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Recurrent versus residual carotid stenosis. Incidence detected by Doppler ultrasound.

A sterile Doppler probe was used for intraoperative monitoring of the integrity of carotid endarterectomy of 125 vessels of 107 patients. Our objective was to reduce the contribution of residual carotid lesions to recurrent stenosis, which was evaluated by Doppler spectrum analysis in the early (less than 3 months, 66 arteries) and late (3-77 months, mean 32 months, 47 arteries) postoperative period. Intraoperative Doppler monitoring detected residual occlusion in six (4.8%) external carotid arteries and stenosis in ten (8.0%) internal carotid arteries permitting selected arteriography and correction of all significant lesions. Follow-up revealed one (1.5%) asymptomatic common carotid occlusion at 6 weeks and three (6.4%) asymptomatic internal carotid stenoses at 6, 10 and 25 months after operation. When compared to previous published experience, these results suggest that intraoperative correction of residual carotid obstruction detected by Doppler ultrasound may reduce the incidence of postoperative "recurrent" carotid stenosis.

Adult↗

Transient pressure signals in mechanical heart valve cavitation.

The purpose of this investigation was to establish a correlation between mechanical heart valve (MHV) cavitation and transient pressure (TP) signals at MHV closure. This correlation may suggest a possible method to detect in vivo MHV cavitation. In a pulsatile mock flow loop, a study was performed to measure TP and observe cavitation bubble inception at MHV closure under simulated physiologic ventricular and aortic pressures at heart rates of 70, 90, 120, and 140 beats/min with corresponding cardiac outputs of 5.0, 6.0, 7.5, and 8.5 L/min, respectively. The experimental study included two bileaflet MHV prostheses: 1) St. Jude Medical 31 mm and 2) Carbomedics 31 mm. High fidelity piezo-electric pressure transducers were used to measure TP immediately before and after the valve leaflet/housing impact. A stroboscopic lighting imaging technique was developed to capture cavitation bubbles on the MHV inflow surfaces at selected time delays ranging from 25 microseconds to 1 ms after the leaflet/housing impact. The TP traces measured 10 mm away from the valve leaflet tip showed a large pressure reduction peak at the leaflet/housing impact, and subsequent high frequency pressure oscillations (HPOs) while the cavitation bubbles were observed. The occurrence of cavitation bubbles and HPO bursts were found to be random on a beat by beat basis. However, the amplitude of the TP reduction, the intensity of the cavitation bubble (size and number), and the intensity of HPO were found to increase with the test heart rate. A correlation between the MHV cavitation bubbles and the HPO burst was positively established. Power spectrum analysis of the TP signals further showed that the frequency of the HPO (cavitation bubble collapse pressures) ranged from 100 to 450 kHz.

Biomedical Engineering↗

Effect of cholinergic and anticholinergic drugs on short-term memory in Alzheimer's dementia: a neuropsychological and computerized electroencephalographic study.

A correlation was found among the degree of memory loss, intellectual impairment, the quantity of senile plaques, and a decrease in choline acetyltransferase and acetylcholinesterase activity in patients affected by senile dementia of the Alzheimer type. In this study, patients were subjected to a series of computerized electroencephalographic (EEG) recordings and neuropsychological evaluations after acute administration of the following drugs: placebo; the cholinergic drugs physostigmine, pyridostigmine bromide, and edrophonium chloride; and the anticholinergic drugs scopolamine and orphenadrine. The results obtained show that the acute administration of some cholinergic drugs improved memory and attention performances, whereas the anticholinergic drugs induced opposite effects. The cholinergic drugs exhibited a tendency to shift the EEG spectrum analysis into more normal patterns compatible with the patient's age. This study supports the view that the cholinergic system plays an important role in memory and attention disturbances found in senile dementia of the Alzheimer type.

Aged↗

Control and variability of gastric pH in critically ill children.

OBJECTIVES: To determine the effect of illness severity and acute central nervous system injury on the control and variability of gastric pH in pediatric intensive care unit (ICU) patients receiving ranitidine. DESIGN: Prospective, descriptive study. SETTING: Pediatric ICU of a children's hospital. PATIENTS: Fourteen pediatric ICU patients. INTERVENTIONS: Ranitidine (4 mg/kg/day) was administered to all patients. MEASUREMENTS AND MAIN RESULTS: Patients enrolled in the study were divided into two groups based on illness type and severity. Illness severity was measured by the Pediatric Risk of Mortality (PRISM) score, with a PRISM score of > or = 20 defining severe illness. Illness type was designated as central nervous system or noncentral nervous system. Gastric pH was continuously monitored in all patients using an intragastric, pH-sensitive electrode. Poor control of gastric pH was defined as a pH of < 4.0 for > 20% of the time monitored. The statistical significance of the differences between groups was measured using the Wilcoxon two-sample test or Fisher's exact test. Patients with severe illness or acute central nervous system injury had a lower mean gastric pH than all other patients (4.6 vs. 6.4; p = .008) and spent more time with a gastric pH of < 4.0 than other patients (47.5% of time monitored vs. 12.5% of time monitored; p = .003). Poor control of gastric pH occurred in 100% of patients with severe illness or acute central nervous system injury, while only 20% of the remaining patients had poor control of gastric pH (p = .01). Using power-spectrum analysis to evaluate gastric pH variability, gastric pH in patients receiving bolus ranitidine was more variable than gastric pH in patients receiving ranitidine continuously (p = .045). Illness severity or type had no effect on gastric pH variability (p = .78). CONCLUSIONS: a) Continuous infusion of ranitidine decreases variability of gastric pH in pediatric ICU patients; b) gastric pH variability may make intermittent monitoring of gastric pH inaccurate; c) children with acute central nervous system injury or PRISM scores of > or = 20 have poor control of gastric pH; d) type of injury and PRISM scores predict response to ranitidine therapy.

Central Nervous System Diseases↗

Chernobyl fallout on Alpine glaciers.

Measurements of the gross beta activity of snow samples from four Alpine glaciers contaminated by radioactive fallout from the Chernobyl nuclear accident and a gamma-spectrum analysis of selected samples are reported. The results are discussed with respect to possible risks to the population from using meltwater from these glaciers as drinking water.

Accidents↗

Natural soil gamma radioactivity levels and resultant population dose in the cities of Zacatecas and Guadalupe, Zacatecas, Mexico.

The study of natural gamma radioactivity was made to determine the concentrations of natural radionuclides in soil. Twenty soil samples collected in the cities of Zacatecas and Guadalupe and their suburban areas in the Mexican state of Zacatecas were analyzed by gamma-ray spectrometry to determine the activity concentrations of 226Ra, 232Th, and 40K. Gamma-spectrometry measurements were made using a hyperpure germanium detector surrounded with shielding material to reduce the background counting rate. The GammaVision-32 MCA emulation software was used for gamma-ray spectrum analysis and the TRUMP card of 2k as a MCA emulator. Conversion factors were used to calculate the dose to the population from outdoor exposure to terrestrial gamma rays. The measured activity concentration of 226Ra varies from 11 to 38 Bq kg(-1), the activity concentration of 232Th varies from 8 to 38 Bq kg(-1). The activity concentration of 40K is in the range 309-1,049 Bq kg(-1). The overall population mean outdoor terrestrial gamma dose rate is 44.94 nGy h(-1).

Background Radiation↗

Noninvasive measurement of cardiac pressures by induced ventricular wall resonance: preliminary results in the dog.

Experiments in the excised dog heart and in live dogs are presented wherein a method of induced right ventricular wall resonance has been utlized to estimate the pressure in the right ventricle of the heart. Externally induced cardiac wall vibrations produced low frequency signals which, when subjected to spectrum analysis and coherent signal processing, permitted close approximation of static pressures and wave forms in the right ventricle at normal and hypertensive levels.

Animals↗

Testing for EMC (electromagnetic compatibility) in the clinical environment.

Testing for electromagnetic compatibility (EMC) in the clinical environment introduces a host of complex conditions not normally encountered under laboratory conditions. In the clinical environment, various radio-frequency (RF) sources of electromagnetic interference (EMI) may be present throughout the entire spectrum of interest. Isolating and analyzing the impact from the sources of interference to medical devices involves a multidisciplinary approach based on training in, and knowledge of, the following: operation of medical devices and their susceptibility to EMI; RF propagation modalities and interaction theory; spectrum analysis systems and techniques (preferably with signature analysis capabilities) and calibrated antennas; the investigation methodology of suspected EMC problems, and testing protocols and standards. Using combinations of standard test procedures adapted for the clinical environment with personnel that have an understanding of radio-frequency behavior increases the probability of controlling, proactively, EMI in the clinical environment, thus providing for a safe and more effective patient care environment.

Electromagnetic Phenomena↗

A clinical and neurophysiological evaluation of clotiazepam, a new thienodiazepine derivative.

The effects of 3 different dosages of clotiazepam, a new short-acting thienodiazepine derivative, were evaluated by using psychometric ratings and EEG spectrum analysis. A random double-blind study versus placebo was performed on 8 patients affected by generalized anxiety disorder (DSM III). The effects of acute administration of clotiazepam 5 mg, 10 mg, 20 mg and placebo per os were evaluated by using HRSA and a time-signed semiquantitative scale for anxiety. The results of the trial confirm the effectiveness of clotiazepam in the treatment of anxiety symptoms, mainly in the reduction of peak anxiety levels, with dose-dependent characteristics. The modifications of the EEG parameters which resulted were dose-dependent and short-lasting with slight sedative findings.

Adult↗

Low-dose transdermal scopolamine decreases blood pressure in mild essential hypertension.

BACKGROUND: Increasing cardiovascular parasympathetic nervous activity could have antihypertensive effects. Low-dose transdermal scopolamine increases vagal-cardiac modulation of sinus node and baroreflex sensitivity in healthy subjects and in cardiac patients. OBJECTIVE: To study the short-term effects of transdermal scopolamine on blood pressure and cardiovascular autonomic control in patients with mild essential hypertension. DESIGN: A randomized, double-blind, placebo-controlled crossover trial with 12 untreated middle-aged [aged 39+/-5 years (mean+/-SD)] patients with mild essential hypertension. METHODS: We recorded the electrocardiogram, auscultatory sphygmomanometric and continuous photoplethysmographic finger arterial pressure, and spirometry signals with patients supine and 70 degrees tilted during controlled (0.25 Hz) breathing. Cardiovascular autonomic regulation was analyzed with power spectrum analysis of R-R interval and arterial pressure variability and a spontaneous sequence method for baroreflex sensitivity. In addition, a deep-breathing test was performed to assess maximal breathing-related sinus arrhythmia. RESULTS: Transdermal scopolamine treatment significantly decreased blood pressure both when patients lay supine and when they were in the 70 degrees tilted position. Scopolamine also slowed heart rate and increased baroreflex sensitivity and R-R interval high-frequency variability for both body positionings. In addition, scopolamine accentuated respiratory sinus arrhythmia during deep breathing and blunted the tilt-induced increase in heart rate. Scopolamine did not affect blood pressure variability. CONCLUSIONS: Transdermal scopolamine decreases arterial pressure, increases baroreflex sensitivity and accentuates vagal-cardiac modulation of sinus node in patients with mild hypertension. Our study supports the hypothesis that increasing cardiovascular parasympathetic activity could have antihypertensive effects in essential hypertension.

Administration, Cutaneous↗

The (+/-) reference in pattern electroretinogram recording.

In this communication, the value of using a simultaneously acquired estimate of background noise, the (+/-) reference, is demonstrated in pattern electroretinogram (PERG) recording. During the signal averaging process, the (+/-) reference inverts the polarity of every other sweep; cycle-locked (stimulus-related) activity is thus cancelled out, leaving a noise distribution similar in statistical properties to that of the signal average. Assessing the presence of a PERG response by comparing the spectrum analysis of the PERG trace with that of the (+/-) reference is discussed. The results of the normal controls and patient groups are summarized and the raw waveforms from a representative normal observer and a patient with optic nerve damage are analyzed.

Electroretinography↗

Influences of the accommodative stimulus and aging on the accommodative microfluctuations.

The effects of the accommodative stimulus and age on the accommodative microfluctuations were investigated in human subjects. Accommodative responses were measured by using an infrared (IR) optometer, and accommodative microfluctuations were quantified by power spectrum analysis. Two frequency bands were determined: low frequency components (< 0.5 Hz, LFC) and high frequency components (1.3 to 2.2 Hz, HFC). Among younger subjects, the changes in the HFC in response to the accommodative stimuli differed between subjects. The activity of the HFC reached a peak in the center of the accommodation range, whereas the activity of the LFC was its maximum in the presence of darkness or blur in the over-accommodation range. Smaller changes in the magnitude of the HFC were observed in older subjects. Although the LFC may be controlled neurologically, the HFC seems to arise from mechanical and elastic properties of the lens, and may be modulated by other physiological rhythmic variations.

Accommodation, Ocular↗

Depressed mood is related to high-frequency heart rate variability during stressors.

OBJECTIVE: The purpose of this study was to examine the relationships between depressed mood and parasympathetic control of the heart in healthy men and women at rest and during two stressors. METHODS: Fifty-three healthy college students completed a laboratory stress protocol that included a baseline resting period, a challenging speech task, and a forehead cold pressor task. Depressed mood was assessed using the Beck Depression Inventory (BDI). Parasympathetic cardiac control was measured as the high-frequency (0.12-0.40 Hz) component (HF) of heart rate variability using power spectrum analysis. Blood pressure, respiration rate, and respiration amplitude were measured simultaneously. RESULTS: Participants were categorized as having a high or low depressed mood on the basis of median splits of their BDI scores. Those in the high depressed mood group had significantly greater reductions in HF during the speech task and significantly smaller increases in HF during the forehead cold pressor task than those in the low depressed mood group. Women had significantly greater reductions in HF during the speech task and smaller increases in HF during the forehead cold pressor task than men. However, gender and depressed mood did not interact to predict changes in HF. CONCLUSIONS: Depressed mood is related to the magnitude of decrease in parasympathetic cardiac control during stressors in healthy men and women. These findings extend those of previous studies, in which a similar phenomenon was observed among patients with cardiac disease. Because the participants in this study were healthy, the relationship between depressed mood and parasympathetic cardiac control does not seem to be secondary to cardiovascular disease.

Adolescent↗

Nitrous oxide added to isoflurane increases brain artery blood flow and low frequency brain electrical activity.

Although changes in cerebral blood flow (CBF) and the electroencephalogram (EEG) have been reported with nitrous oxide (N2O) administration, the interaction of these parameters is unclear. The purpose of this study was to measure CBF and EEG during N2O administration in eight patients. A craniotomy was performed and CBF was measured in major brain arteries using a transit time Doppler flowmeter. EEG was recorded bilaterally from frontooccipital leads. Power spectrum analysis was performed on the EEG and power for delta, theta, alpha, and beta frequency bands analyzed over time. Arterial blood pressure was recorded continuously. N2O (66%) was added to the inspired gases during isoflurane anesthesia (0.8% end tidal) under hypocapnic (Paco2 = 29 mm Hg) and normocapnic conditions (Paco2 = 39 mm Hg). During hypocapnia, N2O administration decreased alpha EEG activity and increased delta activity but did not change CBF. During normacapnia, N2O produced similar but greater changes in EEG and increased CBF 39%. In three patients, the isoflurane concentration was increased to 1.6% end tidal during normocapnia. N2O administration in these patients also enhanced delta EEG activity and increased CBF. The slowing of EEG activity with N2O is temporally related to increases in CBF during normocapnia. Hypocapnia abolished the increase in CBF during N2O and attenuated the shift of EEG to delta activity.

Adult↗

Circadian rhythm of autonomic nervous function in patients with normal-tension glaucoma compared with normal subjects using ambulatory electrocardiography.

PURPOSE: To compare circadian rhythm of autonomic nervous function in patients with normal-tension glaucoma with subjects with normal eyes. METHODS: Thirty-two patients with normal-tension glaucoma and 32 age-matched normal subjects who had no history of systemic disorders and no currently treated systemic disorders, especially diseases of the autonomic nervous system, were studied. An ambulatory electrocardiogram was installed that recorded heartbeats for 48 hours. Low-frequency and high-frequency values were calculated as markers of the autonomic nervous system status based on heart-rate variability using a power-spectrum analysis. RESULTS: The low-frequency values of patients with normal-tension glaucoma during the spans of an active day and a resting night were significantly greater than those of normal subjects, and this difference was emphasized during the night resting span. However, the high-frequency values of patients with normal-tension glaucoma were similar to those of normal subjects. The normal subjects showed a significant age-related decrease in all investigated parameters except the low-frequency values during the resting span. However, the patients with normal-tension glaucoma showed a significant age-related decrease only in low-frequency values during the active day. Patients with normal-tension glaucoma with progressive visual field defects showed much greater values than other cases, although the values were not significantly different. CONCLUSION: These results indicate that a disturbance of the circadian rhythm of the autonomic nervous system may exist in patients with normal-tension glaucoma.

Adult↗

Reproducibility of heart rate variability, blood pressure variability and baroreceptor sensitivity during rest and head-up tilt.

OBJECTIVE: Previous studies have indicated moderate-to-poor reproducibility of heart rate variability (HRV) but the reproducibility of blood pressure variability (BPV) and spectral measures of baroreceptor sensitivity (BRS) are not well established. METHODS: We measured normal-to-normal heart beat (RR) interval and finger blood pressure (Finapres) in 14 healthy individuals on three different days. The protocol was 1 h of supine rest and 1 h of 60-degree head-up tilt. Time-series of consecutive 300-s segments as well as 1024-s segments of RR intervals and systolic, diastolic and mean blood pressures were extracted for the assessment of day-to-day and short-term reproducibility. Power spectrum analysis (Fourier) and transfer function analysis was performed. Reproducibility was assessed using the coefficient of variation (CV). The reproducibility of the mean RR interval, mean systolic, diastolic and mean blood pressure was good (CV<10 %). However, there was only moderate-to-poor reproducibility of the spectral parameters of HRV (CV range 18-36%) and BPV (16-44%) and moderate reproducibility of BRS (14-20%). CONCLUSION: Spectral estimates of BRS had only moderate reproducibility although it was better than the spectral estimates of HRV and BPV.

Adult↗

Molecular intermediates of fitness gain of an RNA virus: characterization of a mutant spectrum by biological and molecular cloning.

The mutant spectrum of a virus quasispecies in the process of fitness gain of a debilitated foot-and-mouth disease virus (FMDV) clone has been analysed. The mutant spectrum was characterized by nucleotide sequencing of three virus genomic regions (internal ribosome entry site; region between the two AUG initiation codons; VP1-coding region) from 70 biological clones (virus from individual plaques formed on BHK-21 cell monolayers) and 70 molecular clones (RT--PCR products cloned in E. coli). The biological and molecular clones provided statistically indistinguishable definitions of the mutant spectrum with regard to the distribution of mutations among the three genomic regions analysed and with regard to the types of mutations, mutational hot-spots and mutation frequencies. Therefore, the molecular cloning procedure employed provides a simple protocol for the characterization of mutant spectra of viruses that do not grow in cell culture. The number of mutations found repeated among the clones analysed was higher than expected from the mean mutation frequencies. Some components of the mutant spectrum reflected genomes that were dominant in the prior evolutionary history of the virus (previous passages), confirming the presence of memory genomes in virus quasispecies. Other components of the mutant spectrum were genomes that became dominant at a later stage of evolution, suggesting a predictive value of mutant spectrum analysis with regard to the outcome of virus evolution. The results underline the observation that greater insight into evolutionary processes of viruses may be gained from detailed clonal analyses of the mutant swarms at the sequence level.

Adaptation, Physiological↗

Identification of indigo-related pigments produced by Escherichia coli containing a cloned Rhodococcus gene.

Pigments produced by Escherichia coli containing a cloned piece of DNA from Rhodococcus sp. ATCC 21145 were extracted in chloroform and separated into blue and pink components. Evidence from TLC, NMR spectroscopy, absorption spectrum analysis and solubility behaviour suggested that the blue pigment was indigo and the pink pigment was indirubin, a structural isomer of indigo. The proposed pathway for pigment production on LB agar involves the conversion of tryptophan to indole by tryptophanase of E. coli and the oxidation of indole to indigo by the product of the cloned Rhodococcus DNA insert.

Chromatography, Thin Layer↗