stroke volume ratio was 0.97 +/- 0.06, which was not statistically different from the theoretically expected ratio of 1. Interobserver and intraobserver measurements were closely correlated. Volume measurements were validated with two-dimensional echocardiography in five volunteers. Cine MR imaging allows reproducible three-dimensional measurement of right and left ventricular volumes with short imaging time and good temporal resolution.

Adult↗

Intermanual transfer of a new writing occupation in young adults without disability.

It has been shown that acquisition of a skill by one hand is facilitated by previous learning of the same skill with the other hand. This is called intermanual transfer of learning, or cross-education. The investigators examined intermanual transfer of occupation of writing in a group of 10 right-handed subjects with no known motor disabilities. Subjects learned to perform a novel occupation of writing a foreign alphabet letter with either their right or left hand. Later, subjects reproduced the skill with the practised and unpractised contralateral hand. Pen movements and surface electromyography of the first dorsal interosseus muscle were recorded to assess the transfer of learning. Analysis revealed an almost full transfer of the learned motor task between hands in either left-to-right or right-to-left direction when movement time and movement size were compared. This indicates that transfer did not depend on hand dominance. These findings suggest that a task already learned by one hand can positively influence the learning of the same task by the other hand. The results have important implications for occupational therapy--namely, that activities comprising tasks previously learned by one hand would be more effective in facilitating improved performance by the other hand than activities comprising previously unlearned tasks in the case of retraining skills in patients with amputation or hemiplegia. Because the participants in this study were a small number of college students, research should be carried out with larger participant pools and participants with disabilities to consolidate the findings.

Adult↗

Face encoding and psychometric testing in healthy dextrals with right hemisphere language.

OBJECTIVE: To document how right hemisphere language dominance in neurologically normal right-handed individuals affects lateralization of face encoding and level of performance in neuropsychological tests. METHODS: Three healthy right-handed adults with predominantly right hemisphere language activation during single-word or sentence-level processing were identified from 210 consecutive right-handed subjects studied using blood oxygenation level-dependent contrast fMRI. These three study subjects (S1 to S3) underwent a second scanning session where they performed word and face encoding. Their functional scans were contrasted with those obtained from six healthy control subjects (C1 to C6) with left hemisphere language dominance. Psychometric tests were performed on the study subjects. RESULTS: Right hemisphere-dominant language activation was reproduced in the second scanning session in the three study subjects. The extent to which the lateralization of face encoding was reversed varied. Right hemisphere language was associated with lower (but within normal) verbal IQ compared with performance IQ in two of three volunteers. Verbal and nonverbal memory scores were normal and did not differ appreciably. CONCLUSION: Right hemisphere-dominant language in healthy dextrals exists but is rare. The extent to which face encoding is reversed in these individuals is variable. Cognitive function does not appear to be significantly compromised even though some psychometric test scores are asymmetric in favor of nonverbal performance when the reversal of lateralization of face and word memory is not complete.

Adult↗

[Reproduction of time intervals by humans predicting signals].

Three series of experiments were carried out on 21 subjects. In the first series the subjects were presented with two temporal intervals--500 and 800 ms, limited by electrocutaneous stimuli of 1 ms duration. According to the instruction, the subjects reproduced them, pressing the left or right button, correspondingly. In the other two series, the subjects made the prognosis of presentation of the one or the other interval by corresponding reaction, after which they were presented with the real interval (at P = 0.5/05 in the 2nd series and P = 0.2/08 in the 3d series), which also had to be reproduced. In reproduction of temporal intervals without preliminarily prognosis, the number of wrong reactions reached 12%. In conditions of preliminary prognosis at equally probable signals distribution, the number of wrong reactions was equal to the number of correct ones, and at different probabilities, for rather improbable signals it exceeded twice,--and for more probable--it was twice less than the number of correct responses. Besides, the accuracy of interval reproduction depended on the prognosis of signals distribution but it could correspond to the really perceived interval and not to the interval chosen at prognosis. The reaction time, as the experiments showed, at prognosis was significantly greater than the reaction time of interval reproduction.

Adult↗

Hand and hemispace effects in tactual tasks in children.

In Experiment I, 3-and 5-yr-old dextrals matched textures better by either hand when it operated in left hemispace. Girls and 3-yr olds were the more disadvantaged by non-alignment of hand and hemispace. In Experiment II, 8-yr-olds reproduced finger sequences; dextrals demonstrated a right-hand and sinistrals a right-hemispace superiority. In Experiment III, both a left-hand and a left-hemispace superiority appeared when 5-yr-old dextrals reproduced a static configuration of finger spacing. Asymmetries were generally stronger for the side of presentation than for the side of response. Our findings are consistent with the operation of two semi-independent systems, one involving hand-hemisphere connections, and the other mapping of extracorporeal space by the hemispheres.

Age Factors↗

Mathematical analysis of canine atrial action potentials: rate, regional factors, and electrical remodeling.

Dogs have been used extensively to study atrial arrhythmias, but there are no published mathematical models of the canine atrial action potential (AP). To obtain insights into the ionic mechanisms governing canine atrial AP properties, we incorporated formulations of K(+), Na(+), Ca(2+), and Cl(-) currents, based on measurements in canine atrial myocytes, into a mathematical model of the AP. The rate-dependent behavior of model APs corresponded to experimental measurements and pointed to a central role for L-type Ca(2+) current inactivation in rate adaptation. Incorporating previously described regional ionic current variations into the model largely reproduced AP forms characteristic of the corresponding right atrial regions (appendage, pectinate muscle, crista terminalis, and atrioventricular ring). When ionic alterations induced by tachycardia-dependent remodeling were incorporated, the model reproduced qualitatively the AP features constituting the cellular substrate for atrial fibrillation. We conclude that this ionic model of the canine atrial AP agrees well with experimental measurements and gives potential insights into mechanisms underlying functionally important electrophysiological phenomena in canine atrium.

Action Potentials↗

Induction of clinical ventricular tachycardia using programmed stimulation: value of third and fourth extrastimuli.

Initiation of ventricular tachycardia (VT) by right ventricular extrastimulation was analyzed in 142 consecutive patients, 53 with electrocardiographically documented episodes of spontaneous VT or ventricular fibrillation (VF) and 68 with no spontaneous VT or VF; 21 patients with a history of sudden death but no documented arrhythmia were excluded from further analysis. All patients received 1 to 4 extrastimuli (S2, S3, S4 and S5) during pacing at fixed cycle lengths of 600 or 500 msec at 1 or 2 right ventricular sites. Clinical VT was reproduced by extrastimulation in 28 of 43 patients (65%) with sustained VT and in 0 of 10 patients with nonsustained VT. Clinical VT was induced by S2 or S3 in 16 patients and by S4 or S5 in 12 patients. Ventricular burst pacing reproduced clinical VT in 3 other patients. Nonclinical VT, which was most often polymorphic and nonsustained, was induced in 24 of 121 patients (20%), in 11 by S2 or S3 and in 13 by S4 or S5. Ventricular burst pacing induced nonclinical VT in 4 other patients. In patients with spontaneous sustained VT, the use of S4 and S5 in the right ventricle increases the yield of inducible clinical VT compared with use of S2 and S3 alone, but at a cost of increased induction of nonclinical VT. Frequent induction of nonclinical VT limits the interpretation of the results of such stimulation in patients without previously documented VT.

Adult↗