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Laboratory markers of colonoscopic activity in ulcerative colitis and Crohn's colitis.

BACKGROUND: Previous studies have not identified a convenient laboratory marker of colonoscopic activity in Crohn's colitis or ulcerative colitis. METHODS: Twenty-eight patients with either ulcerative colitis or Crohn's colitis undergoing colonoscopy by the same observed had laboratory measurements of serum albumin, orosomucoid, C-reactive protein, plasma viscosity, haemoglobin, leucocyte and platelet counts, and faecal alpha-1-antitrypsin from single non-lyophilized samples. Multiple linear regression was performed using each laboratory variable as the dependent variable and the lengths of each grade of endoscopic activity as the explanatory variables. RESULTS: Multiple regression analysis using all the endoscopic grades of acute activity showed significant correlations with faecal alpha-1-antitrypsin (p < 0.001), serum albumin (p < 0.001), C-reactive protein (p = 0.02), and plasma viscosity (p = 0.03). CONCLUSIONS: The highest multiple correlation coefficients were obtained with faecal alpha-1-antitrypsin (r = 0.82) and serum albumin (r = 0.80), and these measurements can be recommended as convenient markers of endoscopic activity in these diseases.

Adult↗

[Effect of soil fertility on chestnut stem diseases].

Studies on the relationship between soil fertility and chestnut stem disease showed that in soil physical factors, the disease index in the chestnut orchards with clay soil and stone soil was higher than that with loam, sand loam and yellow-brown loam soil. It was increased with the increasing soil bulk density, and decreased with increasing soil depths. In soil chemical factors, the disease index negatively associated with the contents of organic matter and available phosphorus, and not with total nitrogen, K and pH value. Based on the above factors and stepwise regression, five factors such as soil depth, bulk density, clay soil, organic matter and available phosphorus were regarded as important to the disease, and a linear multiple regression model that predicts the development level of the diseases was derived, which could assist in manageming the particular stand against chestnut stem diseases in Anhui Province.

Fagaceae↗

Haloperidol dosing requirements: the contribution of smoking and nonlinear pharmacokinetics.

Previous data suggest the possibility that haloperidol daily dosing requirements may be confounded by smoking and, at higher doses, capacity-limited metabolism. Forty hospitalized patients suffering from an acute exacerbation of schizophrenia were treated for 2 weeks with fixed oral doses of haloperidol ranging from 10 to 70 mg/day (0.13 to 0.95 mg/kg/day) that produced mean steady-state concentrations between 4.5 and 55.4 ng/ml. No significant differences between the smoking and nonsmoking groups were obvious for the factors of weight, age, sex, daily doses, steady-state clearance, and steady-state haloperidol concentrations in plasma at week 1, week 2, and their mean. The hypothesis that the relationship between haloperidol dose and steady-state haloperidol concentration in plasma was affected by patients' smoking status and metabolic capacity was tested by multiple linear regression analysis and initially rejected. The relationship of dose to haloperidol concentration was fitted as a linear function. To improve the curve fit, the haloperidol concentrations and doses were transformed to their natural logs and then the regression line was refitted. The multiple regression analysis was repeated with the data in their transformed state. It was found that, although smoking status and dose of the drug did not independently affect the average haloperidol concentration, together they interacted in such a way that individual haloperidol concentrations were dependent on the smoking status at specific doses. Thus, two haloperidol dosing equations were generated, one for smokers and one for nonsmokers.

Adult↗

Arterial pulse wave velocity and risk factors for peripheral vascular disease.

Non-invasive measurement of arterial pulse wave velocity (PWV) is used to diagnose peripheral vascular disease. We examined the relationship between PWV and risk factors related to peripheral vascular disease [body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), atherogenic index (AI) and blood glucose (GLU)] in 45 healthy male volunteers, aged 25-85 years. The correlation coefficient of PWV with age was r = 0.46, and the correlation coefficients of PWV with DBP, AI and GLU were r = 0.71, 0.56, and 0.22, respectively (P < 0.05). Multiple linear regression analysis revealed that 67% of the variance in PWV could be accounted for by these three variables. The relative contributions of DBP, AI and GLU to PWV were 66%, 26% and 8%, respectively. To test the applicability of PWV for clinical use, a multiple regression equation of PWV derived from these three variables was then applied to male patients with hypertension (n = 53), hyperlipidaemia (n = 35) or hyperglycaemia (n = 39). The results suggest that the multiple regression equation of PWV is an indicator that discriminates between these patient categories and healthy men.

Adult↗

Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure.

AIMS: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. METHODS AND RESULTS: We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). CONCLUSIONS: In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that when adjusted for age and BMI, LVFAC and LVESAI are independent predictors of NT-proBNP levels in both dilated and ischemic etiologies. Patients with dilated cardiomyopathy showed better results than those with ischemic cardiomyopathy. We think LV areas are a useful and reproducible parameter, do not need geometric assumptions and reflect NT-proBNP plasma levels.

Aged↗

Low-density lipoprotein cholesterol estimation by a new formula in Indian population.

BACKGROUND: Estimation of low-density lipoprotein cholesterol is crucial in the management of ischemic heart disease patients. Low-density lipoprotein cholesterol is routinely calculated in laboratories world over by applying Friedewald formula for logistic reasons. We derived a new formula based on multiple regression approach. METHODS: Lipid profiles were done on blood samples of 2008 patients. In initial 1000 patients, low-density lipoprotein cholesterol was estimated by a direct method and also by Friedewald formula. By applying linear regression methods on the data of direct estimation method, a new formula was obtained and the accuracy of this new formula was validated in the next 1008 patients. RESULTS: The mean low-density lipoprotein cholesterol was 116+/-41.5 mg/dl (3.02+/-1.08 mmol/l) measured by direct low-density lipoprotein cholesterol assay and that calculated by Friedewald formula was 119+/-46 mg/dl (3.09+/-1.2 mmol/l) for the initial 1000 patients. Low-density lipoprotein cholesterol measured by direct low-density lipoprotein cholesterol assay and calculated from Friedewald formula showed good correlation (r = 0.88), however, there was minimal overestimation by the Friedewald formula. The correlation improved between direct low-density lipoprotein cholesterol and calculated low-density lipoprotein cholesterol after excluding the patients with triglycerides more than 350 mg/dl (r = 0.92). The mean low-density lipoprotein cholesterol measured by the direct assay and by new formula in the next 1008 patients was 117+/-40 mg/dl (3.04+/-1.04 mmol/l) and 113.7+/-37 mg/dl (2.96+/-0.96 mmol/l), respectively with very good correlation (r = 0.97) between them. CONCLUSIONS: The new formula derived from multiple linear regression analysis appears to be more accurate than Friedewald formula in Indian population.

Algorithms↗

Interocular difference in progression of glaucoma correlates with interocular differences in retrobulbar circulation.

PURPOSE: To evaluate the correlation between interocular difference in progression of glaucomatous damage and interocular differences in retrobulbar blood flow. METHODS: On the basis of a retrospective analysis of visual fields, progressive damage was identified in 20 patients with primary open-angle glaucoma. As a parameter of interocular difference in progression of visual field damage, the angle (gamma) between the regression lines of the visual field index mean defect over time per eye was calculated for each subject. The relationship between the angle gamma and interocular differences in intraocular pressure and retrobulbar color Doppler imaging parameters was analyzed by a multiple linear regression analysis in a stepwise forward approach. RESULTS: With larger interocular differences in progression of glaucomatous damage, lower mean blood flow velocities in the ophthalmic artery (partial r = -.69; P <. 0016), higher resistivity indices in the central retinal artery (partial r =.48; P <.0456), and higher peak systolic velocities in the ophthalmic artery (partial r =.52; P <.0285) were noted in the eyes with more marked progression of damage (multiple r =.71; P <. 0099). Interocular differences in progression of visual field damage were not related to intraocular pressure or extent of visual field damage. CONCLUSION: Independent of the extent of the interocular difference in glaucomatous damage and intraocular pressure, interocular difference in progression of glaucomatous visual field damage correlates with interocular difference in retrobulbar hemodynamic parameters.

Blood Circulation↗

Patterns of dietary intake and serum lipids interact with proteinuria as risk factors for progression of chronic renal failure.

UNLABELLED: This prospective study assessed the interactions between patterns of nutrient intake and serum lipids with other risk factors for progression of chronic renal failure. The study cohort consisted of 52 individuals with documented chronic renal failure, 18 women and 34 men, with a mean age of 65 +/- 11 years at the time of recruitment. The dependent variable was the rate of progression of chronic renal failure, which was determined by the slope of the curve generated from five or more values of the reciprocal of serum creatinine (SCr-1) and divided by time (in months of follow-up) for each patient, and recorded in dung/month. The independent variables included dietary factors (phosphorus, protein); serum lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides); proteinuria; serum phosphorus; serum albumin; serum glucose; and blood pressure. Serum creatinine was drawn in a fasting state and determined using the picric acid technique on five or more occasions for each patient. The mean monthly rate of decline in dL/mg/month was calculated for each patient. The cohort was followed for 1.5 years. Descriptive statistics were determined for all variables. Analysis of principal components was used to generate variables representing patterns of nutrient intake and serum lipids. The outcome variable was modeled using stepwise linear regression which included principal components representing dietary and serum lipid patterns. The Student's t test and the F test were used for hypothesis testing. All tests were significant at p < 0.05. RESULTS AND CONCLUSIONS: Multicolinearity prevented the inclusion of more than one individual dietary or serum lipid variable into the multiple linear regression model of rate of decline in kidney function. Principal components representing patterns of dietary intake and serum lipids, contributed to the prediction of rate of decline in renal function together with proteinuria.

Adolescent↗

Influence of nonlinearities on estimates of respiratory mechanics using multilinear regression analysis.

To investigate the influence of nonlinearities on estimates of respiratory mechanics, differing patterns of mechanical ventilation patterns were analyzed from 8 puppies and 14 children. Respiratory mechanics were calculated using multiple linear regression to fit a linear single-compartment model, a volume-dependent single-compartment model (VDSCM), and a flow-dependent single-compartment model. The ratio of the compliance of the last 20% of the dynamic volume-pressure (V-P) curve to the total compliance (C20/C) and the contribution of a volume-dependent elastance to total elastance [%E2 = E2 (VT)/[(E1 + E2)VT], where E1 + E2 is total elastance, E2 is the volume-dependent component, and VT is tidal volume] were used as the indexes of over-distension. By positioning the dynamic loops on the static V-P curves, ventilation patterns were classified as overdistended or nonoverdistended. In the overdistended group, the C20/C was significantly lower (0.71 +/- 0.10 vs. 0.92 +/- 0.16; P < 0.0001) and %E2 was significantly higher (43.4 +/- 15.0 vs. 0.51 +/- 18.02%, P < 0.0001) than in the nonoverdistended group. The mode of ventilation (pressure controlled vs. volume controlled) and the resistive pressures that resulted in widening of the dynamic V-P loop were found to alter C20/C but not %E2. When the respiratory system was overdistended, i.e., ventilated up to the flattened portion of the V-P curve, the VDSCM gave more accurate estimates of respiratory mechanisms. Furthermore, %E2 calculated from VDSCM is a useful parameter for estimating respiratory system overdistension that is not affected by resistive pressures.

Animals↗

Models of polychlorinated dibenzodioxins, dibenzofurans, and biphenyls binding affinity to the aryl hydrocarbon receptor developed using (13)c NMR data.

Quantitative spectroscopic data-activity relationship (QSDAR) models for polychlorinated dibenzofurans (PCDFs), dibenzodioxins (PCDDs), and biphenyls (PCBs) binding to the aryl hydrocarbon receptor (AhR) have been developed based on simulated (13)C nuclear magnetic resonance (NMR) data. All the models were based on multiple linear regression of comparative spectral analysis (CoSA) between compounds. A 1.0 ppm resolution CoSA model for 26 PCDF compounds based on chemical shifts in five bins had an explained variance (r(2)) of 0.93 and a leave-one-out (LOO) cross-validated variance (q(2)) of 0.90. A 2.0 ppm resolution CoSA model for 14 PCDD compounds based on chemical shifts in five bins had an r(2) of 0.91 and a q(2) of 0.81. The 1.0 ppm resolution CoSA model for 12 PCB compounds based on chemical shifts in five bins had an r(2) of 0.87 and a q(2) of 0.45. The models with more compounds had a better q(2) because there are more multiple chemical shift populated bins available on which to base the linear regression. A 1.0 ppm resolution CoSA model for all 52 compounds that was based on chemical shifts in 12 bins had an r(2) of 0.85 and q(2) of 0.71. A canonical variance analysis of the 1.0 ppm CoSA model for all 52 compounds when they were separated into 27 strong binding and 25 weak binding compounds was 98% correct. Conventional quantitative structure-activity relationship (QSAR) modeling suffer from errors introduced by the assumptions and approximations involved in calculated electrostatic potentials and the molecular alignment process. QSDAR modeling is not limited by such errors since electrostatic potential calculations and molecular alignment are not done. The QSDAR models provide a rapid, simple and valid way to model the PCDF, PCDD, and PCB binding activity in relation to the aryl hydrocarbon receptor (AhR).

Benzofurans↗

Statistical evaluation of internal and external mass calibration laws utilized in fourier transform ion cyclotron resonance mass spectrometry.

The statistical evaluation of two common and three new calibration laws utilized in Fourier transform ion cyclotron resonance mass spectrometry are presented. Electrospray ionization was used to prepare a series of mass spectra of ammonium-adducted polypropylene glycol (PPG) with an average molecular weight of 1000 Da. The singly charged PPG-1000 oligomers allowed for the description of a broad range of m/z and abundance values within each mass spectrum. The hexapole accumulation time was varied to afford a range of total ion abundance values of about an order of magnitude. To examine each of the calibration laws, we utilized cross-validation both "within-spectrum" and "between-spectra" for internally and externally calibrated data, respectively. In addition, we used t-statistics to ensure that each calibration coefficient was statistically significant and necessary to accurately describe the variation in the data. In comparison to commonly used calibration laws for internal calibration, our new calibration law based on multiple linear regression offered a 2-fold improvement in mass measurement accuracy (MMA). In comparison to external calibration laws without automatic gain control, our new calibration law using multiple regression improved the MMA by >10-fold; this improvement would increase further as the dynamic range of the measurement increases (e.g., a biological system). For both our internal and external calibration laws, the median MMA was less than 1 part-per-million. Furthermore, we investigate the number of calibrant ions as well as their required m/z range in order to successfully achieve high MMA.

Calibration↗

Rapid analysis of methanol in grape-derived distillation products using near-infrared transmission spectroscopy.

Samples of distillates derived from the production of wine-fortifying spirit were analyzed for methanol by gas chromatography (GC) and near-infrared spectroscopy (NIRS). NIRS calibration models were developed which could accurately predict methanol concentrations in samples of fortifying spirit that had been produced over a period of three years from four different commercial distillation facilities. The best accuracy of the predictive models, as measured by the standard error of prediction value, was 0.06 g/L methanol. Other distillation fractions, produced during preparation of commercial fortifying spirit, were also examined. The most useful NIRS calibration models used partial least squares regression on continuous spectra from a scanning instrument, but it was demonstrated that calibrations could also be developed with a smaller number of fixed wavelengths, using multiple linear regression models. NIRS offers the advantages of rapid analysis, with simple routine operation, and may offer the potential for in-line process control in the operation of a commercial distillation facility.

Calibration↗

Mean platelet volume and coronary heart disease in hemodialysis patients.

BACKGROUND: Mean platelet volume (MPV) has been shown to be an independent risk factor for myocardial infarction in the general population. METHODS: In the present cross-sectional study it was examined whether MPV may be associated with coronary heart disease (CHD) in patients in chronic hemodialysis treatment (n = 518). CHD was diagnosed if there was a history of myocardial infarction, coronary artery bypass grafting, or critical stenosis on coronary angiography. RESULTS: Mean platelet volume in hemodialysis patients was 8.22 +/- 0.06 fl. As compared with hemodialysis patients with a MPV <7.168 fl (the lower quintile limit), significantly more hemodialysis patients with a MPV >9.172 fl (the upper quintile limit) had CHD (odds ratio, 1.29; 95% confidence interval, 1.02-1.64). In a stepwise multiple logistic regression analysis MPV appeared to be an independent factor of CHD together with age, smoking, predialysis systolic blood pressure and serum triglyceride concentration. In a stepwise multiple linear regression model, MPV significantly depended on platelet count, volume of ultrafiltrate removed in one hemodialysis session, white blood cell count, treatment with beta blockers, heart rate, serum sodium and serum potassium concentrations. Additional measurements in 30 patients showed that MPV after a single hemodialysis session was not significantly different compared to predialysis values. CONCLUSION: From the present study it is concluded that MPV may be associated with CHD in hemodialysis patients.

Blood Platelets↗

Physiologic, health and lifestyle factors associated with femoral neck bone density in older women.

Three hundred eleven women aged between 60 and 91 years (mean age 72.2) who were randomly recruited from the community underwent bone density assessments of the femoral neck. Two complementary multivariate techniques were used to assess the relationships between femoral neck bone density and a range of anthropometric, health, and lifestyle measures. Stepwise multiple linear regression analysis revealed age, weight, height, quadriceps strength, and lifelong smoking to be variables that independently and significantly explained part of the variance in femoral neck bone density within the group. Multiple logistic regression revealed that after adjusting for established predictors of bone mineral density, age, height, and weight, reduced quadriceps strength, lifelong smoking, and little childhood activity were significantly associated with low bone density (< 0.70 g/cm2), whereas superior quadriceps strength, nonsmoking, and high levels of current physical activity were significantly associated with high bone density (> 0.84 g/cm2). In contrast, current calcium intake was not significantly associated with bone density. The study findings highlight possible public health initiatives for minimizing age-related femoral neck bone loss in older women.

Aged↗

Urinary 2/16 alpha-hydroxyestrone ratio: correlation with serum insulin-like growth factor binding protein-3 and a potential biomarker of breast cancer risk.

Metabolism of estradiol occurs via two mutually exclusive hydroxylative pathways, yielding metabolites of divergent biological properties. 2-hydroxyestrone (2OHE1) is anti-estrogenic while 16 alpha-hydroxyestrone (16 alpha OHE1) is a potent estrogen. The ratio of 2OHE1 to 16 alpha OHE1 (2/16 alpha-OHE1 ratio) represents the net in vivo estrogenic activity. In this study, we sought to determine if the urinary 2/16 alpha-OHE1 ratio could be a predictor of breast cancer risk and the factors which influence this ratio. Variables analysed included age at diagnosis, menopausal status, parity, use of oral contraceptives, body mass index, serum levels of insulin-like growth factor-I (IGF-I), IGF binding proteins (BPs) and the presence of breast cancer. Serum and urine were collected from 65 breast cancer patients and 36 controls after an overnight fast. Urinary estrogen metabolites were measured by enzyme immunoassays while serum levels of IGF-I, BP-1 and BP-3 were determined by immunoradiometric assays. 2OHE1 levels and 2/16 alpha-OHE1 ratios were significantly lower (P < 0.05) while 16 alpha OHE1 levels were higher (P < 0.01) in cancer patients. Multiple linear regression analysis showed that levels of urinary metabolites were influenced by parity and breast carcinoma. 2/16 alpha-OHE1 ratio correlated positively with serum BP-3 level (P = 0.03). By multiple logistic regression, 2/16 alpha-OHE1 ratio was the most significant factor predictive of breast cancer. The odds ratio for women with higher 2/16 alpha-OHE1 ratios was 0.10 (0.03-0.38, 95% confidence interval). In conclusion, the profile of urinary estradiol metabolites was distinctly altered in breast cancer patients. In addition, BP-3 may be a potential mechanism by which estradiol metabolites influence breast cancer progression. As 16 alpha OHE1 has been shown to initiate neoplastic transformation of mammary epithelial cells, the 2/16 alpha-OHE1 ratio may serve as a biomarker of increased risk of breast cancer.

Age Factors↗

Statistical testing of drug accumulation in skin tissues by linear regression versus contents of stratum corneum lipids.

This investigation is a contribution to standardization in in vitro drug penetration measurements using excised human skin and to statistical treatment of the observations. The wide variations observed in measurements of drug accumulation in and drug permeation through the stratum corneum are caused not only by analytical errors but also by the variability of the horny layer lipid composition. The last-mentioned systematic influence can be compensated for by stepwise (multiple) linear regression using the contents of the main lipid classes as independent variables. In consequence, the S.E. of estimate given by the regression calculation is lower than the S.E. of the means of the observations. Significant differences in drug quantities accumulated in skin tissues (stratum corneum and dermis) are sensitively detected by Chow's F-test of structural change. Accumulation data of flufenamic acid and hydrocortisone penetrated from different bases are given as examples. The calculation mode is exemplarily explained and discussed. The results of the test for structural change, two-independent-groups t-test and paired-samples t-test are compared. The F-test of structural change proves to be a helpful statistical method suitable to the assessment of biopharmaceutical quality parameters and to measurements using biological materials.

Administration, Topical↗

Relative bioavailability of supplemental inorganic zinc sources for chicks.

Three experiments were conducted to investigate the relative bioavailability of reagent-grade (RG) and feed grade (FG) Zn sources for 1-d-old broiler chicks. In Exp. 1, 13 treatments included a basal corn-soybean meal diet (63 ppm Zn) or the basal diet supplemented with 400, 800, or 1,200 ppm Zn from RG sulfate, basic carbonate, oxide, or metal and fed for 20 d. Using multiple regression slope ratios with Zn sulfate set at 100%, bioavailability estimates were 78, 77, and 46% for carbonate, oxide, and metal, respectively. In Exp. 2, chicks were allotted randomly to 16 treatments that included a basal corn-soybean meal diet (75 ppm Zn) or basal diet supplemented with 300, 600, or 900 ppm Zn as either RG sulfate, FG sulfate-A, FG sulfate-B, FG oxide-A, or FG oxide-B and fed for 21 d. Multiple linear regression slope ratios gave relative estimates of 99, 81, 78, and 54% for sulfate-A, sulfate-B, oxide-A, and oxide-B sources, respectively, with RG sulfate set at 100%. In Exp. 3, chicks were fed a basal corn-soybean meal diet (35 ppm Zn) or the basal diet supplemented with 40, 80, or 120 ppm Zn from RG Zn sulfate, FG sulfate, or FG oxide and fed for 20 d. Multiple regression slope ratios with RG sulfate set at 100% gave relative bioavailability estimates of 94 and 74% for the FG sulfate and oxide, respectively. Bioavailability estimates were similar when Zn was supplemented to diets at high or low concentrations.

Animals↗

M-mode echocardiography in normal children and adolescents: some new perspectives.

Normal M-mode echocardiography values were determined using computer-assisted measurements of echocardiograms (ECHO) in 202 children and young adults 25 days to 23 years of age: 77 were female, and 125 were male and, reflecting the population served by our Center, 99 were black and 103 were white children. The values for left and right heart wall thicknesses and chamber sizes were graphically displayed as a function of body surface area, and with an illustration of the regression line and 2 standard deviation (SD) range of normal for each parameter. In addition, normal ECHO predicting equations for dimension and function parameters were derived using multiple linear regression analysis with age, height, weight, sex, race, and heart rate as independent variables. A comparison was made between the observed data and the data derived from the normal predicting equations for each of the parameters. Also, values obtained from these equations were compared to data generated from other published normal predicting equations. A description of the digitizer measurements, computer interfacing, and a sample ECHO report form utilizing the predicted normal ranges for each of the parameters is presented. We propose that quantitative M-mode echocardiographic reporting should be easily accessible to all pediatric cardiology laboratories.

Adolescent↗