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PubMed1988

[Improving color Doppler echocardiography of the right heart chambers following intravenous injection of SHU 454].

The echocardiographic contrast agent SHU 454 provides microbubbles of defined size (median 3 micron) in a solution of galactose and is available in different reproducible concentrations. In 22 patients with suspected tricuspid regurgitation, color flow mapping (CFM) Doppler echocardiography was performed before and after intravenous injection of 2-4 ml SHU 454. Without SHU 454 the diastolic blood flow was imaged on 13.6 +/- 7.5% (mean value + standard deviation) of the cross sectional area of the right ventricle (four-chamber view) in comparison to 39.0 +/- 15.0% with SHU 454 (p less than 0.001). For the right atrium, the area analyzed by CFM increased from 9.4 +/- 12.9% to 62.4 +/- 25.3% (p less than 0.001). The interindividual variability of measurements after injection of SHU 454 was 5.9 +/- 4.0% as compared to 10.7 +/- 6.9% without SHU 454 (p less than 0.05). These findings demonstrate that intravenous SHU 454 administration increases the detection of blood flow by CFM within the right heart.

Adult↗
PubMed2000

Tissue Doppler imaging of the fetal heart.

OBJECTIVES: The objectives of this study were: (i) to assess the feasibility of a tissue Doppler imaging (TDI) evaluation in the fetus, (ii) to identify color-TDI patterns consistent with the various phases of the cardiac cycle; and (iii) to assess myocardial velocities and the myocardial velocity gradient. METHODS: Eighty-nine normal fetuses between the 17th and the 37th week of gestation were studied. Color-TDI was superimposed on an apical four-chamber view of the fetal heart and three cardiac cycles captured in cine-loop format. By reviewing the cine-loop strip, color patterns consistent with the various phases of the cardiac cycle were identified. The procedure was then repeated with a transverse four-chamber view. On each frame corresponding to mid-systole, early and late diastole, myocardial velocities were calculated at the subepicardial and subendocardial layer and regressed against gestational age. Statistics included correlation and regression analysis, calculation of the 95% confidence intervals and of the Cronbach's alpha reliability coefficient for repeated observations. RESULTS: TDI examination is acceptably reproducible in the fetus. We were able to identify color-TDI patterns depicting the systolic contraction wave, ventricular relaxation and atrial contraction. Statistical evaluation demonstrated that: all variables (systolic right and left subendocardial and subepicardial velocities, early diastolic right and left subendocardial and subepicardial velocities, end diastolic right and left subendocardial velocities, right subepicardial velocities) except end-diastolic right and left subepicardial velocities, showed a positive correlation with advancing gestational age; subendocardial velocities were higher than subepicardial ones throughout the cardiac cycle in both ventricles; systolic myocardial velocities were higher in the left ventricle whereas early diastolic velocities were higher in the right ventricle; and the ratio between early and late diastolic subendocardial velocities (EM/AM) was constantly < 1 and did not change with advancing gestational age. CONCLUSIONS: TDI evaluation of the fetal heart is feasible and reproducible. Color-TDI is able to identify the various phases of the cardiac cycle. Quantitative evaluation of myocardial velocities has shown also in the fetus the existence of the myocardial velocity gradient found in postnatal life.

Blood Flow Velocity↗
PubMed1989

Canine bone blood flow estimated with microspheres.

Blood flow rate in the periosteal and endosteal cortices of the diaphysis of long bones was determined in eight anesthetized adult dogs using the radioactively labeled microsphere method. The flow rate in endosteal and periosteal cortices is not significantly different unless the endosteal cortex contains cancellous bone from the medullary cavity. The highest flow rate is in the ulna, with 6.50 ml/min/100 g for the endosteal cortex and 5.15 ml/min/100 g for the periosteal cortex. The lowest flow rate is in the femur, with 2.89 ml/min/100 g for the endosteal cortex and 2.29 ml/min/100 g for the periosteal cortex. The results of this study indicate that variation of blood flow does exist between bones of dogs. However, the flow rates of individual bone on the left and right sides in the same dog are not significantly different. This indicates that the data are reproducible and reliable, and differences are not an inaccuracy of the radioactively labeled microsphere method. The results also demonstrate that there are no significant differences in bone blood flow as measured with small numbers (fewer than 400 microspheres per sample) and large numbers (more than 400 microspheres per sample) of microspheres. The adequate number of microspheres in each bone sample is 150-250. Therefore, a dose of 0.5 x 10(6) spheres/kg body weight can be sufficient.

Animals↗
PubMed1989

Anomalous influence of reduced internal ATP levels on sodium efflux in Myxicola giant axons.

Giant axons from the marine annelid, Myxicola infundibulum, were internally dialyzed with ATP-free media and with media with lower than normal ATP levels in an attempt to determine quantitatively the ATP requirement of the Na pump in these cells. This was accomplished by using 22Na ions to measure Na efflux. When [ATP]i in dialysis fluid fell to values within the range of 20-40 microM, a marked stimulation of Na efflux was observed even though an essentially normal ouabain sensitivity of Na efflux persisted; when axons were dialyzed with ATP-free solutions with ouabain present in the external medium throughout the dialysis period, the stimulation of Na efflux still occurred. The stimulation of Na efflux produced by low [ATP]i levels could be reversed by reintroducing normal ATP levels into the dialysis medium. Reversibility was complete provided axons were not depleted of ATP for periods longer than about 1 hr. Longer periods of ATP depletion led to larger and ultimately irreversible increases in Na efflux. The increases in Na efflux occasioned by ATP depletion either prevented or obscured the decrease in Na efflux expected to occur from unfueling the Na pump. Since [ATP]i levels required to significantly unfuel the Na pump lie below the levels at which the Na efflux stimulation occurred, it is problematic to quantitatively assess the influence of [ATP]i levels on Na pump rate by measurements of Na efflux in this preparation. Substitutes for ATP failed to prevent increases in Na efflux. The large increases in Na efflux observed at low [ATP]i occurred with no important changes in the resting membrane potential, and also occurred in Na-free and Ca-free external media. At least part of the increased Na efflux under these conditions may be due to a Na/Na exchange component, as a significant dependence of Na efflux on [Na]o appropriate for this kind of exchange was observed in the ATP-depleted axons. Whether the highly reproducible anomalous effect on Na efflux in Myxicola axons has some fundamental significance in its own right is a matter for future investigation. A few possible explanations of the anomalous effect of reduced ATP levels are discussed.

Adenosine Triphosphatases↗
PubMed1994

Evaluation of cardiac function with magnetic resonance imaging.

A large body of evidence has accumulated to substantiate the accuracy of functional MR measurements of both ventricles. Because of good accuracy and superior reproducibility, MR imaging may be considered the gold standard for in vivo quantification of left and right ventricular ejection fraction, myocardial mass, and wall stress. New prospects for functional MR imaging include determination of the end-systolic volume-pressure relation as an index of myocardial contractility. The ability of MR imaging to detect wall motion disturbances may be enhanced further by combining myocardial tagging techniques with finite element analysis. Conventional MR imaging is limited by long examination times, but recent ultrafast modifications of echo-planar imaging allow completion of a functional heart study within seconds. Implementation of ultrafast MR imaging will greatly increase the usefulness of MR imaging for routine evaluation of cardiac function.

Cardiac Volume↗
PubMed2002

Grey scales uncover similar attentional effects in homonymous hemianopia and visual hemi-neglect.

Multi-component models of visual hemi-neglect have postulated that visual hemi-neglect is characterised by various attentional deficits. A grey scales task has been developed to quantify the early, automatic, (perhaps obligatory) ipsilesional orienting of visual attention, frequently assumed as the first of these attentional deficits. Explanations for this attentional imbalance are up until now mainly formulated in terms of right hemisphere activation. This lateral attentional bias has also been demonstrated in controls, in whom it is expressed as a leftward perceptual asymmetry. We reproduced previous literature findings on a grey scales task, considering controls and neglect patients. Three patients with neglect showed an extreme ipsilesional lateral bias. This bias did not change during or after cognitive rehabilitation. Additionally, we presented this grey scale task to 32 patients with left- and right-sided homonymous hemianopia (HP). HP is the loss of sight in one visual hemi-field. The HH patients had no clinical signs of impaired lateralised attention. Results revealed that HH patients showed a similar ipsilesional bias, albeit to a lesser degree than in neglect. Left-sided HH patients presented a quantitatively similar, but qualitatively opposite bias than the right-sided HH patients. We suggest that sensory effects can be an alternative source of attentional imbalance, which can interact with the previously proposed (right) hemispheric effects. This suggests that the perceptual asymmetry in the grey scales task is not necessarily an indicator of impaired right hemisphere attention. It rather suggests a pattern of functional cerebral asymmetry, which can also be caused by asymmetric sensory input.

Adolescent↗
PubMed1996

Validation of a test of competence in transesophageal echocardiography.

OBJECTIVE: A test was developed that is based on intraoperative findings to evaluate knowledge of intraoperative echocardiography. This study examines the performance of attending anesthesiologists and residents at various levels of training in order to validate the test's ability to measure physician competence in intraoperative echocardiographic diagnosis. DESIGN: This study was a prospective evaluation of a test of competence in transesophageal echocardiography. SETTING: Two university medical centers. PARTICIPANTS: Volunteer anesthesia faculty and residents. INTERVENTIONS: The participants took an echocardiographic examination that consisted of 34 "K"-type multiple-choice questions and a 45-second video-loop sequence for each question. The video sequences were chosen for their high quality and unambiguous representation of both normal and pathologic images obtained by transverse transesophageal echocardiographic imaging. The questions were written by experienced echocardiographers. The test was administered to 25 individuals at two academic institutions: 11 residents with minimal transesophageal echocardiography exposure and 14 faculty who were relatively experienced with transesophageal echocardiography. All of the residents repeated the examination at the end of their third clinical anesthesia year, which included transesophageal echocardiography training. The differences between the groups' scores were analyzed using the Kruskal-Wallis test and Wilcoxon's rank-sum test. To correct for the multiple comparisons, p < 0.025 was deemed significant. MEASUREMENTS AND MAIN RESULTS. Before their transesophageal echocardiography training, the residents scored significantly lower than the faculty (p < 0.002). After 1 year of training, their scores significantly increased (p = 0.021), and their scores were not significantly different from the faculty level (p = 0.052). CONCLUSIONS: Test performance differed according to level of experience. This suggests that the test is a valid measure of intraoperative transesophageal echocardiography competence.

Anesthesiology↗
PubMed2001

Three-dimensional echocardiography: historical development and current applications.

Three-dimensional (3D) echocardiography facilitates spatial recognition of intracardiac structures, potentially enhancing diagnostic confidence of conventional echocardiography. The accuracy of 3D images has been validated in vitro and in vivo. In vitro, a detail 1.0 mm in dimension and 2 details separated by 1.0 mm can be identified from a volume-rendered 3D image. In vitro 3D volume measurements are underestimated by approximately 4.0 mL. In vivo, left ventricular volume measurements correlate highly with both cineventriculography (limits of agreement +/-18 mL for end diastole and +/-10 mL for end systole) and magnetic resonance imaging, including measurements for patients with functionally single ventricles. Studies on congenital heart lesions have shown good accuracy and good reproducibility of dynamic "surgical" reconstructions of septal defects, aortoseptal continuity, atrioventricular junction, and both left and right ventricular outflow tract morphology. Transthoracic 3D echocardiography was shown feasible in 81% to 96% of patients with congenital heart defects and provided additional information to that available from conventional echocardiography in 36% of patients, mainly in more detailed description of mitral valve morphology, aortoseptal continuity, and atrial septum. In patients with mitral valve insufficiency, 3D echocardiography was shown to be accurate in the quantification of the dynamic mechanism of mitral regurgitation and in the assessment of mitral commissures in patients with mitral stenosis. This includes not only valve tissue reconstruction but also color flow intracardiac jets. Three-dimensional reconstructions of the aortic valve were achieved in 77% of patients, with an accuracy of 90%. In conclusion, the role of 3D echocardiography, which continues to evolve, shows promise in the assessment of congenital and acquired heart disease.

Cardiac Volume↗
PubMedDate not supplied

The tyranny of feminist methodology in women's health research.

Awareness of the insufficient degree to which mainstream research has created useful knowledge about women's health has drawn many researchers to feminist methodologies. Such approaches tend to privilege qualitative designs, emancipatory objectives, and cooperative strategies. They challenge the notions of expert power, the appropriation of voice, and ownership of the research products. By uncovering the extent to which power inequities are embedded in our research traditions, including such issues as who conducts research, which questions are studied, and how they are studied, feminist critique can be a powerful tool toward stronger research with more socially relevant findings. However, taken to extremes, feminist methodological requirements can immobilize and discourage active inquiry. In this paper, we articulate major directives of a feminist stance, explain the extremes at which they become problematic, and propose responsive options for women's health researchers. We intend such analysis to overcome divisiveness and promote inclusiveness without sacrificing excellence in research and action.

Female↗
PubMed1995

Feminist research: its relevance to nursing.

It is the author's intention to explore feminist research and discover its relevance to nursing practice. In order to achieve this, definitions of feminism and feminist research will be made. From these it will be possible to place the feminist research process within a historical context to further understand its focus. Then an analysis of feminist research will be made, examining feminist epistemology, feminist methodology and the methods used by feminist researchers. At this point an examination of who should or can do feminist research will be made, followed by a discussion about the validity of feminist research.

Bias↗
PubMed1984

Inhibition by sodium cromoglycate of bronchoconstriction stimulated by respiratory heat loss: comparison of pressurised aerosol and powder.

The protective effect was examined of three doses (2, 10, and 20 mg) of sodium cromoglycate inhaled from a pressurised metered dose inhaler on the response to isocapnic hyperventilation of cold dry air in 10 asthmatic subjects. This was compared with the effect of cromoglycate powder (20 mg) inhaled from a Spincap and with placebo given on two occasions. The medications were inhaled on separate days, in random order and with the use of a double blind double dummy technique, 20 minutes before isocapnic hyperventilation of two fold increasing volumes of air (-15 degrees C, 0% humidity) to produce a 20% fall in the post-treatment FEV1. The response was expressed as the provocative dose of respiratory heat loss required to cause a fall in FEV1 of 15% (PD15, kcal/min). The mean baseline spirometric indices exceeded 85% of predicted normal values on each test day; both placebo treatments reduced the baseline FEV1 by comparison with all active treatments (p less than 0.0001). Comparison of the PD15 on the two placebo days confirmed excellent reproducibility. All doses of cromoglycate shifted the respiratory heat loss dose-response curve to the right of the placebo curve; PD15 after all active treatments exceeded PD15 after placebo (p less than 0.0001). There was no cromoglycate dose-response relationship between the three doses of aerosol (p greater than 0.05), or between any dose of aerosol and powder (p greater than 0.05). It is concluded that cromoglycate aerosol inhaled from a pressurised inhaler in a dose of 2 mg gives the same magnitude of protection against bronchoconstriction stimulated by airway cooling as 20 mg of pressurised aerosol or powder from a Spincap.

Adult↗
PubMedDate not supplied

The sodium-potassium pump in volume expanded hypertension.

Decreased arterial Na+-K+ pump and cardiac Na+, K-+ATPase activities have now been demonstrated in several types of experimental volume expanded hypertension. The changes are not secondary to elevated pressure since they also occur in veins and right ventricle where the pressure is not elevated. Decreased arterial Na+-K+ pump activity can be reproduced by acute volume expansion of the normal rat and plasma extracts from this rat suppress pump activity when applied to arteries from another rat. Suppression of Na+-K+ pump activity in arteries, veins and heart, with ouabain for example, leads to increased contractile activity. Thus the volume expansion, reduced pump activity, and hypertension appear to be causally related through an ouabain-like humoral agent. Certain other evidence suggests that the pump defect extends to the sympathetic nerve endings, thereby reducing the efficiency of neural compensatory mechanisms.

Animals↗
PubMed1995

An instrument for measuring autonomy-related attitudes and behaviors in women nursing students.

For the past 30 years, researchers have attempted to measure the characteristic of autonomy in nursing students, yet for the most part, the findings reflect neither an accurate nor current profile. Historically, there has been a misunderstanding of how women manifest autonomy due to the tradition of defining autonomy based on the male model, i.e., autonomy through power and separation. Nurse researcher-educators are in a unique position to develop instruments, conduct research, and interpret findings concerning characteristics identified as important for women nursing students. The purpose of this study was to design an instrument for quantitative measurement of autonomy-related attitudes and behaviors specific to women nursing students based on the female model, i.e., autonomy through caring and affiliation. Stability reliability (test/retest = 0.90), internal consistency (Cronbach's alpha = 0.84), and content and construct (factor analysis, contrasted groups, experimental manipulation, and convergent) validity have been established for this instrument. It is intended that the instrument be used to evaluate the efficacy of the socialization process in nursing education.

Attitude of Health Personnel↗
PubMed2000

Isolation of large terminal sequences of BAC inserts based on double-restriction-enzyme digestion followed by anchored PCR.

Isolation of the terminal portions of genomic DNA cloned in bacterial artificial chromosomes (BACs) is an important step in map-based cloning, and several methods have been developed. Here, we present a new method based on double-restriction-enzyme digestion followed by anchored PCR. BAC DNA was digested with two enzymes: NotI and one of four enzymes (EcoRV, HpaI, StuI, or XmnI) that produce blunt termini. After dephosphorylation, these digestions were ligated to NotI- and EcoRV-digested pMSK, a new cloning vector developed in this work that is derived from pBluescript SK(+). PCR products representing the left- and right-terminal sequences of BAC inserts were obtained using a primer complementary to pMSK and a primer complementary to sequences in either the left arm or the right arm of the BAC vector pBeloBAC11. We have tested this method with 15 different BAC clones, and PCR products representing both the left- and right-terminal sequences have been obtained from all 15 BAC clones. This method is simple, fast, reproducible, and uses the same set of primers for any restriction enzyme used. With some modifications, it can also be used for isolating the terminal portions of genomic DNA cloned in yeast artificial chromosomes and P1-derived artificial chromosomes.

Chromosome Walking↗
PubMed2002

Limb volume reduction after physical treatment by compression and/or massage in a rodent model of peripheral lymphedema.

Lack of a standardized experimental counterpart of peripheral lymphedema (LE) in a small animal has hampered research into treatment of this debilitating condition. We recently refined a rodent model consisting of radical unilateral lymphatic/nodal groin excision in conjunction with a circumferential integumental gap, followed by regional irradiation of the groin to reproduce stable unilateral hindlimb LE (1). In the current study, Wistar-Fuzzy rats with established right hindlimb LE, were subdivided into five groups and subjected to one of the following daily physical regimens over a 5-day period: pneumatic compression pumping at 30 torr (PCP); low-stretch multi-layered compressive bandaging using Coban (CB); manual lymphedema drainage (MLD) or a light massage consisting of stationary circular motions using the fingertips; combined physiotherapy (CPT consisting of MLD + CB); and a no treatment or control group (CTRL). Hindlimb and LE volumes were serially measured before and after treatment. Whereas CTRL showed progressive worsening of hindlimb swelling, PCP, CB, CPT and MLD each produced similar and substantial edema reduction over the 5 day interval, PCP, CB and CPT induced vacillating edema reduction which, however, exceeded rebound swelling on a daily basis. MLD, on the other hand, showed a steady gradual daily decline in LE volume.

Animals↗
PubMed1991

Characterization of normal human bone marrow by flow cytometry.

Fifteen bone marrow samples were obtained from consenting donors for allogenic bone marrow transplantation and were studied by flow cytometry. The simultaneous analysis, cell by cell, of size (forward angle light scattering), structure (right angle light scattering) and surface antigenic expression with 20 monoclonal antibodies allowed selection of ten reproducible cell subsets which were sorted and studied by microscopic examination in order to confirm their distinct characteristics. This very accurate analysis of a bone marrow cytogram should find applications in view of a better characterization of normal and pathological human bone marrow.

Adult↗