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Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods.

Beat-to-beat heart rate variability analysis is a powerful tool for the diagnosis of neuropathy. Respiration-related heart rate variability (respiratory sinus arrhythmia, RSA) reflects the function of parasympathetic nervous system during spontaneous ventilation while awake. RSA is also claimed to monitor the depth of anaesthesia. Power spectrum analysis or various averaging techniques of the heart rate variability are usually applied. The current literature, however, does not usually interpret the ground rules and limitations of the method used, and this may sometimes lead to erroneous conclusions on the data. The aim of our study was to compare and analyse critically the performance of different methods of evaluating RSA during anaesthesia and positive pressure ventilation. Power spectrum analysis, the root mean square of the successive RR-interval difference (RMSSD), and two respiration related methods, RSA index and average phase RSA, were included in the comparison. To test these methods, 11 patients were anaesthetised with isoflurane and their lungs were ventilated mechanically with a frequency of 6 cycles min-1. Each patient received a bolus dose of atropine (20 micrograms kg-1) during the trial. Electrocardiogram, electroencephalogram and tracheal pressure signal from respirator were recorded and analyses were performed off-line. We demonstrated that general indices, such as RMSSD, may be strongly affected by heart rate level and other non-respiration related variations in heart rate. We also showed that the effect of unwanted fluctuations on RSA can be reduced with respiration dependent beat-to-beat methods. Furthermore we confirmed that in addition to the amplitude, also the pattern of respiratory sinus arrhythmia is of interest: the pattern is reversed in phase compared to spontaneous breathing while awake, as we have shown earlier. To analyse RSA during anaesthesia, we recommend the use of an average phase RSA method based on beat-to-beat variability that shows both the amplitude and pattern of RSA. Finally, no measure of RSA should be used without a presentation of the actual beat-to-beat heart rate curve.

Adjuvants, Anesthesia↗

Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.

OBJECTIVE: To determine the dynamic force-time and force-frequency characteristics of the Activator Adjusting Instrument and to validate its effectiveness as a mechanical impedance measurement device; in addition, to refine or optimize the force-frequency characteristics of the Activator Adjusting Instrument to provide enhanced dynamic structural measurement reliability and accuracy. METHODS: An idealized test structure consisting of a rectangular steel beam with a static stiffness similar to that of the human thoracolumbar spine was used for validation of a method to determine the dynamic mechanical response of the spine. The Activator Adjusting Instrument equipped with a load cell and accelerometer was used to measure forces and accelerations during mechanical excitation of the steel beam. Driving point and transfer mechanical impedance and resonant frequency of the beam were determined by use of a frequency spectrum analysis for different force settings, stylus masses, and stylus tips. Results were compared with beam theory and transfer impedance measurements obtained by use of a commercial electronic PCB impact hammer. RESULTS: The Activator Adjusting Instrument imparted a very complex dynamic impact comprising an initial high force (116 to 140 N), short duration pulse (<0.1 ms) followed by several lower force (30 to 100 N), longer duration impulses (1 to 5 ms). The force profile was highly reproducible in terms of the peak impulse forces delivered to the beam structure (<8% variance). Spectrum analysis of the Activator Adjusting Instrument impulse indicated that the Activator Adjusting Instrument has a variable force spectrum and delivers its peak energy at a frequency of 20 Hz. Added masses and different durometer stylus tips had very little influence on the Activator Adjusting Instrument force spectrum. The resonant frequency of the beam was accurately predicted by both the Activator Adjusting Instrument and electronic PCB impact hammer, but variations in the magnitude of the driving point impedance at the resonant frequency were high (67%) compared with the transfer impedance measurements obtained with the electronic PCB impact hammer, which had a more uniform force spectrum and was more repeatable (<10% variation). The addition of a preload-control frame to the Activator Adjusting Instrument improved the characteristics of the force frequency spectrum and repeatability of the driving point impedance measurements. CONCLUSION: These findings indicate that the Activator Adjusting Instrument combined with an integral load cell and accelerometer was able to obtain an accurate description of a steel beam with readily identifiable geometric and dynamic mechanical properties. These findings support the rationale for using the device to assess the dynamic mechanical behavior of the vertebral column. Such information would be useful for SMT and may ultimately be used to evaluate the [corrected] biomechanical effectiveness of various manipulative, surgical, and rehabilitative spinal procedures.

Acceleration↗

Multiplex polymerase chain reaction-based analysis of T-cell receptor gamma gene rearrangements for the determination of T-lymphocyte clonality.

Determination of the frequency of mutations at hprt or other loci in human lymphocytes provides a useful biomarker for human exposure to mutagens. One problem, however, is distinguishing between unique mutants and sibling mutants arising as progeny of an earlier mutant cell. We have developed a multiplex polymerase chain reaction (PCR)-based method to analyze T-cell receptor (TCR) gamma gene rearrangements for determination of T-cell clonality in mutational spectrum analysis. PCR primers for different subgroups of the V gene segment of the TCR gamma gene were selected at different sites in the TCR gamma gene so that the size of PCR products could define which V subgroup was involved in rearranged TCR gamma genes; gamma genes involving different V and J subgroups could be determined directly by PCR. Mutant T-lymphocytes with rearranged TCR gamma genes containing the same V and J subgroups were analyzed using PCR-based denaturing polyacrylamide gel electrophoresis. All of the 161 hprt mutant clones analyzed contained rearranged TCR gamma genes. Rearrangements among all subgroups of the V and J gene segments of the TCR gamma gene could be detected. VgammaI and Jgamma1/2 subgroups were involved in 69 and 71% of rearranged TCR gamma genes, respectively. This PCR-based analysis of TCR gamma gene rearrangements provides a simple and comprehensive method for identifying the clonality of mutant T-lymphocytes in human hprt mutant lymphocyte assay and mutational spectrum analysis.

Electrophoresis, Polyacrylamide Gel↗

Carotid endarterectomy without angiography.

Three patients with unilateral hemispheric symptoms suggestive of extracranial carotid occlusive disease and one patient with bilateral symptoms who were allergic to radiographic contrast media were studied by pulsed Doppler ultrasonic arteriography and real time spectrum analysis. Four high grade (greater than 50% diameter reduction) internal carotid stenoses and one low grade (less than 50% diameter reduction) stenosis were identified. The noninvasive findings were confirmed at endarterectomy in all five arteries. Pulsed Doppler ultrasonic imaging combined with real time spectrum analysis can accurately quantitate the degree of atherosclerotic stenosis at the carotid bifurcation. Experience with these four patients suggests that these techniques can be used in lieu of angiography to evaluate patients who are unable to undergo standard radiographic examination.

Aged↗

Seasonality of mortality in Sri Lanka: biometeorological considerations.

The seasonal variation of mortality in Sri Lanka was studied in relation to meteorological variables. Time series data of the total monthly number of deaths in men and women from 1976 to 1980 were analyzed by power spectrum analysis of the fast Fourier transformation method in the areas of Colombo (lowland area, altitude 7 m) and Nuwara-Eliya (highland area, altitude 1890 m), respectively. In the Colombo area, where the mean temperature was always high (mean, 27.5 degrees C), a seasonal variation in mortality of 6 months was validated by power spectrum analysis with peak times in June and November. These mortality peaks corresponded to those of the amounts of rainfall which also showed an identical predominant period of 6 months. In the Nuwara Eliya area, where the mean temperature was always low at about 15-16 degrees C, a seasonal variation of approximately 3 months was found in addition to the 6 months' periodicity. The comparison of the power spectrum pattern of mortality with those of meteorological variables suggested that the amount of rainfall was associated with the seasonal variation of mortality in the Nuwara-Eliya area. In conclusion, the seasonality of mortality in Sri Lanka, a typical tropical zone country, was related to seasonal variation in the amount of rainfall, or a humidity factor, but not to mean temperature.

Female↗

Early abnormalities of vascular and cardiac autonomic control in Parkinson's disease without orthostatic hypotension.

Cardiac autonomic abnormalities have been described in Parkinson's disease. Little is known about possible alterations of vascular sympathetic regulatory activity in patients without orthostatic hypotension or symptoms of orthostatic intolerance. Nineteen patients with Parkinson's disease without orthostatic hypotension (PD), 21 with orthostatic hypotension (PDOH), and 20 healthy controls underwent ECG, beat-to-beat arterial pressure, and respiration recordings while recumbent and during a 75 degrees head-up tilt. Spectrum analysis of RR interval and systolic arterial pressure (SAP) variability provided indices of cardiac sympathovagal interaction (low frequency [LF]/high frequency [HF]) to the sinoatrial node and sympathetic vasomotor control (LF(SAP)). Arterial baroreceptor mechanisms were assessed by the spontaneous sequences technique and bivariate spectrum analysis (alpha index). Plasma catecholamines provided the neurohormonal profile. At rest, hemodynamics and spectral markers of autonomic function were similar in PD and control subjects. Norepinephrine was lower in PD and PDOH than in control subjects. In PDOH, SAP was higher, whereas LF/HF ratio and LF(SAP) were lower compared with control subjects. During tilt, SAP was unchanged in PD; however, similar to PDOH, the increase of heart rate, LF/HF ratio, and LF(SAP) was blunted compared with control subjects. Baroreflex indices were unmodified in PD and PDOH compared with control subjects. Initial alterations in both cardiac and vascular sympathetic modulatory activity were found in PD and revealed by a gravitational stimulus. Prompt recognition of sympathetic abnormalities might result in earlier therapeutic intervention, reduced orthostatic intolerance, and increased quality of life.

Aged↗

Autonomic nervous activity before and after eradication of Helicobacter pylori in patients with chronic duodenal ulcer.

BACKGROUND: Helicobacter pylori infection is involved in the formation of chronic peptic ulcer. However, a previously reported hypothesis concerning the involvement of central autonomic nervous disorder in this condition cannot be ruled out. AIM: To use spectrum analysis of heart rate viability to examine autonomic nervous activity before and after H. pylori eradication. METHODS: Twenty patients with chronic duodenal ulcer (duodenal ulcer group) and 20 age-matched normal adults (N group). In both groups, 24-h Holter electrocardiograms (ECGs) were recorded and spectrum analysis of heartrate variability was performed. In the duodenal ulcer group, Holter ECG was recorded before and after H. pylori eradication. RESULTS: In the N group, analysis of heart rate variability showed that high frequency (HF) power, an index of parasympathetic activity, was high at night, while the low frequency (LF)/HF ratio, an index of sympathetic function, was high during the daytime. In the duodenal ulcer group, HF power was higher at night than during the daytime, showing a similar pattern to the N group, but the power value was higher than in the N group (P < 0.05). In the duodenal ulcer group, LF/HF at night was significantly higher than that of the N group. In addition, in the duodenal ulcer group, autonomic activity after H. pylori eradication did not differ significantly from that before H. pylori eradication. CONCLUSIONS: In patients with chronic peptic ulcer, both sympatheticotonia and parasympatheticotonia may occur at night, and this abnormality in autonomic nervous activity may cause increased gastric acid secretion and gastric mucosal vasoconstriction. Abnormalities in autonomic activity persist even after H. pylori eradication, suggesting that they may be an independent risk factor in the formation of chronic peptic ulcer in addition to H. pylori infection.

Autonomic Nervous System Diseases↗

Dysfunctional baroreflex regulation of sympathetic nerve activity in remitted patients with panic disorder. A new methodological approach.

BACKGROUND: Many researchers have studied the abnormalities of autonomic nervous system (ANS) such as decreased heart rate variability, which is a risk factor for sudden cardiac death, in patients with panic disorder (PD). However, no consistent abnormality has been uncovered to date. One of the reasons for this controversy may be due to the fact that most of these conventional studies have analyzed each physiological variable independent of other indices. We examined the ANS in PD patients using a new method which can more directly investigate the function of the baroreflex by examining the relation between the blood pressure (BP) and heart rate (HR). METHODS: During rest and audiovisual stimulation (AS) as mental stress such as being exposed to video imaginary of experiences such as driving motor vehicles, cardiovascular parameters, HR and BP were consecutively measured in 13 remitted PD patients and twenty aged and gender-matched normal controls (NC). In this study, to assess the cardiovascular ANS function (baroreflex) in PD we used the power spectrum analysis as usual and the mean of lag time (tau) between the Mayer wave components, which was closely related to sympathetic nerve activity of vasomotor, of HR and BP variability as a new trial. RESULTS: The PD patients and NC did not differ with regard to the power spectrum analysis of the heart rate. We found that tau in the PD group was significantly shorter than that in the NC both before and after AS, especially before. CONCLUSIONS: These findings suggest that remitted PD patients may have a dysfunctional baroreflex regulation of sympathetic nerve activity.

Acoustic Stimulation↗

Simultaneous analysis of 4- and 5-series lipoxygenase and cytochrome P450 products from different biological sources by reversed-phase high-performance liquid chromatographic technique.

Quantification of lipoxygenase and cytochrome P450 products of both arachidonic acid (AA) and eicosapentaenoic acid (EPA) is of broad interest due to the multiple biological activities of these compounds. We developed a method combining (i) solid-phase extraction, (ii) isocratic reversed-phase high-performance liquid chromatographic separation, and (iii) online photodiode array detection with spectrum analysis for identification and measurement of all main 4- and 5-series eicosanoids (leukotrienes, hydroxyeicosatetraenoic acids/hydroxyeicosapentaenoic acids, epoxyeicosatrienoic acids) within one run. With these procedures, standard mixtures of AA- and EPA-derived lipid mediators were recovered from different biological liquids, like lung perfusate, human bronchoalveolar lavage fluid, and cell supernatant with linear characteristics for each compound. Recoveries of the different lipid mediators exceeded 80% showing excellent reproducibility. Application of the method to isolated, perfused, and ventilated human lungs challenged with the calcium ionophore A23187 and to human neutrophils stimulated in the presence of arachidonic acid and eicosapentaenoic acid with N-formyl-methionyl-leucyl-phenylalanine demonstrated the generation of a large array of lipoxygenase and cytochrome P450 products. Thus, convenient quantification of 4- and 5-series eicosanoids in fluids of biological interest is achieved by a technique comprising solid-phase extraction, isocratic reversed-phase high-performance liquid chromatography, and photodiode array-based online spectrum analysis of eluting compounds.

Arachidonate 5-Lipoxygenase↗

Effects of angiotensin I-converting enzyme inhibitor from Ashitaba (Angelica keiskei) on blood pressure of spontaneously hypertensive rats.

The inhibitory activity of angiotensin I-converting enzyme (ACE) was extracted with 80% ethanol from the leaves of Ashitaba (Angelica keiskei). The present ACE inhibitor was fractionated and separated with various chromatographies. The antihypertensive effects of the sample (G fraction) from Ashitaba on spontaneously hypertensive rats (SHR) were observed by long-term administration for 10 wk. Another sample (S fraction) from Ashitaba also had antihypertensive effects after a single intravenous administration to SHR. The sample was further purified by using several chromatographies. The ACE inhibitor fraction was characterized as follows: no significant absorbance, a zwitterion, a water-soluble substance and a positive ninhydrin reaction. According to a mass spectrum analysis, the molecular weight of the ACE inhibitor was determined to be 303 and Na-salt ions of carboxyl groups were detected. The ACE inhibitor from Ashitaba contained in the anti-hypertensive fraction was speculated to be very similar to authentic nicotianamine based on a comparative study of inhibitory activity, mass spectrum analysis and thin-layer chromatographies.

Angiotensin-Converting Enzyme Inhibitors↗

Alterations in R-R variability associated with experimental motion sickness.

Motion sickness is a complex integration of responses from multiple physiological systems. Whether the changes that occur during the time course of motion sickness are mediated by the sympathetic or parasympathetic systems is still controversial. The present study evaluates alterations in R-R variability during experimental motion sickness in motion sick and non-motion sick subjects. Ten motion sick subjects and 7 non-motion sick subjects participated in the study. Power spectrum analysis of R-R variation was conducted for all subjects 10 min before a brief vestibular disorientation test (BVDT), for 5-10 min of the test, and 10 min after the test. Subjects were also asked to report their symptoms during the test. The motion sick group showed a significant reduction in the power spectrum density of the R-R interval at the mid and high frequencies during the BVDT test period (BVDT), in comparison with the rest period (Rest). These changes probably indicate a decrease in parasympathetic activity during the time course of motion sickness. The non-motion sick group did not show significant differences at any of the frequencies during BVDT. Power spectrum analysis of the R-R interval provides an objective measure of the autonomic response to experimental motion sickness.

Adolescent↗

Effects of stroke localization on cardiac autonomic balance and sudden death.

BACKGROUND AND PURPOSE: Stroke has been shown to alter autonomic function. The purpose of this study was to show the differential effects of stroke localization on autonomic function parameters assessed by heart rate variability (HRV). METHODS: To determine the differential effect of ischemic stroke localization on autonomic cardiac innervation, we evaluated 62 patients with ischemic stroke and 62 age- and sex-matched controls. The localization of the infarct was determined by CT and MRI. Power spectrum analysis of HRV was performed. Myocardial necrosis was ruled out by echocardiography and creatine kinase myocardial isoenzymes measurements. RESULTS: All stroke patients had significantly decreased low frequency, high frequency, and standard deviation of all relative risk intervals values (P<0.001). However, patients with right-middle cerebral artery (R-MCA) and insula lesions had significantly lower power spectrum analysis values compared with all other localizations (P<0.001). In addition, 5 patients with R-MCA insular lesions died suddenly compared with 2 patients with left-middle cerebral artery insular lesions during hospitalization. Both sympathetic- and parasympathetic-controlled HRV were decreased in patients with ischemic stroke. The most pronounced decrease was found in the territory of R-MCA insular cortex, which suggests that cardiac autonomic tone may be regulated by insula and that these patients are more prone to cardiac complications such as arrhythmias and sudden death due to autonomic imbalance. CONCLUSION: We conclude that stroke in the region of insula (especially the right) leads to decreased HRV and to increased incidence of sudden death.

Aged↗

Autoinflation of eustachian tube in young children.

Inflation of the middle ear has long been thought to be beneficial in the treatment of otitis media. We describe a new system of autoinflation based on a modified Valsalva technique consisting of an anesthesia mask and a flowmeter which can be used successfully by children. An objective method to record eustachian tube opening during autoinflation using frequency spectrum analysis of the ear canal sounds is also presented. Tubal opening results of this method were compared to the traditional method using preinflation and postinflation tympanometry. Study subjects included 20 adults with normal otologic findings and 35 children with middle-ear effusion; all together 107 ears of children and adults with and without effusion were tested. Using the frequency spectrum analysis, tubal opening was recorded in 75% of adult ears and 56% of children's ears. Also, in both groups, a sound pressure peak with the same characteristic frequency around 2 kHz was associated with tubal openings. The methods described are incorporated into a clinical trial being conducted at the Children's Hospital of Pittsburgh.

Acoustic Impedance Tests↗

Live recordings of sound levels during the use of powered instruments in ENT surgery.

Otolaryngology is one of the surgical specialities employing high-powered instruments and this study was designed in order to establish whether sound levels at work conform to HSE guidelines. No study to date has measured intra-operative noise levels in ENT operation theatres. A prospective observational study was therefore performed. Sound levels were measured during the use of bone drills for mastoid surgery and microdebriders for endoscopic sinus surgery. A SLM/IS Acos Class I sound level meter calibrated to BS 1259 was employed. A spectrum analysis of drill-generated noise was measured using a calibrated B and K precision sound level meter. Sound levels emitted varied as follows: Large burrs- 72.4 dB (A), medium size; 71.2 dB (A), small sized burrs- 68.8 dB (A) (all values for cutting burrs) and 60.8 dB (A) for diamond burs. With microdebriders, the average sound level was 60.1 dBA. Spectrum analysis revealed that the maximum intensity was at 3.15 kHz, followed by 4 kHz, while the least sound was produced at 40 kHz and 31.5 kHz. Essentially sound produced by drills was between 1.6 kHz and 6.3 kHz. Powered instruments used in ENT surgery are safe and pose no occupational hazard.

Humans↗

Comparison of vocal tract formants in singing and nonperiodic phonation.

The skilled use of nonperiodic phonation techniques in combination with spectrum analysis has been proposed here as a practical method for locating formant frequencies in the singing voice. The study addresses the question of the degree of similarity between sung phonations and their nonperiodic imitations, with respect to both frequency of the first two formants as well as posture of the vocal tract. Using magnetic resonance imaging (MRI), linear predictive coding (LPC), and spectrum analysis, two types of nonperiodic phonation (ingressive and vocal fry) are compared with singing phonations to determine the degree of similarity/difference in acoustic and spatial dimensions of the vocal tract when these phonation types are used to approximate the postures of singing. In comparing phonation types, the close similarity in acoustic data in combination with the relative dissimilarity in spatial data indicates that the accurate imitations are not primarily the result of imitating the singing postures, but have instead an aural basis.

Acoustics↗

Throaty voice quality: subglottal pressure, voice source, and formant characteristics.

"Throaty" voice quality has been regarded by voice pedagogues as undesired and even harmful. This study attempts to identify acoustic and physiological correlates of this quality. One male and one female subject read a text habitually and with a throaty voice quality. Oral pressure during p-occlusion was measured as an estimate of subglottal pressure. Long-term average spectrum analysis described the average spectrum characteristics. Sixteen syllables, perceptually evaluated with regard to throaty quality by five experts, were selected for analysis. Formant frequencies and voice source characteristics were measured by means of inverse filtering, and the vocal tract shape of the throaty and normal versions of the vowels [a,u,i,ae] of the male subject were recorded by magnetic resonance imaging. From this material, area functions were derived and their resonance frequencies were determined. The throaty versions of these four vowels all showed a pharynx that was narrower than in the habitually produced versions. To test the relevance of formant frequencies to perceived throaty quality, experts rated degree of throatiness in synthetic vowel samples, in which the measured formant frequency values of the subject were used. The main acoustic correlates of throatiness seemed to be an increase of F1, a decrease of F4, and in front vowels a decrease of F2, which presumably results from a narrowing of the pharynx. In the male subject, voice source parameters suggested a more hyperfunctional voice in throaty samples.

Female↗

[Effects of antitussive drugs on the central respiratory mechanisms during the cough reflex].

Effects of antitussive drugs on the phrenic nerve activities during the cough reflex were investigated by means of a power spectrum analysis as a quantitative evaluation of each of the frequency band components of the phrenic nerve activities in anesthetized dogs. The efferent activities of the phrenic nerve were recorded from the central cut end of the phrenic nerve. Each fraction of the phrenic nerve activity was fractionated into bands spanning a range of 100 Hz each by a variable filter and analyzed using a program for the power spectrum analysis. The increase in power of each of the frequency band components was observed during the cough reflex induced by mechanical stimulation of the tracheal mucosa. Particularly, the power of the 2 approximately 100 Hz band components increased significantly as compared with the other frequency band components. An i.v. administration of codeine (3 mg/kg) significantly inhibited the increase in power of all frequency band components during the cough reflex. After administration of dextromethorphan (10 mg/kg, i.v.) or fominoben (8 mg/kg, i.v.), the increase in power of the 2 approximately 100 Hz band components of the phrenic nerve activity during the cough reflex was decreased significantly for 5 approximately 10 min; however, the other frequency band components were not affected. These results provide some evidence for a difference between these three antitussive drugs with respect to the mechanisms of action in the process of the central integration for the cough reflex.

Animals↗

The fast Fourier transform in the analysis of the normal phonocardiogram.

The present study is focused on spectrum analysis as a useful method of processing the PCG in order to obtain the frequency spectral distribution of normal heart sounds. Thirty normal subjects aged from 17 to 34 were studied. PCG was recorded on the fourth intercostal space at the left sternal border using a sound level meter coupled with a standard 6 ml cavity. The microphone had a linear response from 0.2 to 8,000 Hz. The signal was filtered with the standard B network according to the ANSI specifications and was registered on a four track FM tape recorder. A four channel analyzer with a microprocessor for off-line elaborations was used with 10 KHz sampling frequency. The PCG signal was triggered by a QRS detector on the R wave of the simultaneously recorded ECG. Fast Fourier transform was performed employing either a four channel analyzer with a microprocessor, or an A/D converter with a computer. Finally the results of the analysis were statistically elaborated. The described procedures permit to obtain a direct and exact tracing of the acoustic features of the heart, thus representing an attempt to come closer to the standardization and automatic analysis of the phonocardiographic technique.

Adolescent↗