Accurate detection of coronary artery disease by integrated analysis of the ST-segment depression/heart rate patterns during the exercise and recovery phases of the exercise electrocardiography test

In this comparative cross-sectional study, we evaluated whether a novel computerized diagnostic variable, ST-segment depression/heart rate ST/HR analysis during both the exercise and postexercise recovery phases of the exercise electrocardiography (ECG) test, can detect coronary artery disease more accurately than methods using either exercise or recovery phase alone. The study population comprised 347 clinical patients referred for a routine bicycle exercise ECG test at Tampere University Hospital, Finland. Of these, 127 had angiographically proven coronary artery disease, whereas 13 had no coronary artery disease according to angiography, 18 had no perfusion defect according to technetium-99m sestamibi single-photon emission computed tomography, and 189 were clinically normal with respect to cardiac diseases. For each patient, the maximum values of the ST/HR hysteresis, ST/HR index, end-exercise ST depression, and recovery ST depression were determined from the Mason-Likar modification of the standard 12-lead exercise electrocardiogram [aVL, aVR, and V1 excluded]. The diagnostic performance of these continuous diagnostic variables was compared by means of receiver-operating characteristic analysis. The area under the receiver-operating characteristic curve of the ST/HR hysteresis was 89%, which was significantly larger than that of the end-exercise ST depression (76%, p < or = 0.0001), recovery ST depression (84%, p = 0.0063), or ST/HR index (83%, p = 0.0023), indicating superior diagnostic performance of the ST/HR hysteresis independent of the partition value selection. In conclusion, computerized analysis of the HR-adjusted ST depression pattern during the exercise phase, integrated with the HR-adjusted ST depression pattern during the recovery phase after exercise, can significantly improve the diagnostic performance and clinical utility of the exercise ECG test for the detection of coronary artery disease.     

Flexible multibody approach in forward dynamic simulation of locomotive strains in human skeleton with flexible lower body bones

A method for bone strain estimation is examined in this article. The flexibility of a single bone in an otherwise rigid human skeleton model has been studied previously by various authors. However, in the previous studies, the effect of the flexibility of multiple bones on the musculoskeletal model behavior was ignored. This study describes a simulation method that can be used to estimate the bone strains at both tibias and femurs of a 65-year-old Caucasian male subject. The verification of the method is performed by the comparison of the results with other studies available in literature. The results of the study show good correlation with the results of previous empirical studies. A damping effect of the flexible bones on the model is also studied in this paper.     

Precision of dual energy x-ray absorptiometry in the upper extremities

Dual energy x-ray absorptiometry (DEXA) has been shown to be a precise method for measuring bone mineral density (BMD) and content (BMC) in lumbar spine and proximal femur, but it has not been widely used in other skeletal sites. The in vivo day-to-day precision of DEXA (Norland XR-26) for seven anatomic sites in the upper extremities was evaluated by twice measuring both the right and left sides in ten subjects. For consistently defined regions-of-interest, the following precision values (coefficient of variation) were obtained for BMD and BMC: 0.8% and 1.0% (proximal humerus); 0.5% and 0.5% (humeral shaft); 0.7% and 0.5% (radial shaft); 1.3% and 1.1% (ulnar shaft); 0.7% and 1.0% (distal radius); 0.7% and 1.2% (distal ulna); 0.4% and 0.6% (hand). The initially observed relative side-to-side differences did not change significantly in the repeated measurements. Our results indicate that DEXA is a precise method for assessment of BMD and BMC also in the upper extremities.     

Effects of immobilization, three forms of remobilization, and subsequent deconditioning on bone mineral content and density in rat femora

Disuse is associated with bone loss, which may not be recoverable. It is not known whether intensified remobilization is beneficial in restoring disuse-related bone loss nor if any such benefit would depend upon continuing mobilization for its maintenance. After an immobilization period of 3 weeks, the effects of free remobilization (11 weeks), and low-and high-intensity treadmill running (11 weeks) with and without subsequent deconditioning (18 weeks) on the bone mineral content (BMC) and density (BMD) of the hindlimb femora of Sprague-Dawley rats (n = 98) were studied using a dual-energy X-ray absorptiometric (DXA) scanner. Our hypothesis was that intensified remobilization is beneficial in restoring the BMC and BMD from disuse to normal while subsequent deconditioning is deleterious to these parameters. Immobilization for 3 weeks produced a significant BMC and BMD loss in the immobilized left femur (range -4.4 to -12.8%; p < 0.05-0.001). In the groups with free remobilization (free cage activity), the body weight-adjusted BMCs and BMDs always remained below those in the controls (range -2.3 to -12.1%; p values ranging from NS to < 0.01). Both low- and high-intensity running restored BMC and BMD in the immobilized limb, the effect being better in the latter group. In both of these groups, the values of the immobilized left limbs and those of the free right limbs exclusively exceeded the corresponding values of the age-matched control rats (left limb values 3.0-21.1% higher with p values ranging from NS to < 0.01; right limb values 7.9-21.4% higher with p < 0.05-0.01). However, after the deconditioning period of 18 weeks, the above described beneficial effects of low- and high-intensity running were lost, the left and right limb BMC and BMD values being lower than those in the age-matched controls (range -3.8 to -8.7%; p values ranging from NS to < 0.05). In conclusion, this study clearly indicates the need for greater than normal activity to restore the BMC and BMD after disuse to normal levels. However, the benefits of intensified remobilization are lost if the activity is terminated, and therefore, after immobilization and disuse, bone loading activities should be continued, perhaps indefinitely.     

Modelling inundation patterns and sediment dynamics in the extensive floodplain along the Tonle Sap River

The Tonle Sap River (TSR) serves as a natural medium for the reversal flow between Tonle Sap Lake (TSL) and the Mekong River to sustain productivity and biodiversity in the TSR floodplain and TSL. Understanding the hydrological connectivity and its dynamics in the TSR, including its floodplain, is therefore important to support activities that aim to maintain ecological services in the TSR–TSL system. Thus, the main objective of this study is to examine the hydrological connectivity of the TSR and its floodplain by a modelling approach that integrates inundation patterns and sediment dynamics. The Caesar–Lisflood model was applied to describe inundation, sediment erosion, transport, and deposition in the TSR for the period of 2003–2013. The inundation areas connected to the TSR ranged from 140 to 2,327 km², whereas the isolated inundation areas from the TSR ranged from 0.27 to 504 km². Sediment dynamics showed its influence on inundation patterns and hydrological connectivity and could alter the yearly inundation ratio (defined as a normalized inundation frequency with a value ranging from 0 to 1) up to 0.8. Our approach provides a quantitative way to determine key factors (e.g., total inundation areas, seasonality, and connectivity of inundation patterns) for further investigation of ecological processes in relation to the inundation patterns and sediment dynamics in the TSR and TSL.     

High surface area nanostructured tubes prepared by dissolution of ALD-coated electrospun fibers

Novel nanostructured and high surface area tubular materials were produced combining electrospinning and atomic layer deposition processes with the removal of polymeric template via dissolution. The dissolution process changed the structure of the tube walls, and the smooth atomic layer deposition coating was transformed into a highly complex, coral-like structure. This material, which we have called “nanocoral,” has a relatively high surface area, 323 m² g⁻¹, due to the interconnected cavities formed after the removal of the template. This kind of material has important potential applications, for example, in the fields of catalysts and filtration.     

Analysis of dynamic strains in tibia during human locomotion based on flexible multibody approach integrated with magnetic resonance imaging technique

Bone is known to adapt to the prevalent strain environment while the variation in strains, e.g., due to mechanical loading, modulates bone remodeling, and modeling. Dynamic strains rather than static strains provide the primary stimulus of bone functional adaptation. The finite element method can be generally used for estimating bone strains, but it may be limited to the static analysis of bone strains since the dynamic analysis requires expensive computation. Direct in vivo strain measurement, in turn, is an invasive procedure, limited to certain superficial bone sites, and requires surgical implementation of strain gauges and thus involves risks (e.g., infection). Therefore, to overcome difficulties associated with the finite element method and the in vivo strain measurements, the flexible multibody simulation approach has been recently introduced as a feasible method to estimate dynamic bone strains during physical activity. The purpose of the present study is to further strengthen the idea of using the flexible multibody approach for the analysis of dynamic bone strains. Besides discussing the background theory, magnetic resonance imaging is integrated into the flexible multibody approach framework so that the actual bone geometry could be better accounted for and the accuracy of prediction improved.     

Good maintenance of high-impact activity-induced bone gain by voluntary, unsupervised exercises: An 8-month follow-up of a randomized controlled trial

The purpose of this study was to evaluate whether premenopausal women's voluntary unsupervised aerobic and step training could maintain the skeletal benefits obtained by an 18-month supervised high-impact training, and if so, to what extent. Thirty women of the original 39 study subjects (i. e., persons who completed the preceding 18-month randomized training intervention and who volunteered to continue the training on their own for a further 8 months) and 19 women of the 45 original control subjects (i.e., persons who volunteered to continue as controls) were included. The study group trained an average of twice per week and the training consisted of regular aerobic and step classes provided by local fitness centers. Areal bone mineral density (BMD, g/cm2) was measured from the lumbar spine, femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, calcaneus, and dominant distal radius at baseline and after 18 and 26 months. During the extended 8-month follow-up, the BMD of the study group increased more at the femoral neck (the intergroup change was +0.9% at 18 months and +2.8% at 26 months, p = 0.004 for the change between 18 and 26 months) and remained at the 18-month level at the distal femur, patella, proximal tibia, and calcaneus. In these sites, the statistically significant changes during the entire 26 months of training were 1.7-4.0% in the training group as compared with the changes of -0.9-1.5% in the control group. In the lumbar spine, BMD decreased from the 18-month level in both groups. In conclusion, the significant BMD increases that were obtained by supervised 18-month high-impact training were effectively maintained with subsequent unsupervised regular aerobic and step classes (twice per week). The finding emphasizes the effectiveness and feasibility of self-controlled aerobic and step exercises in the primary prevention of osteoporosis among healthy premenopausal women.     

Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures

BACKGROUND: Osteoporotic fractures among the elderly are common, and without preventive measures the burden of these fractures on health-care systems will increase further. The purpose of this randomised controlled study was to evaluate, in premenopausal women, the effects of high-impact loading on several determinants osteoporotic fractures. METHODS: 98 healthy, sedentary female volunteers aged 35-45 years were randomly assigned to either a training (n = 49) or a control group (n = 49). Progressive high-impact exercises were done three times per week for 18 months. We measured bone mineral density (BMD) in specific axial and lower-limb sites, by dual-energy X-ray absorptiometry, at baseline and after 12 and 18 months. Maximum isometric strength, muscular and cardiovascular performance, and dynamic balance were also assessed. FINDINGS: BMD at the femoral neck, a weightbearing site, increased significantly more in the training group (mean 1.6% [95% CI 0.8-2.4]) than in the control group (0.6% [-0.2 to 1.4], p = 0.006). By contrast, at non-weightbearing sites, such as the distal radius, there was no significant difference between the training and control groups (-1.5% [-2.7 to -0.3] vs -0.7% [-1.9 to -0.5], p = 0.60). In the training group there was a significant improvement in vertical jump and predicted oxygen consumption per min at maximum exercise compared with controls. INTERPRETATION: High-impact exercises that load bones with a rapidly rising force profile in versatile movements improve skeletal integrity, muscular performance, and dynamic balance in premenopausal women. If done on a regular basis, this type of exercise may help decrease the risk of osteoporotic fractures in later life. Long-term studies are required to show whether these 18-month results can be translated into long-term benefit.