Effects of respiration and posture on paroxysmal supraventricular tachycardia

The capacity of deep inspiration and the dependent body position to terminate episodes of tachycardia was studied in 11 patients with recurrent paroxysmal supraventricular tachycardia (PSVT). In eight patients, a deep inspiration and a dependent position repeatedly terminated episodes of PSVT. Reasons for failure were found in the other three patients. A deep inspiration or assumption of a dependent position dramatically raised arterial blood pressure and terminated episodes of PSVT by reflexly increasing vagal drive. The magnitude of the rise in blood pressure was directly proportional to the depth of the inspired volume and to the extent of body dependency. The upright position attenuated the respiratory-induced increase in blood pressure and blocked PSVT termination. Likewise, vagal blockade with atropine did not affect the effects of respiration or dependent position on blood pressure but prevented termination of PSVT.     

Effect of negative middle-ear pressure on transient-evoked otoacoustic emissions

OBJECTIVE: To seek an optimal treatment plan from the results of treatment for metastatic disease of the spine in children. DESIGN: An 8-year retrospective study of children with metastatic disease of the spine. Imaging studies were reviewed and treatment modalities analysed. SETTING: The divisions of pediatric orthopedics and pediatric neurosurgery at the Children's Hospital of Eastern Ontario, Ottawa. PATIENTS: All children seen between April 1980 and December 1987 who had lesions metastatic to the spine by hematogenous or direct extension. There were 20 children (15 boys, 5 girls) with a mean age at the time of diagnosis of 9.5 years. Follow-up ranged from 2 weeks to 108 months. One child was lost to follow-up. INTERVENTIONS: Eleven children underwent laminectomy and decompression. Of the 14 neurologically compromised children, 5 received chemotherapy and radiotherapy and 9 received chemotherapy, radiotherapy and surgery. MAIN OUTCOME MEASURES: Type of metastatic lesion, vertebrae involved and response to therapy. RESULTS: Vertebrae involved with metastases were as follows: cervical (3), thoracic (5), lumbar (8) and multilevel (2). Meninges were involved in 2 cases. The most common causes of metastatic spinal involvement were neuroblastoma (4 cases) and astrocytoma (6 cases). Pathologic fractures occurred in 4 children and kyphoscoliosis in 4. Spinal cord paresis developed in 14 of the 20 children. Of the 6 children who survived from 48 to 108 months, 5 had tumours of neural origin, 4 being astrocytomas. Children with neuroblastoma or leukemic infiltration had a good initial response to chemotherapy. Five of the 6 surviving children had astrocytomas, and 5 were treated by surgical decompression. CONCLUSIONS: Metastatic disease of the spine in children secondary to astrocytoma should be treated aggressively, but from the experience gained from this study it is impossible to devise a rigid treatment plan for each type of metastatic tumour. The choice of chemotherapy, radiotherapy or surgery depends on the type of tumour, the age of the child and whether or not the spinal cord is compromised.     

Effect of pressure on cultured smooth muscle cells

Recent studies indicate that smooth muscle cell (SMC) growth and morphology can be modulated by repetitive strain. However, there is very little known about the influence of pressure, without an associated cell stretch, on SMC phenotype. To study this, cultured bovine aortic SMC were grown on a rigid surface and placed in a custom-designed plexiglass pressure chamber with a carefully regulated 5% CO2/air environment. SMC were exposed to either atmospheric, 105 mm Hg or 120/90 mm Hg pressure at a frequency of 60 cycles/min (0.5 s systole, 0.5 s diastole). SMC number was determined on days 1, 3, 5, 7 and 9. SMC exposed to pressure were more elongated and displayed a significant increase in cell number by day 5 which persisted until day 9. Lactate dehydrogenase (LDH) in the conditioned media, an index of cytotoxicity, was not different between the groups at each time point. There was also no difference in pH or pCO2 of the media of SMC in any group. This is the first report of the effects of increased static and pulsatile pressure on SMC in vitro and indicates an increased proliferative rate. We hypothesize that the systemic pressure that the blood vessel is exposed to in vivo may have a significant regulatory influence on the phenotype of the smooth muscle cells which may affect the SMC response to injury or stimuli.     

Indicators of circulation, respiration and muscle strength in puberty]

Single radial hemolysis (SRH) is a simple method for measuring concentrations of antibody specific for influenza A viruses. There are many differences in reported assay methods and these changes may significantly affect results. This study evaluated the effect of changing erythrocyte concentrations, influenza virus concentrations used to sensitize erythrocytes, incubation times, and incubation temperatures. These factors were shown to significantly affect results of the SRH assay. A method for standardizing the assay and expressing results as relative antibody concentrations is described. Standardized relative antibody concentrations show significantly less variability than do hemolysis zone measurements when the SRH assay method is changed. This paper demonstrates that use of this method would allow for more consistent results to be obtained within laboratories. Use of this method with quantified, internationally standardized sera would allow results of the single radial hemolysis assay to be directly compared between laboratories.     

Bipedal posture and hand preference in humans and other primates.

Hand preference for quadrupedal and bipedal reaching in humans and rhesus macaques (Macaca mulatta) was examined, and the data were compared with postural reaching data that have been reported for 8 other primate species. Population-level biases were found toward use of the right hand for quadrupedal and bipedal reaching in humans and use of the left hand for quadrupedal reaching in rhesus macaques. Rhesus macaques showed a significant shift toward greater use of the right hand for bipedal vs. quadrupedal reaching. Comparisons with other species showed significant variance in the direction and strength of hand preference across reaching postures. The study noted right-hand biases for bipedal reaching in humans, great apes, and tufted capuchins and shifts toward greater use of the right hand for bipedal vs. quadrupedal reaching in great apes, tufted capuchins, and rhesus macaques. These results suggest that posture alters both the direction and strength of primate hand preference and that bipedalism may have facilitated species-typical right-handedness in humans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in body core temperatures and heat balance after an abrupt release of lower body negative pressure in humans

Changes in body core temperature (T(cor)) and heat balance after an abrupt release of lower body negative pressure (LBNP) were investigated in 5 volunteers under the following conditions: (1) an ambient temperature (Ta) of 20 degrees C or (2) 35 degrees C, and (3) Ta of 25 degrees C with a leg skin temperature of 30 degrees C or (4) 35 degrees C. The leg skin temperature was controlled with water perfusion devices wound around the legs. Rectal (T(re)), tympanic (T(ty)) and esophageal (T(es)) temperatures, skin temperatures (7 sites) and oxygen consumption were measured. The intensity of LBNP was adjusted so that the amount of blood pooled in the legs was the same under all conditions. When a thermal balance was attained during LBNP, application of LBNP was suddenly halted. The skin temperatures increased significantly after the release of LBNP under all conditions, while oxygen consumption hardly changed. The release of LBNP caused significant falls in T(cor)s under conditions (1) and (3), but lowered T(cor)s very slightly under conditions (2) and (4). The changes in T(es) were always more rapid and greater than those of T(ty) and T(re). The falls in T(ty) and T(re) appeared to be explained by changes in heat balance, whereas the sharp drop of T(es) could not be explained especially during the first 8 min after the release of LBNP. The results suggest that a fall in T(cor) after a release of LBNP is attributed to an increase in heat loss due to reflexive skin vasodilation and is dependent on the temperature of venous blood returning from the lower body.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neck afferents and muscle sympathetic activity in humans: implications for the vestibulosympathetic reflex

We have shown previously that head-down neck flexion (HDNF) in humans elicits increases in muscle sympathetic nerve activity (MSNA). The purpose of this study was to determine the effect of neck muscle afferents on MSNA. We studied this question by measuring MSNA before and after head rotation that would activate neck muscle afferents but not the vestibular system (i.e., no stimulation of the otolith organs or semicircular canals). After a 3-min baseline period with the head in the normal erect position, subjects rotated their head to the side (approximately 90%) and maintained this position for 3 min. Head rotation was performed by the subjects in both the prone (n = 5) and sitting (n = 6) positions. Head rotation did not elicit changes in MSNA. Average MSNA, expressed as burst frequency and total activity, was 13 +/- 1 and 13 +/- 1 bursts/min and 146 +/-34 and 132 +/- 27 units/min during baseline and head rotation, respectively. There were no significant changes in calf blood flow (2.6 +/- 0.3 to 2.5 +/- 0.3 ml.100 ml-1.min-1, n = 8) and calf vascular resistance (39 +/- 4 to 41 +/- 4 units; n = 8). Heart rate (64 +/- 3 to 66 +/- 3 beats/min; P = 0.058) and mean arterial pressure (90 +/- 3 to 93 +/- 3; P < 0.05) increased slightly during head rotation. Additional neck flexion studies were performed with subjects lying on their side (n = 5), MSNA, heart rate, and mean arterial pressure were unchanged during this maneuver, which also does not engage the vestibular system. HDNF was tested in 9 of the 13 subjects. MSNA was significantly increased by 79 +/- 12% (P < 0.001) during HDNF. These findings indicate that neck afferents activated by horizontal neck rotation or flexion in the absence of significant force development do not elicit changes in MSNA. These findings support the concept that HDNF increases MSNA by the activation of the vestibular system.     

Relationship between mandibular position and the coordination of masseter muscle activity during sleep in humans

Although bruxism has been regarded as having a possibly important role in the aetiology of craniomandibular disorders, the activity of masticatory muscles relative to mandibular position during sleep grinding as recorded by electromyography (EMG) has not yet been clarified. Surface EMGs of the bilateral superficial masseter muscles were recorded simultaneously with mandibular position during sleep from 12 volunteers for three consecutive nights. The incidence of two mandibular positions were recorded with magnetic sensors for both left- and right-sided mandibular grinding. One of the mandibular positions was the canine edge-to-edge position, and the other was the midpoint between the intercuspal position and the canine edge-to-edge position. The mode of the working/ balancing activity ratio ranged from 1/10 to 2/10, showing the marked predominance of balancing side masseter muscle activity during sleep grinding. During sleep grinding, EMG bursts of masseter muscle were observed mainly with mediotrusive mandibular movement from the canine edge-to-edge position. From the results of the present study, it is suggested that muscular dynamics during sleep are unique compared to that during voluntary clenching, and exert a greater mechanical load to the balancing side temporomandibular joint.     

BMCP1, a novel mitochondrial carrier with high expression in the central nervous system of humans and rodents, and respiration uncoupling activity in recombinant yeast

We report here the cloning and functional analysis of a novel homologue of the mitochondrial carriers predominantly expressed in the central nervous system and referred to as BMCP1 (brain mitochondrial carrier protein-1). The predicted amino acid sequence of this novel mitochondrial carrier indicates a level of identity of 39, 31, or 30%, toward the mitochondrial oxoglutarate carrier, phosphate carrier, or adenine nucleotide translocator, respectively, and a level of identity of 34, 38, or 39% with the mitochondrial uncoupling proteins UCP1, UCP2, or UCP3, respectively. Northern analysis of mouse, rat, or human tissues demonstrated that mRNA of this novel gene is mainly expressed in brain, although it is 10-30-fold less expressed in other tissues. In situ hybridization analysis of brain showed it is particularly abundant in cortex, hippocampus, thalamus, amygdala, and hypothalamus. Chromosomal mapping indicates that BMCP1 is located on chromosome X of mice and at Xq24 in man. Expression of the protein in yeast strongly impaired growth rate. Analysis of respiration of total recombinant yeast or yeast spheroplasts and in particular of the relationship between respiratory rate and membrane potential of yeast spheroplasts revealed a marked uncoupling activity of respiration, suggesting that although BMCP1 sequence is more distant from the uncoupling proteins (UCPs), this protein could be a fourth member of the UCP family.     

Effect of oxygen on sleep quality, cognitive function and sympathetic activity in patients with chronic heart failure and Cheyne-Stokes respiration

BACKGROUND: Cheyne-Stokes respiration disrupts sleep, leading to daytime somnolence and cognitive impairment. It is also an independent marker of increased mortality in heart failure. This study evaluated the effectiveness of oxygen therapy for Cheyne-Stokes respiration in heart failure. METHODS: Eleven patients with stable heart failure and Cheyne-Stokes breathing were studies. Oxygen and air were administered for 4 weeks in a double-blind, cross-over study. Sleep and disordered breathing was assessed by polysomnography. Symptoms were assessed using the Epworth Sleepiness Scale, visual analogue and quality of lift scores. Cognitive function was assessed by neuropsychometric testing. Overnight urinary catecholamine excretion was used as a measure of sympathetic nerve activity. RESULTS: Ninety-seven percent of apnoeas were central in origin. Oxygen therapy reduced the central apnoea rate (18.4 +/- 4.1 vs 3.8 +/- 2.1 per hour; p = 0.05) and periodic breathing time (33.6 +/- 7.4 vs 10.7 +/- 3.9% of actual sleep time; p = 0.003). Oxygen did not improve sleep quality, patient symptoms or cognitive failure. Oxygen reduced urinary noradrenaline excretion (8.3 +/- 1.5 vs 4.1 +/- 0.6 nmol.mmol-1 urinary creatinine; p = 0.03). CONCLUSION: Oxygen stabilized sleep disordered breathing and reduced sympathetic activity in patients with heart failure and Cheyne-Stokes respiration. We were unable to demonstrate an effect on either patient symptoms or cognitive function.     

Influence of upper airway pressure oscillations on soft palate muscle electromyographic activity

Snoring is characterized by high-frequency (30-50 Hz) pressure oscillations (HFPO) in the upper airway (UA). The soft palate is a major oscillating structure during snoring, and soft palate muscle (SPM) activity is an important determinant of velopharyngeal patency. Consequently, we examined the effect of artificial HFPO applied to the UA on the integrated electromyographic (EMG) activity of the SPMs in 11 supine mouth-closed anesthetized (pentobarbital sodium/chloralose) dogs breathing spontaneously via a tracheostomy. The EMGs of the palatinus (Pal; n = 11), levator veli palatini (LP; n = 9), and tensor veli palatini (TP; n = 8) were monitored with intramuscular fine-wire electrodes. Peak inspiratory and peak expiratory EMG activity was measured in arbitrary units (au) as the mean of five consecutive breaths. HFPO [+/- 4.5 +/- 0.4 (SE) cmH2O; 30 Hz] applied at the laryngeal end of the isolated UA increased peak inspiratory EMG from 3.3 +/- 2.0 to 8.4 +/- 1.7 au (P < 0.05) for Pal and from 2.0 +/- 1.1 to 7.3 +/- 2.7 au (P < 0.05) for LP. For the TP, increases were evident in four dogs, but mean values for the group did not change (5.8 +/- 2.4 to 11.0 +/- 4.1 au, P = 0.5). The peak expiratory EMG did not change for any SPM (all P > 0.3). Thus HFPO applied to the UA augments inspiratory SPM activity. Reflex augmentation of SPM activity by HFPO may serve to dilate the retropalatal airway and/or stiffen the soft palate during inspiration in an attempt to stabilize UA geometry during snoring.     

Effect of respiration, exercise, and food intake on hepatic vein circulation

Since the effects of respiration, nutrition, and exercise on blood flow in the hepatic vein are not well understood, the objective of this study was to determine the hemodynamic influence of these factors on hepatic venous circulation using Doppler ultrasonographic tracings. The venous blood flow of the middle hepatic vein was determined during arrested full inspiration, midinspiration, and expiration in 25 healthy subjects. The maximum velocity and the systolic-to-diastolic ratio of the blood flow were measured. The portal vein blood flow velocity was measured in 20 volunteers before and after food intake. The portal vein blood flow and the hepatic vein flow velocity were examined in eight volunteers after exercise. During inspiration, maximum blood flow velocity of the hepatic veins decreased compared to midinspiration (P < 0.001). With expiration the maximum velocity increased (P < 0.001). After food consumption, there was no change in the velocity of the hepatic veins, but the portal vein blood flow increased (P = 0.041). After physical exercises, the maximum velocity of the hepatic venous flow increased, on average, about 148% (P = 0.01), and the portal vein blood flow decreased about 44% (P = 0.027). To achieve standard measurements of hepatic venous blood flow, the state of respiration and physical exertion should be established. The nutritional status had only a minor influence on hepatic vein measurements.     

Effect of dose, schedule, and route of administration on the in vivo toxicity and antitumor activity of two activated sulfhydryl derivatives of cyclophosphamide

Two cyclophosphamide (CP) derivatives, 4-S-(hexane-6-ol)-sulfidocyclophosphamide (C-1) and 4-S-(propionic acid)-sulfidocyclophosphamide (C-2), that hydrolyze spontaneously under physiological conditions to 4-hydroxycyclophosphamide, are compared to CP for antitumor activity in male C57BL/6 x DBA/2 F1 mice with ascites L1210 leukemia or solid Lewis lung carcinoma. When C-1 or C-2 is administered i.p. as a single injection at 10% lethal dose (approximately LD10) to mice bearing L1210 (1 x 10(5) cells i.p.), early treatment produces a 5- to 6-log tumor cell kill and results in substantial numbers of long-term survivors (greater than or equal to 30 days). Such antitumor activity is comparable to that of CP treatment. However, i.p. administration of either sulfido derivative produces liver atrophy and fibrosis of hepatic capsular structures. Hepatotoxicity is eliminated if single-dose C-2 (less than or equal to LD10) is administered i.v.; however, when administered by this route, C-2 results in only a 1-log cell kill of i.v. implanted leukemic cells as compared to the 4-log tumor cell kill obtained with CP given i.v. In addition to hepatotoxicity, C-2 causes an acute and dose-limiting toxicity in mice, manifested by severe muscular spasms and cessation of breathing. In the treatment of advanced L1210, C-2 shows no therapeutic advantage over CP. When mice bearing s.c. Lewis lung carcinoma receive early i.p. treatment with CP, C-1, or C-2, each drug results in long-term tumor-free survivors. However, CP (< LD10) consistently cures all mice, whereas C-1 or C-2 (approximately LD10) produces only 10 to 30% tumor-free survivors. These data suggest that, in the L1210 and Lewis lung tumor systems studied, the two activated CP derivatives offer no therapeutic advantage over CP. In addition, two forms of toxicity occur with these derivatives that do not occur with CP.     

Skeletal muscle GLUT-4 and postexercise muscle glycogen storage in humans

The purpose of this study was to examine the relationship between skeletal muscle GLUT-4 protein and postexercise glycogen storage in human subjects fed adequate carbohydrate. Eleven men completed 2 h of cycling, and a biopsy of the vastus lateralis was performed immediately after exercise cessation for the determination of muscle GLUT-4 protein and glycogen concentrations, glycogen synthase activity, and citrate synthase activity. The subjects ingested meals providing 2.0 g carbohydrate/kg body weight at 0, 2, and 4 h postexercise, and a second biopsy was performed 6 h postexercise. Muscle glycogen concentration increased significantly during the 6-h recovery period (glycogen immediately postexercise, 27.2 +/- 5.4 mmol/kg wet weight; glycogen storage, 52.4 +/- 2.9 mmol x kg wet weight-1 x 6 h-1; P<0.05). Glycogen storage during recovery was directly related to GLUT-4 protein (2.20 +/- 0.33 arbitrary standard units; r = 0.63; P<0.05) and inversely related to glycogen immediately postexercise (r = -0.70; P < 0.05). A direct correlation existed between glycogen storage during recovery and the activity of the I form of glycogen synthase (r = 0.60; P < 0.05). These results suggest that muscle GLUT-4 protein concentration, as well as factors relating to glucose disposal, may affect postexercise glycogen storage in humans fed adequate carbohydrate.     

Intentional changes in sound pressure level and rate: their impact on measures of respiration, phonation, and articulation

The purpose of the study was to compare the effects of changing sound pressure level (SPL) and rate on respiratory, phonatory, and articulatory behavior during sentence production. Ten subjects, 5 men and 5 women, repeated the sentence, "I sell a sapapple again," under 5 SPL and 5 rate conditions. From a multi-channel recording, measures were made of lung volume (LV), SPL, fundamental frequency (F0), semitone standard deviation (STSD), and upper and lower lip displacements and peak velocities. Loud speech led to increases in LV initiation, LV termination, F0, STSD, and articulatory displacements and peak velocities for both lips. Token-to-token variability in these articulatory measures generally decreased as SPL increased, whereas rate increases were associated with increased lip movement variability. LV excursion decreased as rate increased. F0 for the men and STSD for both genders increased with rate. Lower lip displacements became smaller for faster speech. The interspeaker differences in velocity change as a function of rate contrasted with the more consistent velocity performance across speakers for changes in SPL. Because SPL and rate change are targeted in therapy for dysarthria, the present data suggest directions for future research with disordered speakers.     

Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans

BACKGROUND: Spectral analysis of RR interval and systolic arterial pressure variabilities may provide indirect markers of the balance between sympathetic and vagal cardiovascular control. METHODS AND RESULTS: We examined the relationship between power spectral measurements of variabilities in RR interval, systolic arterial pressure, and muscle sympathetic nerve activity (MSNA) obtained by microneurography over a range of blood pressures. In eight healthy human volunteers, MSNA, RR interval, intra-arterial pressure, and respiration were measured during blood pressure reductions induced by nitroprusside and during blood pressure increases induced by phenylephrine. Both low-frequency (LF; 0.10 +/- 0.01 Hz) and high-frequency (HF; 0.23 +/- 0.01 Hz) components were detected in MSNA variability. Increasing levels of MSNA were associated with a shift of the spectral power toward its LF component. Decreasing levels of MSNA were associated with a shift of MSNA spectral power toward the HF component. Over the range of pressure changes, the LF component of MSNA variability was positively and tightly correlated with LF components of RR interval (in normalized units; P < 10(-6)) and of systolic arterial pressure variability (both in millimeters of mercury squared and normalized units; P < 5 x 10(-5) and P < 5 x 10(-6), respectively). The HF component of MSNA variability was positively and tightly correlated with the HF component (in normalized units) of RR-interval variability (P < 3 x 10(-4)) and of systolic arterial pressure variability (P < .01). CONCLUSIONS: During sympathetic activation in normal humans, there is a predominance in the LF oscillation of blood pressure, RR interval, and sympathetic nerve activity. During sympathetic inhibition, the HF component of cardiovascular variability predominates. This relationship is best seen when power spectral components are normalized for total power. Synchronous changes in the LF and HF rhythms of both RR interval and MSNA during different levels of sympathetic drive are suggestive of common central mechanisms governing both parasympathetic and sympathetic cardiovascular modulation.     

Slow rhythmic oscillations of blood pressure, intracranial pressure, microcirculation, and cerebral oxygenation. Dynamic interrelation and time course in humans

BACKGROUND AND PURPOSE: Various biological signals show nonpulsatile, slow rhythmic oscillations. These include arterial blood pressure (aBP), blood flow velocity in cerebral arteries, intracranial pressure (ICP), cerebral microflow, and cerebral tissue PO2. Generation and interrelations between these rhythmic fluctuations remained unclear. The aim of this study was to analyze whether stable dynamic interrelations in the low-frequency range exist between these different variables, and if they do, to analyze their exact time delay. METHODS: In a clinical study, 16 comatose patients with either higher-grade subarachnoid hemorrhage or severe traumatic brain injury were examined. A multimodal digital data acquisition system was used to simultaneously monitor aBP, flow velocity in the middle cerebral artery (FVMCA), ICP, cerebral microflow, and oxygen saturation in the jugular bulb (SjO2). Cross-correlation as a means to analyze time delay and correlation between two periodic signals was applied to a time series of 30 minutes' duration divided into four segments of 2048 data points (approximately 436 seconds) each. This resulted in four cross-correlations for each 30-minute time series. If the four cross-correlations were consistent and reproducible, averaging of the original cross-correlations was performed, resulting in a representative time delay and correlation for the complete 30-minute interval. RESULTS: Reproducible cross-correlations and stable dynamic interrelations were found between aBP, FVMCA, ICP, and SjO2. The mean time delay between aBP and ICP was 6.89 +/- 1.90 seconds, with a negative correlation in 81%. A mean time delay of 1.50 +/- 1.29 seconds (median, 0.85 seconds) was found between FVMCA and ICP, with a positive correlation in 94%. The mean delay between ICP and SjO2 was 9.47 +/- 2.21 seconds, with a positive correlation in 77%. Mean values of aBP and ICP did not influence the time delay and dynamic interrelation between the different parameters. CONCLUSIONS: These results strongly support Rosner's theory that ICP B-waves are the autoregulatory response of spontaneous fluctuations of cerebral perfusion pressure. There is casuistic evidence that failure of autoregulation significantly modifies time delay and the correlation between aBP and ICP.