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Mucociliary transport in chickens infected with Newcastle disease virus and exposed to sulfur dioxide.

Mucociliary transport was studied in the nasal mucous membranes and sinuses of 3-week-old chickens which were either exposed to sulfur dioxide (SO2), infected intranasally with the mesogenic strain of Newcastle disease virus (NDV), or exposed to SO2 after NDV infection. A newly developed apparatus was used to follow intranasal transport rates over time in the same animal, and to follow sinus transport rates over time in a separate group of animals. Intermittent exposure to concentrations of 1.4-66.0 ppm SO2 produced peaks of increased intranasal transport time, with intervening recovery periods. This suggests a homeostatic mechanism. Transport was also decelerated in the sinus when concentrations of SO2 were above 10 ppm. NDV infection produced decelerated intranasal transport rates but did not decelerate sinus rates. Combined NDV and SO2 interacted to produced persistent deceleration of the intransal transport rate. In the sinus, the combination seemed to conteract the decelerating effect of SO2 alone, suggesting a separate mechanism of homeostasis.

Animals↗
PubMed2006

Effect of stiffness and movement speed on selected dynamic torque characteristics of hydraulic-actuation joystick controls for heavy vehicles.

The purpose of this work was to quantify the effects of joystick stiffness and movement speed on the dynamic torque characteristics of hydraulic-actuation joystick controls, as found in off-road vehicles, as one of the initial steps towards the development of a joystick design protocol. Using a previously developed mathematical model in which a hydraulic-actuation joystick is assumed to rotate about two axes where the rotation origin is a universal joint, the dynamic torque characteristics incurred by an operator were predicted. Utilizing a laboratory mock-up of an excavator cab environment, three actuation torque characteristics (peak torque, angular impulse and deceleration at the hard endpoint) were quantified for nine unskilled joystick operators during the use of a commonly used North American hydraulic-actuation joystick. The six different experimental conditions included combinations of three joystick stiffnesses and two movement speeds. The highest instantaneous input torque over the course of the joystick movement (not including the hard endpoint) was evaluated using the peak torque value. Angular impulse provided an indication of the sustained exposure to force. The third indicator, deceleration at the hard endpoint, was included to provide a description of impact loading on the hand as the joystick came to a sudden stop. The most important result of this work is that the dynamic torque characteristics incurred during hydraulic-actuation joystick use are substantial. While the peak torque values were not very different between the fast and slow motion conditions, the high decelerations even for slow movements observed at maximum excursion of the joystick indicate that the dynamics do matter. On the basis of deceleration at the hard endpoint and peak torque, the joystick movements that require the highest values for a combination of torque variables are the side-to-side ones. This suggests that less stiff balance and return springs should be considered for these directions than for forward and backward movements. However, if the design does not minimize acceleration, it is important that the spring stiffness not be too low since deceleration at the joystick hard endpoint will be very high causing the operator to incur large palm and finger impacts.

Adult↗
PubMed2006

Fetal acidemia and electronic fetal heart rate patterns: is there evidence of an association?

OBJECTIVE: Despite the ubiquity of electronic fetal monitoring, the validity of the relationship between various fetal heart rate (FHR) patterns and fetal acidemia has not yet been established in a large unselected series of consecutive pregnancies. The aim of this study was to examine the published literature for evidence of such a relationship. METHODS: Four hypotheses based on assumptions in common clinical use were examined. The literature was searched for relationships between certain aspects of FHR patterns (e.g., degree of FHR variability, depth of decelerations), and fetal acidemia, or fetal vigor (5-minute Apgar score >or=7). We also attempted to relate duration of these patterns to the degree of acidemia. Using standardized FHR nomenclature we defined patterns based on baseline FHR variability, baseline rate, decelerations, and accelerations. RESULTS: The following relationships were observed: (1) Moderate FHR variability was strongly associated (98%) with an umbilical pH >7.15 or newborn vigor (5-minute Apgar score >or=7). (2) Undetectable or minimal FHR variability in the presence of late or variable decelerations was the most consistent predictor of newborn acidemia, though the association was only 23%. (3) There was a positive relationship between the degree of acidemia and the depth of decelerations or bradycardia. (4) Except for sudden profound bradycardia, newborn acidemia with decreasing FHR variability in combination with decelerations develops over a period of time approximating one hour. Most studies identified were observational and uncontrolled (grade III evidence of US Preventive Services Task Force); however, there was general agreement amongst the various studies, strengthening the validity of the observations. CONCLUSIONS: The validity of the relationship between certain FHR patterns and fetal acidemia and/or vigor, is supported by observations from the literature. In addition four assumptions commonly used in clinical management are supported. These conclusions need to be confirmed by a prospective examination of a large number of consecutive, unselected FHR patterns, and their relationship to newborn acidemia. Pending the completion of such studies, these observations can be used to justify certain aspects of current clinical management, and may assist in standardizing the diversity of opinions regarding FHR pattern management.

Acidosis↗
PubMed1994

Vibroacoustic stimulation of the fetus entering the second stage of labor.

OBJECTIVE: To evaluate the fetal heart rate (FHR) response to vibroacoustic stimulation of fetuses entering the second stage of labor as a predictor of neonatal outcome. METHODS: Three hundred sixteen cases and 316 controls were studied during the second stage of labor. All cases had vibroacoustic stimulation on entering the second stage of labor using an electronic artificial larynx. For control patients, the artificial larynx was not activated. The patients were stratified into groups based on the quality of FHR response: acceleration (n = 124), acceleration followed by deceleration (n = 120), and no response (n = 72). RESULTS: Subsequent FHR accelerations and accelerations followed by decelerations were significantly more frequent in the study group than in controls (77.2 versus 15.2%; P < .05). The frequencies of low 5-minute Apgar scores (below 7) and low umbilical cord arterial pH (below 7.20) did not differ significantly in the group with the acceleration response when compared to those with acceleration followed by deceleration and the no-response groups. The incidence of nuchal cord was significantly higher for the group with a response pattern of acceleration followed by deceleration than for the acceleration and no-response groups (39.2 versus 10.5 versus 11.1%; P < .05). CONCLUSIONS: Vibroacoustic stimulation in the second stage of labor is associated with FHR reactivity, but the quality of FHR response does not predict neonatal outcome and therefore appears to have little value in enhancing the management of the second stage of labor. However, an acceleration followed by deceleration response suggests the presence of nuchal cord.

Acoustic Stimulation↗
PubMed2002

Acceleration effect of coupled oscillator systems.

We have developed a curved isochron clock (CIC) by modifying the radial isochron clock to provide a clean example of the acceleration (deceleration) effect. By analyzing a two-body system of coupled CICs, we determined that an unbalanced mutual interaction caused by curved isochron sets is the minimum mechanism needed for generating the acceleration (deceleration) effect in coupled oscillator systems. From this we can see that the Sakaguchi and Kuramoto (SK) model, which is a class of nonfrustrated mean field model, has an acceleration (deceleration) effect mechanism. To study frustrated coupled oscillator systems, we extended the SK model to two oscillator associative memory models, one with symmetric and the other with asymmetric dilution of coupling, which also have the minimum mechanism of the acceleration (deceleration) effect. We theoretically found that the Onsager reaction term (ORT), which is unique to frustrated systems, plays an important role in the acceleration (deceleration) effect. These two models are ideal for evaluating the effect of the ORT because, with the exception of the ORT, they have the same order parameter equations. We found that the two models have identical macroscopic properties, except for the acceleration effect caused by the ORT. By comparing the results of the two models, we can extract the effect of the ORT from only the rotation speeds of the oscillators.

Animals↗
PubMed1991

Weak sensory stimuli induce a phase sensitive bradycardia.

We attempted to demonstrate that significant perceptual stimuli would induce different degrees of heart rate deceleration depending on when (phase) in the cardiac cycle they occurred. Relative to previous work, we concurrently examined a number of factors that might alter the amplitude of such a cardiac cycle time effect. Stimulus intensity and presence or absence of a speeded response were manipulated. Liminal stimuli and a perceptual rather than motor set were expected to maximize any cardiac cycle time effect. Respiratory phase, length of average interbeat interval, and number of trials were also investigated. Twenty-four college aged, male volunteers were randomly separated into equal groups receiving instructions either to judge which of two weak visual stimuli occurred or to execute a speeded, discriminative response to the stimuli. Discriminative stimuli were presented at either 0, 150, 250, 350, or 500 ms after the R-wave of the electrocardiogram. Stimuli were presented with an intensity that had yielded either 63% or 90% correct detections in a prior psychophysical assessment. A phase dependent deceleration occurred after both intensities of stimuli. Poststimulus deceleration was greater for stimuli in early to mid cycle as suggested by earlier work. As expected, this result was clear when the stimuli were presented during the expiratory phase of respiration. Neither perceptual/motor set nor stimulus intensity altered the phase sensitive deceleration. Thus, phase sensitive deceleration was confirmed using demanding sensory stimuli and an improved representational technique.

Adolescent↗
PubMed2000

The development and validation of an algorithm for real-time computerised fetal heart rate monitoring in labour.

OBJECTIVE: To develop and validate a computerised algorithm for the interpretation of the characteristics of fetal heart rate monitoring in labour. DESIGN: Prospective observational study. SETTING: Labour ward in a tertiary hospital. SAMPLE: Intrapartum cardiotocograms from 24 pregnancies. METHODS: A computerised algorithm was developed to assess the fetal heart baseline rate, variability, the number of accelerations and the number of decelerations. Twenty five minute segments of cardiotocograms were interpreted by the algorithm and also by seven expert reviewers independently. The reviewers were unaware of the outcome of labour. The reliability of the characteristics of cardiotocography and the validity of the computerised algorithm were assessed using the intraclass correlation coefficient and weighted kappa statistic for continuous and ordinal variables respectively. RESULTS: The inter rater reliability of the baseline fetal heart rate and the number and type of decelerations was good (intraclass correlation coefficient 0.93, 0.93 and 0.79, respectively). The reliability of baseline variability (kappa = 0.27) and accelerations (intraclass correlation coefficient = 0.27) was poor. The computerised algorithm had good agreement with the reviewers for the baseline fetal heart rate (intraclass correlation coefficient 0.91 to 0.98) and the number of decelerations (intraclass correlation coefficient 0.82 to 0.91), but was less valid as regards the number of late decelerations (intraclass correlation coefficient 0.68 to 0.85) and the number of accelerations (intraclass correlation coefficient 0.06 to 0.80), and was invalid as regards baseline variability (kappa 0.00 to 0.34). CONCLUSIONS: The high level of validity of the computerised algorithm for the estimation of the baseline fetal heart rate and the number of decelerations justifies its further technical development.

Adolescent↗
PubMed1990

Movement-related phasic muscle activation. II. Generation and functional role of the triphasic pattern.

1. Electromyographic (EMG) activity of arm movements made at constant velocity was studied in humans. In these movements, acceleration was temporally separated from deceleration by a period of constant velocity (zero acceleration) lasting up to 600 ms. 2. Agonist (AG1) and antagonist (ANT1) bursts were associated with acceleration. AG1 began before acceleration onset. ANT1 started after the onset of AG1 and was often partially coextensive with AG1. The initial phasic activity was followed by tonic EMG activity during the constant-velocity phase of the movements. Movement deceleration was associated with an antagonist burst (ANT2) and an agonist (AG2) burst. 3. Subjects could alter the magnitudes of the acceleration- and deceleration-related activities independently, with resulting independent changes in the movement acceleration and deceleration. 4. When the duration of the constant-velocity phase was decreased, the agonist/antagonist burst pairs occurred progressively closer in time. When movement duration was decreased to the point at which the velocity profile resembled that of step-tracking movements, the four periods of phasic EMG activity formed the classic triphasic pattern. 5. Triphasic EMG patterns were occasionally seen at the beginning or end of long-duration, constant-velocity movements. When they occurred, these triphasic patterns were associated with an acceleration/deceleration pattern similar to that seen in step-tracking movements. 6. The data indicate that paired agonist/antagonist activation is the basic unit of movement control. The AG1/ANT1 burst pair determines the increase and decrease of acceleration, respectively, and the ANT2/AG2 burst pair the increase and decrease of deceleration. These muscle activation pairs can be combined as needed to produce movements having different temporal characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Acceleration↗
PubMed1996

Cycle length dynamics and spatial stability at the onset of postinfarction monomorphic ventricular tachycardias induced in patients and canine preparations.

BACKGROUND: The aim of this study was to determine whether cycle length (CL) variations at the onset of monomorphic ventricular tachycardias follow distinctive patterns. METHODS AND RESULTS: We retrospectively analyzed 59 monomorphic ventricular tachycardias induced in 40 patients in whom intraoperative mapping was performed with 63 epicardial and 64 endocardial electrograms recorded simultaneously. Activation times and CL were determined at each electrode site over several beats (36+/-10 beats, mean+/-SD) starting with the first after programmed stimulation. In the majority of the tachycardias, CL variations were accounted for by fitting to an exponential function: CL=CLs+Ae-b/tau, where CLs is the stable CL, b is beat number, tau is the time constant (in beat number), and A is the magnitude of CL relaxation. A decelerating trend (with reference to rate) (negative A) accounted for 21 tachycardias, an accelerating trend in rate (positive A) accounted for 12 tachycardias, and 4 others displayed a double dynamic behavior, with an initial acceleration followed by a decelerating trend in rate. Among the ventricular tachycardias that were not fitted to exponential models, 12 showed a constant trend and 10 others showed irregular CL fluctuations. The monomorphic character of the tachycardias was established by principal-component analysis, which also indicated that CL dynamics associated with the accelerating and decelerating trends may be related to shortening and prolongation of activation times, respectively, occurring in equal proportion at all recording sites. In canine preparations in which reentry circuits could be mapped with high resolution, CL showed an accelerating trend in rate when circus movement of excitation occurred around a transmural scar in muscle generating unipolar electrograms with relatively high -dV/dtmax, and a decelerating trend in rate occurred when functional reentry occurred in muscle generating unipolar electrograms with depressed -dV/dtmax. CONCLUSIONS: Beat-to-beat CL variations may occur at the onset of sustained monomorphic ventricular tachycardia as a result of uniform acceleration or deceleration of activation times while the overall activation pattern remains constant. The associated initial trends in the rate of sustained monomorphic ventricular tachycardia follow typical patterns that might provide "signatures" corresponding to reentry substrates with distinctive functional properties.

Adult↗
PubMed1996

Changes in early and late diastolic filling patterns induced by long-term adrenergic beta-blockade in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: beta-Blockers have been used in patients with idiopathic dilated cardiomyopathy to improve cardiac performance and theoretically would be beneficial to diastolic function. However, there are few reports on changes in diastolic function during chronic pharmacological treatment of congestive heart failure. METHODS AND RESULTS: The present study was a substudy in the international Metoprolol in Dilated Cardiomyopathy Trial. Transmitral Doppler echocardiography was used to evaluate diastolic function in 77 patients randomly assigned to placebo (n = 37) or metoprolol (n = 40). The patients were treated for 12 months. Changes in Doppler flow variables in the metoprolol group implied a less restrictive filling pattern, expressed as an increase in E-wave deceleration time (placebo, 185 +/- 126 to 181 +/- 64 ms; metoprolol, 152 +/- 63 to 216 +/- 78 ms; P = .01, placebo versus metoprolol). Maximal increase in deceleration time had occurred by 3 months, whereas systolic recovery was achieved gradually and maximal effect was seen by 12 months of treatment. Although deceleration time was correlated to heart rate at baseline, changes in deceleration time were not significantly correlated to changes in heart rate during treatment. CONCLUSIONS: During the first 3 months of treatment, maximal effects on diastolic variables were reached, whereas the most prominent effect on systolic function was seen late in the study. It is suggested that effects on diastolic filling account for subsequent later myocardial systolic recovery. The E-wave deceleration time, which in recent studies has been shown to be a powerful predictor of survival, was significantly improved in the metoprolol-treated patients.

Adrenergic beta-Antagonists↗
PubMed2005

Quantitative assessment of harmonic power doppler myocardial perfusion imaging with intravenous Levovist in patients with myocardial infarction: comparison with myocardial viability evaluated by coronary flow reserve and coronary flow pattern of infarct-related artery.

BACKGROUND: Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. AIM: To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. METHODS: Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR). Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. RESULTS: Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time > or = 600 msec, Group B; 10 pts with deceleration time < 600 msec). In acute phase, there were no significant differences in left ventricular end-diastolic volume and ejection fraction (Left ventricular end-diastolic volume 112 +/- 33 vs. 146 +/- 38 ml, ejection fraction 50 +/- 7 vs. 45 +/- 9 %; group A vs. B). However, left ventricular end-diastolic volume in Group B was significantly larger than that in Group A (192 +/- 39 vs. 114 +/- 30 ml, p < 0.01), and ejection fraction in Group B was significantly lower than that in Group A (39 +/- 9 vs. 52 +/- 7%, p < 0.01) at 6 months. PIR and coronary flow velocity reserve of Group A were higher than Group B (PIR, at rest: 0.668 +/- 0.178 vs. 0.248 +/- 0.015, p < 0.0001: during hyperemia 0.725 +/- 0.194 vs. 0.295 +/- 0.107, p < 0.0001; coronary flow velocity reserve, 2.60 +/- 0.80 vs. 1.31 +/- 0.29, p = 0.0002, respectively). CONCLUSION: The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction.

Blood Flow Velocity↗
PubMed1998

Diving speeds and angles of a gyrfalcon (Falco rusticolus)

An optical tracking device recorded the three-dimensional paths of 11 dives by a 1.02 kg gyrfalcon, trained to dive to a falconer. The dives started at altitudes up to 500 m above the ground and were inclined at angles of 17-62 degrees from the horizontal. The falcon controlled its speed during the dives, rather than simply falling from the sky, and the dives had three phases. During the first (acceleration) phase, the falcon accelerated to speed limits between 52 and 58 m s-1 in the seven fastest dives, evidently with minimum drag, because its accelerations were close to those predicted from theory for minimum drag. The falcon then began a constant-speed phase by increasing drag by a factor of 1.3-4.8 while still 100-350 m above the ground in most dives. The constant-speed phase lasted no more than a few seconds, and the falcon then began a deceleration phase by increasing its drag further, this time by factors of 1.7-3. 2, and decelerating with a mean value of -0.95 times gravitational acceleration. During all three phases, the dive angle was nearly constant or increased during the deceleration phase, and the falcon made no changes in its body shape that were obvious through the tracking device telescope except to reduce its wing span as it accelerated. The falconer, however, was close to the falcon at the end of the dive and could see that, during the deceleration phase, the falcon held its wings in a cupped position, apparently with a high angle of attack and therefore high drag. At the end of the deceleration phase, the falcon dropped its legs, spread its toes and finally spread its wings as it approached the falconer. Although the speeds reported here are the fastest ever measured with known accuracy in animals, the falcon could theoretically have reached more than 70 m s-1 if it had continued to accelerate with minimum drag until close to the ground. Even at this speed, it would have had enough altitude to pull out of the dive before crashing into the ground. Several authors have estimated that diving falcons reach speeds of more than 70 m s-1, and wild falcons may reach such speeds when they make long, steep dives upon birds flying high in the air.

Journal Article↗
PubMed2002

Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation.

STUDY OBJECTIVE: The clinical usefulness of varying inspiratory flow waveforms during mechanical ventilation has not been adequately studied. The aim of this study was to compare the effects of three different respiratory waveforms on the pulmonary mechanics, gas exchange, and respiratory metabolism of ventilated patients with COPD. DESIGN: A randomized and comparative trial of consecutive patients. SETTING: Medical ICUs of a 2,000-bed university hospital. PATIENTS: Fifty-four patients with COPD were enrolled. INTERVENTIONS: Constant, decelerating, and sine waveforms were applied to each patient in a random order. MEASUREMENTS AND RESULTS: With tidal volume, inspiratory time, and inspiratory frequency being kept constant, the decelerating waveform produced statistically significant reductions of peak inspiratory pressure, mean airway resistance, physiologic dead space ventilation (VD/VT), PaCO(2), and symptom score. There was also a significant increase in alveolar-arterial oxygen pressure difference with the decelerating flow waveform, but there were no significant changes in mean airway pressure, arterial oxygenation, heart rate, mean BP, and other hemodynamic measurements. In addition, assessment on the work of breathing (WOB) revealed that ventilator WOB values were reduced with the decelerating waveform. Oxygen consumption and carbon dioxide output were virtually not affected by changing inspiratory flow waveforms. Except for VD/VT, the effects of constant square and sine waveforms were similar to each other and could not be separated statistically. CONCLUSIONS: The most favorable flow pattern for ventilated patients with COPD appeared to be the decelerating waveform. There are possibilities for the improvement of ventilation in these patients by selecting an appropriate inspiratory flow.

Aged↗
PubMed1997

European Community Multicentre Trial "Fetal ECG Analysis During Labour": the P-R interval.

The aim of the European Community Multicentre Trial on Fetal ECG Analysis During Labour was to collect a clinical database of electrocardiograms on which the different patterns of ST waveform and time interval changes, so far identified, could be studied. The aim of this paper was to study the PR-RR relationship and the P wave patterns during normal labour. One thousand three hundred fifty accelerations and 350 decelerations were analysed in 618 labours, all with normal fetal outcome. All ECGs were recorded with the STAN recorder and linked to a PC system for data acquisition and analysis. A positive relationship between P-R and R-R intervals was identified in all reactive fetal heart rate traces. A P-R shortening was identified also with all decelerations of more than 40 bpm from the baseline, resulting in a negative PR-RR relationship. Experimental works have described a P-R shortening concurrent with the maximal R-R lengthening during acutely induced hypoxemia in fetal lambs. In our study normal cord acid-base status indicated that the majority of bradycardia episodes recorded were not related to acute hypoxemia: PR-RR relationship changes seem therefore to indicate an intact physiological fetal heart adaptive response to rapid change in the environment of either hypoxemic or haemodynamic origin. A negative PR-RR relationship by itself seems to be nothing more than an indicator of decelerations during labour and seems unable to discriminate between decelerations of different origin. Finally the P wave was no longer detectable during decelerations of more than 800 msec: in this situation the P-R interval can not be reliably measured.

Electrocardiography↗
PubMed1977

Effect of stimulus context and repeated aversive visual stimulation on the cardiac correlate of attention.

The experiment investigated cardiac deceleration responses to repeated presentations of an aversive visual stimulus (a slide of a mutilated homicide victim) as a function of interspersing presentations of different types of other provocative visual stimuli amidst the aversive stimulus. 30 male volunteers were divided into three groups of 10 subjects each. One group viewed the aversive stimulus randomly interspersed with presentations of female nudes (positive context); a second group viewed the aversive stimulus amidst presentations of slides of skin-disease patients (negative context); and the third group viewed the aversive slide surrounded by presentations of other male undergraduates (neutral context). After repeatedly viewing the single homocide-victim slide, subjects viewed five different homicide scenes without contextual slides. These identical procedures were repeated during a second experimental session. A significant context-by-sessions interaction (p less than .05) reflected a decrement in cardiac deceleration over sessions for the positive context and an increase in deceleration from the first to the second session for the negative context. The neutral context did not affect cardiac deceleration over sessions. The series of different homicide scenes elicited greater cardiac deceleration than repeated exposures to the same slide. These results were discussed in terms of the possible role of stimulus context in affecting attention and vigilant-avoidant coping orientations.

Adolescent↗
PubMed2004

Evaluating short stature in children.

A child's growth reflects his or her general state of health. Growth deceleration therefore may result from processes that ultimately threaten much more than height and weight. Accurate height and weight measurements and routine plotting of growth data on standard growth charts are important elements of pediatric practice. A decrease in length of height percentiles may be physiologic in infancy and in puberty. However, in order to distinguish physiologic from pathologic growth deceleration, a careful history and physical examination needs to be obtained. Quite frequently, laboratory and radiographic studies are needed to distinguish with confidence between causes of slow growth in these phases of life. Such studies are always required to evaluate growth deceleration during childhood, because growth deceleration in this phase is virtually always the result of a pathological process. If constitutional growth delay is diagnosed, reassurance is often adequate treatment, though continued monitoring of growth and bone age is indicated. Growth deceleration due to other processes is often treatable. Delineation of the causes of poor growth is particularly important because these disease processes may produce other serious problems.

Adolescent↗
PubMed2002

Peroneal Reaction Times and Eversion Motor Response in Healthy and Unstable Ankles.

OBJECTIVE: To measure and compare latency, electromechanical delay, and speed of motor response of the peroneus longus muscle in a large sample of subjects with healthy or unstable ankles. DESIGN AND SETTING: Subjects with healthy or unstable ankles underwent identical test procedures consisting of 6 consecutive, sudden 50 degrees ankle-inversion movements in the standing position with full weight on the tested leg. Latency, first and second decelerations, and total inversion time were monitored. In a separate setting, electromechanical delay was measured during a voluntary ankle eversion. SUBJECTS: We tested 81 subjects (27 males, 54 females) with healthy ankles or unilateral or bilateral ankle instability: 40 individuals with 48 unstable ankles (18 males, 22 females; age range, 18 to 23 years), and 41 individuals with 46 healthy ankles (9 males, 32 females; age range 15 to 29 years). MEASUREMENTS: Using surface electromyography, the latency of the peroneus longus muscle was measured during sudden inversion. Simultaneously, using accelerometry, first and second decelerations were measured. Separately, the electromechanical delay was measured using electromyography and accelerometry. RESULTS: The time of the first deceleration was significantly shorter in subjects with unstable ankles (25.5 milliseconds versus 28.4 milliseconds for those with healthy ankles). The latency, total inversion time, second deceleration time, and electromechanical delay were not shown to be significantly different between healthy and unstable ankles. CONCLUSIONS: The significantly shorter first deceleration during sudden inversion in the standing position in subjects with unstable ankles compared with subjects with healthy ankles is explained by less control of inversion speed in the first phase of the sudden inversion in unstable ankles. Our study does not confirm the results of the systematic literature search showing a longer latency in subjects with unstable ankles.

Journal Article↗
PubMed2005

[Effect of atrial fibrillation on left ventricle function in the elderly].

INTRODUCTION: Atrial fibrillation (FA) coexists with heart failure, and its occurrence frequency increases with age. This arrhythmia can precede heart failure as well as can be a consequence of cardiac function deterioration. AIM OF STUDY: The influence of atrial fibrillation on left ventricle (LV) function assessed by echocardiography in the elderly. Investigated group. Study group consists of 30 older patients 75,9 (+/- 4,6) years old with chronic atrial fibrillation, mean duration 319,5 (+/- 292,5) days and 30 younger patients 56,7 (+/- 3,7) years old with atrial fibrillation, mean duration 254,2 (+/- 191,2) days. In control group were 30 persons 74,7 (+/- 5,1) years old with sinus rhythm (SR). In all patients transthoracic (TTE) echocardiography was performed to assess following parameters: end-diastolic diameter of LV (LVEDd), end-systolic diameter of LV (LVESd), fractional shortening of LV (FS LK), stroke volume of LV (SV LK), cardiac output (CO), ejection fraction of LV (EF LK), preejection period of LV (PEP LK), ejection period of LV (LVET), maximal aortic flow velocity (V max LK), maximal velocity of mitral early diastolic flow (E ampl LK), deceleration time of mitral early diastolic flow (E dcct LK). Consequently transoesophageal (TEE) echocardiography was made to record flow in left superior pulmonary vein (LSPV) and following parameters were measured: maximal systolic flow velocity in LSPV (PVS), maximal diastolic flow velocity in LSPV (PVD), integral of systolic flow in LSPV (PVS intg), deceleration time of diastolic flow in LSPV (PVD dcct). During Holter electrocardiographic recording were calculated: maximal heart rate (HR max), minimal heart rate (HR min), mean heart rate (Hr sr). RESULTS: Older patients with atrial fibrillation characterised significantly lower EF LK and FS LK than younger patients and older patients with sinus rhythm. Most of Doppler echocardiographic parameters recorded from aortic flow as well as measured in left superior pulmonary vein have lower values in older patients with arrhythmia compared to younger ones. LVEDd was significantly greater in older patients with atrial fibrillation than in those with sinus rhythm. E ampl LK was markedly lower in older patients with atrial fibrillation and coexisted with shortening deceleration time of this flow in this group of patients. PVD did not differ in studied groups but deceleration time of this flow similarly to deceleration time of mitral flow was markedly shortened in older group of patients with arrhythmia. HR mean and Hr max in older patients with atrial fibrillation were significantly higher in older patients with atrial fibrillation compared to those without arrhythmia whereas HR min did not differ between mentioned groups. HR mean calculated from 24 hours correlated with poorer hemodynamic parameters of left ventricle. CONCLUSIONS: Atrial fibrillation in the elderly causes greater systolic and diastolic dysfunction of left ventricle compared to younger patients with this kind of arrhythmia. The left ventricle contractility deterioration in older patients with atrial fibrillation correlates with high maximal and mean diurnal heart rate.

Aged↗