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Biomedical subjects

E D'Angelo

Publications and source records attributed to E D'Angelo.

At least 55 records · Page 3Linked to original sources
PubMed1992

Correlates of medical compliance among hemophilic boys.

Twenty-nine males with hemophilia completed the Medical Compliance Incomplete Stories Test (M-CIST), and their scores were correlated with health care professionals' ratings of four aspects of medical compliance, along with measures of possible moderating variables. The results indicated that significant associations were found between most of the M-CIST category scores, particularly the Compliance/coping subscale, and the health care specialists' ratings of how well the children exhibited compliant responses to bleeding episodes, and inverse associations with the incidence of monthly bleeding episodes. The findings suggested that the M-CIST continues to demonstrate promise as an instrument to be used in studies of compliance among pediatric chronic illness patients.

Achievement↗
PubMed1992

Effect of PEEP on respiratory mechanics in anesthetized paralyzed humans.

With the use of the technique of rapid airway occlusion during constant flow inflation, respiratory mechanics were studied in eight anesthetized paralyzed supine normal humans during zero (ZEEP) and positive end-expiratory pressure (PEEP) ventilation. PEEP increased the end-expiratory lung volume by 0.49 liter. The changes in transpulmonary and esophageal pressure after flow interruption were analyzed in terms of a seven-parameter "viscoelastic" model. This allowed assessment of static lung and chest wall elastance (Est,L and Est,W), partitioning of overall resistance into airway interrupter (Rint,L) and tissue resistances (delta RL and delta RW), and computation of lung and chest wall "viscoelastic constants." With increasing flow, Rint,L increased, whereas delta RL and delta RW decreased, as predicted by the model. Est,L, Est,W, and Rint,L decreased significantly with PEEP because of increased lung volume, whereas delta R and viscoelastic constants of lung and chest wall were independent of PEEP. The results indicate that PEEP caused a significant decrease in Rint,L, Est,L, and Est,W, whereas the dynamic tissue behavior, as reflected by delta RL and delta RW, did not change.

Abdominal Muscles↗
PubMed1991

Electrical and mechanical output of the expiratory muscles in anesthetized dogs.

In anesthetized intact and vagotomized dogs chest wall diameters, expiratory muscles' (EM) electrical activity, work, mean pressure and volume displacement contributed by EM contraction were assessed in the supine and upright posture during rebreathing, and during continuous positive pressure breathing (CPAP) in the supine posture. Corresponding inspiratory mechanical output variables were related to diaphragm activity. During resting breathing triangularis sterni and internal interosseous were more easily recruited than transversus abdominis and external oblique. EM activity increased with tilting, CPAP and rebreathing. Vagotomy depressed or abolished abdominal EM activity, with lesser effects on rib cage EM. Expiratory mechanical output grossly paralleled EM activity: it markedly depended on rib cage and abdominal EM coactivation, besides lung inflation and chest wall shape. Upper rib cage configuration at end-expiration never departed from the relaxation one, suggesting trivial effects of the triangularis sterni contraction. Lower chest wall distortion occurred almost regularly, so that much of EM activity was not converted into external work. In contrast with expiratory electromechanical relations, those for the diaphragm were always highly significant and independent of EM activation.

Animals↗
PubMed1991

Pulmonary and chest wall mechanics in anesthetized paralyzed humans.

Pulmonary and chest wall mechanics were studied in 18 anesthetized paralyzed supine humans by use of the technique of rapid airway occlusion during constant-flow inflation. Analysis of the changes in transpulmonary pressure after flow interruption allowed partitioning of the overall resistance of the lung (RL) into two compartments, one (Rint,L) reflecting airway resistance and the other (delta RL) representing the viscoelastic properties of the pulmonary tissues. Similar analysis of the changes in esophageal pressure indicates that chest wall resistance (RW) was due entirely to the viscoelastic properties of the chest wall tissues (delta RW = RW). In line with previous measurements of airway resistance, Rint,L increased with increasing flow and decreased with increasing volume. The opposite was true for both delta RL and delta RW. This behavior was interpreted in terms of a viscoelastic model that allowed computation of the viscoelastic constants of the lung and chest wall. This model also accounts for frequency, volume, and flow dependence of elastance of the lung and chest wall. Static and dynamic elastances, as well as delta R, were higher for the lung than for the chest wall.

Adolescent↗
PubMed1991

Pleural liquid pressure.

The knowledge of pleural liquid pressure (Pliq) is essential for understanding the mechanical coupling between lung and chest wall and the liquid exchanges of the pleural space. In the last decade, research in this field contributed new ideas and stimulating controversies but also caused some confusion. These aspects, along with the older contributions, are considered in this review, which is divided into three sections. The topics of the first section are 1) measurements of Pliq with different techniques in various mammals and various regions of the pleural space, 2) comparison of Pliq with the pressure exerted by the lung recoil (Ppl), and 3) vertical gradient of Pliq and downward flow of pleural liquid. In the second section the mechanisms absorbing liquid from the pleural space are analyzed: 1) Starling forces of the visceral pleura, 2) lymphatic drainage through the stomata of the parietal pleura, and 3) active transport of solutes. The third section deals with 1) measurements of pleural liquid thickness with two approaches in the costal region of various mammals and 2) mechanisms preventing a complete removal of pleural liquid and, thus, ensuring the lubrication.

Animals↗
PubMed1990

Dual-component NMDA receptor currents at a single central synapse.

Present thinking about the way that the NMDA (N-methyl-D-aspartate) class of glutamate receptor operates at central synapses relies mainly on information obtained from single-channel and whole-cell recordings from cultured neurons stimulated by exogenous NMDA receptor agonists. The mechanisms that operate in the postsynaptic membrane of a normal neuron following release of the natural transmitter are far less clear. An important problem is that most normal neurons receive many excitatory synapses (10(3)-10(5) per cell) and these synapses are located on slender dendritic elements far away from the somatic recording site, making the study of discrete synaptic events difficult. Typically, when populations of synapses are activated, NMDA receptor-mediated synaptic potentials appear as slowly rising, long-lasting waves superimposed on faster, non-NMDA-receptor potentials. Although believed to be critical for NMDA receptor function, this slow time-course would not be predicted from single-channel kinetics and its origin remains puzzling. We have now analysed the events occurring at the level of a single excitatory synapse using a simple, small, neuron--the cerebellar granule cell--which has an unusually simple glutamatergic input. By applying high-resolution whole-cell recording techniques to these cells in situ, we were able to study the nature of elementary NMDA receptor-mediated synaptic currents. Contrary to expectations, the prominent currents are fast but are followed by slow ones. Both types of current are strongly voltage-dependent but differ subtly in this respect. Furthermore, the currents are absent unless glycine is provided.

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed1990

Electrical and mechanical output of the inspiratory muscles in anesthetized dogs.

In anesthetized dogs with progressive hypercapnia, the relationships between tidal volume (VT) or occluded inspiratory esophageal pressure swings (Pes) and diaphragm (Edi) or thoracic inspiratory muscle (Etm) peak electrical activity were determined after either cordotomy at C7-T1 or bilateral phrenicotomy, and used together with the Etm vs Edi relationships established in intact and vagotomized dogs to estimate the contribution of each muscle group to VT and Pes observed under the latter conditions. Etm was obtained as the mean of scalene, 2nd and 5th parasternal peak activity, the relationships between these activities being the same under all conditions. In supine and head-up phrenicotomized dogs, VT and Pes increased linearly with Etm and were unaffected by body position. After cordotomy, VT and Pes increased progressively less with increasing Edi and at any Edi were smaller in the head-up posture. Diaphragm relative contribution to VT and Pes was greater when supine than head-up and greater after than before vagotomy, but in all cases it decreased with increasing chemical drive. That of the thoracic inspiratory muscles increased with chemical drive and eventually became equal to (supine) or larger than (head-up) diaphragm contribution.

Anesthesia↗
PubMed1989

Respiratory mechanics in anesthetized paralyzed humans: effects of flow, volume, and time.

The effects of inspiratory flow rate and inflation volume on the resistive properties of the total respiratory system were investigated in 16 anesthetized paralyzed humans by using the technique of rapid airway occlusion during constant flow inflation. This allowed measurement of the intrinsic resistance (Rmin,rs) and of the effective additional resistance (delta Rrs) as the result of viscoelastic pressure dissipations within the pulmonary and chest wall tissues. We observed that 1) at fixed inflation volume, Rmin,rs increased linearly with increasing flow although delta Rrs decreased according to an exponential function; 2) at fixed inflation flow, Rmin,rs decreased with increasing inflation volume although there was a concomitant increase in delta Rrs. This behavior could be explained in terms of a spring-and-dashpot model incorporating 1) the standard resistance and elastance and 2) a spring-and-dashpot in parallel with standard elastance, reflecting the stress adaptation units within the thoracic tissues.

Adolescent↗
PubMed1989

School functioning and disease severity in boys with hemophilia.

There have been few recent studies investigating the scholastic progress of children with hemophilia. The advent of PL94-142, which ensures an appropriate educational program based on a child's specific learning disabilities, and home Factor VIII therapy, which increases the hemophiliac's school attendance and sense of freedom and control, might have had a positive impact on the academic performance of these patients. We investigated past and current educational functioning of 26 boys with hemophilia, using both parental and teacher reports. Twenty-two of these children were administered reading and math achievement tests. Results indicate that school absenteeism is a continuing problem for these children, with the average hemophiliac missing 18 school days in an academic year (median = 11 school days missed); one child had missed 77% of the year. Although these boys had normal intelligence and made average grades in school, six of the 22 tested performed more than two grade levels below expectations in reading and 10 performed greater than two grade levels below expectations in math. School underachievement did not necessarily correlate with disease severity (as indicated by serum factor level), school absenteeism, or grade point average. Although eight parents indicated that their children had past or current school problems, and teachers reported that greater than 50% of the group received special tutoring or classes for learning disabled students, six out of 22 (27%) performed below expectations in either math or reading and yet had no current individual educational remediation plan.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1989

Calcium-dependent chloride transient currents in the immature oocyte of the frog, Rana esculenta.

Transient currents of chloride were studied in the plasma membrane of immature frog oocyte in voltage clamp conditions. The transients appeared to be activated by an influx of Ca2+ from the external medium. The mechanism leading to a surge of intracellular Ca2+ concentration needed at least 30 sec before full recovery. It was inhibited by substituting Ba2+ for Ca2+ in the external medium, or in the presence of La3+, Co2+ and Cd2+, or when external Na+ was replaced by Li+. Verapamil proved ineffective. The data suggest that an intracellular system of Ca-activated Ca-release is present in the frog oocyte, which can be primarily activated by membrane hyperpolarization via an influx of Ca2+ through non-selective channels.

Animals↗
PubMed1988

Inspiratory muscle activity during unloaded and obstructed rebreathing in dogs.

Moving-average electromyogram (EMG) of the diaphragm (DI), scalenes, and cranial and caudal parasternals was assessed in anesthetized, supine, and head-up dogs during rebreathing. The shape of EMG trajectory was similar for all muscles and conditions; activation of different muscles could be thus compared on the basis of changes in peak activity. In intact dogs changes in peak activity were greater for the scalenes and cranial parasternals than for the caudal parasternals and greater for the inspiratory thoracic muscles (ITM) than for the DI. Posture, vagotomy, and cordotomy at C7-T1 did not affect the rate of rise of DI activity. The relations between peak activity of ITM did not change because of posture, vagotomy, and phrenicotomy. Vagotomy selectively depressed the rate of rise of ITM activity, but relative changes in peak ITM activity for a given change in peak DI activity were independent of intact vagi. Differences in the pattern of activation between inspiratory muscles with rebreathing are largely independent of proprioceptive inputs and likely reflect properties of central control mechanisms. However, airway occlusion at end expiration caused a reflex fall of DI activity and reflex increase of ITM activity in intact and vagotomized dogs. Cordotomy at C7-T1 did not change DI response, whereas reduction of ITM activity occurred after phrenicotomy, indicating that both facilitatory and inhibitory segmental inputs are involved in ITM response to loading.

Airway Obstruction↗
PubMed1985

Verification of a model for the mechanisms controlling expiratory duration in rabbits under various conditions.

A mathematical model for the mechanisms controlling expiratory (E) duration was verified through comparison of its prediction with the relationships between TE and waveform parameters of various input patterns obtained by bilateral, simultaneous electrical stimulation of the largest vagal afferent fibers in vagotomized, paralyzed rabbits at normal or elevated chemical drive under light or deep barbiturate anesthesia. The model accurately reproduced experimental results in each animal and condition; it suggests that in the absence of vagal input (v.i.) an exponentially decaying central activity (phi) prevents inspiratory (I) onset until a time independent threshold (phi thr) is reached; the vagal component of phi results from fixed gain, long time constant (tau = 1.07 +/- 0.03 sec; mean +/- SE for N = 37 for N = 37 animals) temporal summation of expiratory v.i., being unaffected by inspiratory v.i.; central and vagal components share a common mechanism, the same value of tau applying to v.i. integration and to phi decay in the absence of v.i. under all conditions; the amplitude of the central component is proportional to tidal changes in central I activity, independently of the condition studied; and phi thr increases at elevated chemical drive, is unaffected by v.i., and decreases under deep anesthesia.

Anesthesia, General↗
PubMed1984

Effects of body temperature, passive limb motion and level of anesthesia on the activity of the inspiratory muscles.

The relationships between relative tidal activity (moving average EMG) of the diaphragm (AdiT) and of the external intercostal or parasternal muscles (AicT) and between the rate of rise of these activities (Adi and Aic) were assessed during rebreathing in rabbits with various body temperatures (BT: 34-41 degrees C) before and after vagotomy (VGT), at rest and during passive limb motion (PLM), and in vagotomized rabbits with or without thoracic dorsal rhizotomy (TDR) under light (LBA) or deep barbiturate anesthesia (DBA). Both relationships had the form AicT = a AdiTb and Aic = a' Adib'. In intact normothermic animals under LBA mean values for b and b' were 1.47 and 1.37, a and a' being unity by definition. No changes in b or b' occurred even with TDR: this suggests that the relation between the central command to phrenic and to inspiratory intercostal alpha-motoneurones was the same under all conditions. Neither BT nor PLM modified a', but a changed owing to BT and PLM dependence of the relation between central inspiratory drive and off-switch threshold. Both VGT, independently of BT, and DBA decreased a and a' before but not after TDR, when a and a' reached the lowest values (0.12 and 0.22). Hence VGT and DBA, but not BT and PLM, change the relation between the central command to inspiratory intercostal alpha- and gamma-motoneurones, the multiplicative effect of alpha-gamma linkage on AicT and Aic being prevented by TDR.

Anesthesia, General↗
PubMed1982

Effects of thoracic dorsal rhizotomy or vagotomy on inspiratory muscle activity at various levels of chemical drive.

The relationship between relative peak activity (moving average EMG) of the diaphragm (Adi) and of the cranial (2nd and 3rd) external intercostal or parasternal muscles (Aic) was assessed during rebreathing in animals before and after bilateral thoracic (T1-T4) dorsal rhizotomy (TDR) and/or bilateral vagotomy (VGT). The relationship had the form Aic=a Adib under all conditions. In intact rabbits and cats mean values for b were 1.48 and 1.79, respectively, a being unity by definition. Neither TDR nor VGT changed b; a decreased to about 0.15 with TDR and halved with VGT only if performed before TDR. Selective reflex facilitation of inspiratory intercostals with occlusions at FRC was observed after VGT and was abolished by TDR. Neither VGT nor TDR affected Adi time course. Hence: (1) central command to alpha-motoneurones of the major inspiratory muscles differs; (2) proprioceptive feedback markedly increases external intercostal activity, apparently by multiplying Aic due to central command to alpha-motoneurones by a factor independent of chemical drive; (3) vagally mediated augmentation of Aic depends entirely on intact proprioceptive feedback. The possible role of fusimotor drive is discussed.

Animals↗
PubMed1982

Inspiratory muscle activity during rebreathing in intact and vagotomized rabbits.

The relation between relative peak 'integrated' diaphragmatic (Adi) and cranial (u) or caudal (1) inspiratory intercostal activity (Aic) was assessed in intact and vagotomized rabbits during rebreathing. During unloaded rebreathing Aic increased markedly more than Adi, and Aicu more than Aicl, independently of intact vagi. Vagal signals facilitated inspiratory intercostals, since vagotomy or vagal blocks increased Adi more than Aic without changing diaphragm activity time course, and delta Aic/delta Adi in the same range of Adi values was greater before than after vagotomy. Reflexes from the chest wall were not involved since phrenic block after vagotomy modified rib cage motion without changing Aic, independently of chemical drive. Possibly chemical and vagal dependent changes in fusimotor activity contribution to VT, as the latter increases. Obstruction at FRC shifted postvagotomy Aic vs. Adi relationship upwards, suggesting reflex facilitation of intercostals by chest wall receptors. The strength of this reflex was largely independent of intact vagi, since pre- and postvagotomy Aic vs. Adi relations coincided, and of chemical drive, since postvagotomy delta Aic/delta Adi for obstructed and unimpeded rebreathing were similar.

Airway Obstruction↗
PubMed1981

Cranio-caudal rib cage distortion with increasing inspiratory airflow in man.

Changes in anteroposterior and transverse diameters of the chest wall, in cranial and caudal esophageal pressure (delta Pes), and diaphragm (Adi) and cranial intercostal muscle activity (Aic) were measured in supine and seated subjects during relaxation and full inspirations from FRC at constant slow or high flow rates. No distortion of the rib cage occurred during relaxation of slow inspirations. During fast inspirations cranial part of rib cage expanded relatively more than caudal one because of greater Aic for any level of Adi. Rib cage distortion during fast inspirations, as well as the occurring between seated and supine posture, was directionally consistent with flow or posture related redistribution of apicobasal lung expansion, suggesting that changes in rib cage shape affect regional lung expansion also in man. During relaxation or slow inspirations cranio-caudal difference in delta Pes (delta Pc-c) was essentially nil over all the inspiratory capacity. During fast inspirations delta Pc-c was negative (seated posture) or nil (supine posture) for small lung volume increments, positive for large volume increments. Delta Pc-c dependence on lung volume is compatible with the response of a model consisting of two parallel compartments with different degree of expansion at FRC and equal volume dependent mechanical properties.

Diaphragm↗