Improved arterial oxygenation with feed restriction in rapidly growing broiler chickens.

1. Rapidly growing broiler chickens fed ad lib. until 56 days, but feed restricted until 60 days of age, had higher arterial oxygen saturations, lower respiratory frequencies, total ventilations that were not different, and higher tidal volumes compared to those fully fed for 56 days. 2. Arterial oxygen saturation correlated negatively with respiratory frequency, but was not related to total ventilation or tidal volume. 3. Hypoventilation appeared not to be the cause of arterial oxygen desaturation. 4. Arterial oxygen desaturation correlated with the degree of right ventricular hypertrophy.     

Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation]

Using a dual channel near infrared (NIR) in vivo optical spectroscopy (INVOS) system (INVOS 3100A, Somanetics Corp. Troy, MI, USA) we investigated the relationship between jugular venous oxygen saturation (SjvO2) and regional cerebral oxygen saturation (rSO2) in 30 infants and children (mean age 4.5 years) with congenital heart disease undergoing cardiac catheterisation. The NIRS-SomaSensor (emitter and dual receiver probe) was applied at a standardised right fronto-temporal location (over the right frontal cortex) on the infant's head and covered with an adhesive flexible bandage. Using NIR light (730 and 810 nm) and two source-detector spacings (3 and 4 cm from the transmitter), percentage values of rSO2 were calculated from detected haemoglobin saturations. Simultaneously, jugular venous oxygen saturation (SjvO2) monitoring was performed via a catheter placed in the right internal jugular vein with its tip positioned in the jugular bulb, as verified by fluoroscopy. To compare the reliability of NIRS measurement characteristics, jugular venous blood was analysed for SjvO2 as a reference measure of global cerebral oxygenation, by co-oximetry (OSM3-Hemoximeter, Radiometer Copenhagen, Denmark). Other measured variables included pulse oximetry, arterial blood pressure, and venous and arterial oxygen saturations. Over a jugular venous oxygen saturation range of 31-83%, a significant positive linear correlation was found between rSO2 (NIRS measurement) and SjvO2 (jugular bulb oximetry) (r = 0.93, p < 0.001). No significant correlation was observed between rSO2 values and arterial blood saturation or pulse oximetry. The quantitative correlation between rSO2 (haemoglobin oxygenation in a small hemi-elliptical area of the brain) and reference SjvO2 measurement (method for monitoring global cerebral oxygenation) suggests that NIRS measurement with subtraction algorithm should identify predominantly intracranial saturation in the pediatric age group, and will tend to reflect global oxygenation under physiological conditions. Transcranial oximetry using dual receiving channel NIRS offers a noninvasive, real-time, reliable and practicable means of monitoring cerebral haemoglobin oxygenation changes infants and children with cyanotic and noncyanotic congenital heart disease.     

Atrial septostomy benefits severe pulmonary hypertension patients by increase of left ventricular preload reserve

At present, it is unknown why patients suffering from severe pulmonary hypertension (PH) benefit from atrial septostomy (AS). Suggested mechanisms include enhanced filling of the left ventricle, reduction of right ventricular preload, increased oxygen availability in the peripheral tissue, or a combination. A multiscale computational model of the cardiovascular system was used to assess the effects of AS in PH. Our model simulates beat-to-beat dynamics of the four cardiac chambers with valves and the systemic and pulmonary circulations, including an atrial septal defect (ASD). Oxygen saturation was computed for each model compartment. The acute effect of AS on systemic flow and oxygen delivery in PH was assessed by a series of simulations with combinations of different ASD diameters, pulmonary flows, and degrees of PH. In addition, blood pressures at rest and during exercise were compared between circulations with PH before and after AS. If PH did not result in a right atrial pressure exceeding the left one, AS caused a left-to-right shunt flow that resulted in decreased oxygenation and a further increase of right ventricular pump load. Only in the case of severe PH a right-to-left shunt flow occurred during exercise, which improved left ventricular preload reserve and maintained blood pressure but did not improve oxygenation. AS only improves symptoms of right heart failure in patients with severe PH if net right-to-left shunt flow occurs during exercise. This flow enhances left ventricular filling, allows blood pressure maintenance, but does not increase oxygen availability in the peripheral tissue.     

Ventricular weights in guinea pigs acclimated to cold plus hypoxia

Weanling male guinea pigs (Cavia porcellus), 2-3 weeks of age, with initial body weights of 207-271 g were exposed for 2-16 weeks to constant cold (6 degrees C) and hypoxia (PO2 = 85 Torr) equivalent to 4800 m above sea level. Their growth rates and body weights did not differ from those of control animals of the same age maintained under normoxic conditions (22 degrees C, PO2 = 133 Torr). After 2, 3, 4, 6, 10, or 16 weeks exposure the animals were sacrificed, the hearts were removed, the ventricles were separated and weighed, and myoglobin concentrations were determined. Total heart weight as well as both right and left ventricular weights increased linearly with age. By the second week of exposure of the guinea pigs to cold plus hypoxia the total heart and right ventricular weights were 25 and 50% greater than those of the normoxic control animals. Both weights increased at greater rates than those of the controls until Week 6 and then remained at 30 and 80% throughout the 16th week. The weights of the left ventricles in these animals were only slightly greater than those of the controls. In spite of the severe right ventricular hypertrophy these animals showed no clinical signs of right heart failure. Myoglobin concentrations were significantly greater in both ventricles for the cold-plus-hypoxic animals than for the controls.     

Partial Endocardial Cushion Defects

Seven partial endocardial cushion defects have been diagnosed and treated surgically without mortality—six of the ostium primum type and one with a defect from left ventricle to right atrium. The last patient likely has an associated cardiomyopathy. The most serious complication of repair is damage to the bundle of His.The electrocardiogram is helpful in diagnosis, showing left axis deviation in standard leads and right ventricular hypertrophy in chest leads (92%). The vector-cardiogram in the frontal plane shows counterclockwise rotation with the loop usually above the isoelectric line (97%). This is due to congenital aberration of the left bundle branch rather than to left ventricular hypertrophy from mitral incompetence. Radiography demonstrates moderate cardiac enlargement with right-sided hypertrophy, a prominent pulmonary artery, and pleonemic lung fields. Cardiac catheterization reveals a moderate rise in oxygen saturation at atrial level and a further minimal increase at ventricular level. The left atrial trace may show a minimal “c-v” configuration, with the “v” wave equal to the “a”.     

Measurement of cerebral oxygenation in neonates after vaginal delivery and cesarean section using full-spectrum near infrared spectroscopy

To investigate whether or not the mode of delivery produces differences in cerebral oxygenation, cerebral hemoglobin oxygen saturation was measured using full-spectrum near infrared spectroscopy in 26 healthy term newborn infants immediately after birth. Infants in group 1 (n=20) were delivered vaginally, and those in group 2 (n=6) by elective cesarean section. Arterial oxygen saturation in the right hand was also measured simultaneously using a pulse oximeter. Changes in arterial oxygen saturation showed no significant difference between the two groups. The mean+/-S.D. of cerebral hemoglobin oxygen saturation in group 1 increased rapidly after birth, from 29+/-17% at 2 min to 68+/-6% at 8.5 min, followed by an almost constant value (66+/-7% at 15 min). In comparison, cerebral hemoglobin oxygen saturation in group 2 also increased rapidly until 8.5 min, but after this time decreased significantly to 57+/-5% at 15 min after birth. This indicates that the mode of delivery has a marked influence on cerebral oxygenation immediately after birth.     

慢性间断性缺氧伴二氧化碳潴留小鼠模型的建立

目的建立慢性间断性缺氧伴二氧化碳潴留（chronic intermittent hypoxia with carbon dioxide retention,CIH-CR）小鼠模型。方法选取雄性昆明小鼠22只,随机分为常氧组（normal control group,NC）和CIH-CR组,每组11只。CIH-CR组小鼠每天CIH-CR处理8 h,共4周,实验期间监测箱内O2和CO2浓度及小鼠尾部末端血氧饱和度（SO2）。实验终点测定右室肥厚指数并观察心、肺、肾、脑组织病理改变。结果 CIH-CR组箱内O2浓度、CO2浓度和小鼠尾部末端SO2随实验仓的关闭和开启出现周期性的变化;与NC组相比CIH-CR组右心室明显肥大（P〈0.01）;小鼠心、肺、肾和脑组织均出现明显缺氧改变。结论成功建立了CIH-CR小鼠模型。     

Successful percutaneous balloon valvuloplasty in a preterm infant weighing 1500 g with critical pulmonary valve stenosis

We describe a successful cardiac intervention in an infant, born at 32 weeks of gestation, with a birth weight of 1040 g, who had a critical pulmonary valve stenosis with the right ventricular pressure twice the systemic pressure. Continuous prostaglandin E infusion kept the arterial duct open and at the age of four weeks and a weight of 1500 g a balloon valvuloplasty was performed, which reduced the systolic right ventricular pressure to below the systemic pressure. Two weeks later the procedure was repeated because of increasing right ventricular pressure. At two months of age the mean systolic transpulmonary Doppler gradient was 30 mmHg with an adequate right ventricular volume. The neurological status of the infant was normal and the femoral vein was patent. Timely interventional heart catheterisation is a successful method of treatment in critical pulmonary valve stenosis in infants with a low birth weight. (Neth Heart J 2008;16:264-6.)     

促红细胞生成素对血液透析患者血浆脂联素水平及左心室肥厚的影响

目的：促红细胞生成素（EPO）在维持性血液透析患者中具有保护心血管的作用,本文旨在探讨EPO在血液透析病人中对脂联素（ADPN）水平及左心室肥厚的影响。方法：46名维持性血液透析患者用EPO治疗8周,分别在治疗前,治疗第2、4、8周后测定血红蛋白（Hb）,红细胞压积（Hct）,血浆白蛋白（ALB）,体重指数（BMI）,C反应蛋白（CRP）,血清铁蛋白（SF）,血清铁饱和度（TAST）,ELISA测定ADPN水平;彩色多普勒超声测定左心室心肌重量（LVM）及计算左心室心肌重量指数（LVMI）。结果：血液透析患者血清ADPN水平高于正常人;用EPO治疗2周后即出现ADPN水平升高,第4周后ADPN水平进一步升高,第8周与第4周比较无明显变化;应用EPO可降低CRP、SF水平;ADPN是LVMI的重要影响因子,EPO可改善左心室肥厚与功能。结论：EPO可提高血液透析患者ADPN水平,降低CRP、SF水平,减轻左心室肥厚。     

Quantification of cerebral oxygenation by full-spectrum near-infrared spectroscopy using a two-point method

The aim of this study was to quantify the relative concentrations of oxyhemoglobin and deoxyhemoglobin within the light path of the brain and to estimate cerebral hemoglobin (Hb) oxygen saturation using full-spectrum near-infrared spectroscopy (fsNIRS). For this purpose, we developed a novel exponential correction equation as well as a two-point spectroscopy method to estimate the relative concentrations of Hb and Hb oxygen saturation in biological tissues. The results of evaluation of measurements using an in vitro model indicated that our fsNIRS method enables accurate and non-invasive measurements of Hb content and saturation in a highly scattered medium such as the human brain. According to the results of analysis using a hypoxic piglet model, the mean cerebral Hb oxygen saturation (SbO(2)) of newborn piglets at an inspired oxygen gas concentration of 0.21 was estimated to be 63+/-4% (mean+/-S.D.). Umbilical arterial and left internal jugular venous Hb oxygen saturation were simultaneously estimated to be 96+/-2% and 52+/-11%, respectively. SbO(2) and arterial Hb oxygen saturation values had a linear relationship. The average oxygenation state of cerebral tissue is comparable with that of the cerebral vein. The results of this study showed that our method can be used to monitor Hb oxygen saturation in the neonatal brain at the bedside in an intensive care unit.     

Prevalence of left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females in Port Harcourt

This study investigated the prevalence of electrocardiographically determined left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females who went for consultation at the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. Two hundred participants mean age 52years, attending the medical outpatient clinic over a 6-month period were recruited for the study.  Of the population studied, 16.5% of the hypertensive and 13.0% of the normotensive diabetics had left ventricular hypertrophy. Cardiovascular abnormalities notably bifascicular block, left atrial block, right ventricular enlargement, and right atrial enlargement were predominately among hypertensive diabetes and also notably  was arrhythmia  and atrial flutter among normotensive diabetes. The significance of these findings is discussed. Keywords: Hypertension, Diabetes mellitus, Cardiovascular disease, Left ventricular hypertrophy.     

银杏叶提取物对野百合碱诱导的大鼠右心室心肌肥厚的干预作用及其机制*

目的: 探讨银杏叶提取物对大鼠右心室心肌肥厚的干预作用及其机制。方法: 72 只SD 大鼠随机分为3 组,每组24只: 对照组(CON组)、野百合碱诱导右心室心肌肥厚组(MCT组)、银杏叶提取物干预组(EGB组)。MCT组与EGB组首日均以2%MCT按60 mg/kg 剂量腹腔注射,注射后第2日开始,MCT组每日予2 ml 0.9% NaCl灌胃,EGB组以60 mg/kg银杏叶提取物灌胃,对照组SD大鼠首日一次性腹腔注射2 ml 0.9%NaCl注射液。3周后检测各组大鼠心脏血流动力学变化、计算心脏重量指数、HE染色观察心肌病理形态学变化、RT-PCR法检测TRPC6 mRNA表达和Western blot法检测蛋白的表达水平。结果: 与对照组比较,MCT组反映右心室肥厚程度的指标如RVSP、RV±dp/dt_max及RVMI显著增加(P＜0.01),而EGB早期干预组虽然与MCT组的各项指标有相同趋势的变化,但是EGB组各项指标变化的幅度均显著降低(P＜0.01),且EGB组的心肌肥厚指数均显著低于MCT组(P＜ 0.01);HE染色观察心肌形态学变化结果:MCT组呈典型心肌肥厚表现;EGB组右心室心肌细胞较MCT组有显著改善;MCT组及EGB组SD大鼠右心室TRPC6 mRNA及蛋白相对表达水平升高(P＜0.05),而EGB组较MCT组显著降低(P＜0.05)。结论: 银杏叶提取物可能通过降低TRPC6的表达阻碍心肌细胞中CaN／NFAT信号路径而发挥对心肌肥厚的早期保护作用。     

Reaction patterns of the myocardial interstitium in different models of cardiac hypertrophy--stereological investigations

Several experimental models of cardiac hypertrophy were investigated in rats: 1. mild hypertrophy induced by physical exercise (18 weeks), 2. mild hypertrophy induced by renovascular hypertension (24 weeks), 3. moderate hypertrophy induced by renovascular hypertension in diabetic and non-diabetic animals (8 weeks), 4. moderate hypertrophy induced by renovascular hypertension in diabetic and non-diabetic animals (12 weeks), 5. moderate hypertrophy induced by thyroxin application (4 weeks), 6. mild hypertrophy in chronic uremia (5/6 nephrectomy, 3 weeks). It is concluded from quantitative stereological parameters of the left ventricular papillary muscles that 1. in hypertrophic hearts myocardial blood flow and oxygen consumption, respectively, rather than the size of muscle fibres determine the capillary supply of the myocardium, 2. interstitial fibrosis occurs in hypertrophy induced by chronic pressure overload and depends on degree and duration of hypertension, 3. the extent of interstitial fibrosis in hypertension is magnified by diabetes mellitus, and 4. the interstitial fibrosis which occurs in chronic uremia is not caused by hypertension.     

慢性低氧对大鼠左右心室的功能及TRPC亚家族表达的影响

目的：探讨慢性低氧3周对大鼠左右心室的影响以及规范性瞬时感受器电位亚家族（TRPC）在慢性低氧诱导的右心室心肌肥厚中的表达。方法：将SD雄性大鼠48只随机分为对照组（CON组）和慢性低氧肺动脉高压模型组（CH组）（n=24）,CH组将大鼠置于连续的慢性低氧（10％±0．2％）环境饲养三周以诱导大鼠发生心肌肥厚。通过左、右心室插管法测定右心室内压（RVSP）、左心室内压（LVSP）、心率（HR）、平均体循环动脉压（mSAP）、左、右心室内压力最大上升速率（＋dp／dtmax）、最大下降速率（-dp／dkmax）、右心肥大指数（RVMI）、左心肥大指数（LVMI）;HE染色观察左、右心室心肌组织切片;通过SYBR Green荧光定量PCR法检测CON组、CH组大鼠的肥厚侧心室心肌组织编码TRPC 1／3／4／5／6／7的rnRNA表达;结合real-time RT-PCR结果对mRNA表达有显著变化的TRPC亚型通过免疫印迹法检测相应蛋白的表达。结果：与CON组相比：CH组的RVSP、RVMI、右心室±dp／dtmax显著增高（P〈0．01）,LVSP、左心室±dp／dmax无显著变化,LVMI显著降低（P〈0．01）;CH组右心室心肌细胞显著增粗（P〈0．01）,细胞内肌原纤维数量增多,心肌纤维排列紊乱,细胞核深染,形状不整;左心室心肌纤维无明显改变;CH组编码TRPCI的mRNA和蛋白显著增高（P〈0．05）,而编码其余TRPC亚型的mRNA无显著变化。结论：慢性低氧3周可特异性诱导sD大鼠产生右心室心肌肥厚,上调了编码右心室心肌细胞TRPCI通道蛋白的mRNA和蛋白的表达,TRPCI可能参与了心肌肥厚的发生发展。     

Lactate dehydrogenase changes following several cardiac hypertrophic stresses.

The effects of four different cardiac hypertrophic stresses on cardiac lactate dehydrogenase (LDH) isozyme composition and activity were examined. Altitude-induced right ventricular hypertrophy was accompanied by an increase of 10% in the M subunit of LDH in right ventricle, left ventricle, and atria. Left ventricular hypertrophy induced by aortic stenosis also produced isozyme changes in the ventricles, but of only half the magnitude. Biventricular hypertrophy, induced by running or swimming, was accompanied by 4-5% increases in M LDH in the ventricles only. We conclude that changes in LDH activity are directly related to changes in the M subunit in all three portions of the heart. No changes in H subunit were noted under any of the stresses. It appears that the magnitude of changes in cardiac LDH isozyme composition are only marginally related to extent of hypertrophy.     

Antioxidant and oxidative stress changes in experimental cor pulmonale

Although right heart failure (RHF) contributes to 20% of all cardiovascular complications, most of the information available on RHF in general is based on the experiences with left heart failure. This study on RHF investigates changes in antioxidants and oxidative stress which are suggested to play a role in the transition from hypertrophy to failure. RHF subsequent to pulmonary hypertension was produced in rats by a single injection of monocrotaline (MCT, 60 mg/kg, i.p.). Based on hemodynamic, clinical and histopathologic observations, the animals were grouped in three functional stages at 1-, 2- and 6-week post-injection periods. In the 1-week group, RV pressure overload and hypertrophy, and a mild increase in antioxidant enzymes was seen. In the 2-week group, compensated HF, a significant increase in antioxidant enzymes, an increase in septal (IVS) wall thickness and leftward displacement of IVS without change in LV free wall were seen. In the 6-week group, lung and liver congestion, RVF and dilation, a decrease in antioxidant enzyme activities, increase in lipid peroxidation and severe bulging of the IVS into the left ventricle were seen. These changes in the hemodynamic, biochemical and histopathologic characteristics suggest that in early stages of MCT-induced pulmonary hypertension at 1 and 2 weeks, RV hypertrophy was accompanied by sustained hemodynamic function and an increase in antioxidant reserve. In the later stage at 6 weeks, clinical RHF was associated with abnormalities of the right heart systolic and diastolic function along with a decrease in antioxidant reserve. These biphasic changes in RV antioxidant enzymes, i.e. an increase during hypertrophy and a decrease in failure may suggest a role of oxidative stress in the pathogenesis of right ventricular dysfunction.     

Antioxidant and oxidative stress changes in experimental cor pulmonale

Although right heart failure (RHF) contributes to 20% of all cardiovascular complications, most of the information available on RHF in general is based on the experiences with left heart failure. This study on RHF investigates changes in antioxidants and oxidative stress which are suggested to play a role in the transition from hypertrophy to failure. RHF subsequent to pulmonary hypertension was produced in rats by a single injection of monocrotaline (MCT, 60 mg/kg, i.p.). Based on hemodynamic, clinical and histopathologic observations, the animals were grouped in three functional stages at 1-, 2- and 6-week post-injection periods. In the 1-week group, RV pressure overload and hypertrophy, and a mild increase in antioxidant enzymes was seen. In the 2-week group, compensated HF, a significant increase in antioxidant enzymes, an increase in septal (IVS) wall thickness and leftward displacement of IVS without change in LV free wall were seen. In the 6-week group, lung and liver congestion, RVF and dilation, a decrease in antioxidant enzyme activities, increase in lipid peroxidation and severe bulging of the IVS into the left ventricle were seen. These changes in the hemodynamic, biochemical and histopathologic characteristics suggest that in early stages of MCT-induced pulmonary hypertension at 1 and 2 weeks, RV hypertrophy was accompanied by sustained hemodynamic function and an increase in antioxidant reserve. In the later stage at 6 weeks, clinical RHF was associated with abnormalities of the right heart systolic and diastolic function along with a decrease in antioxidant reserve. These biphasic changes in RV antioxidant enzymes, i.e. an increase during hypertrophy and a decrease in failure may suggest a role of oxidative stress in the pathogenesis of right ventricular dysfunction.     

Arterial oxygen saturation and breathing movements during the first year of life.

Sixteen healthy term infants underwent 12 hour tape recordings of arterial oxygen saturation (SaO2)(Nellcor N100 in beat to beat mode) and breathing movements at around 6 weeks, 3 and 6 months of age. Six of these infants had an additional recording at around their first birthday. Recordings were analysed throughout for pauses in breathing movements of greater than or equal to 4 s (apnoeic pauses), episodes in which SaO2 fell to 80% (desaturations), and (only during regular breathing) baseline SaO2. In the 16 infants studied at 6 weeks, 3 and 6 months, the median frequency of both apnoeic pauses (5.6, 5.7, and 6.1/h, respectively) and desaturations (0.7, 0.4 and 0.5/h, respectively) showed little change. The majority of desaturations followed an apnoeic pause (median 73.2, 86.2 and 93.8% of desaturations). The median proportion of apnoeic pauses followed by a desaturation did not change significantly (9.0, 7.5 and 9.1%), despite an increase in the proportion of apnoeic pauses of greater than or equal to 8 s in duration from 2.0% at 6 weeks to 5.3% at 3 months (P less than 0.01). Baseline SaO2 was 97.3% or higher in all recordings. Median baseline SaO2 increased from 99.6 to 99.9% between 6 weeks and 3 months (P less than 0.02) and remained unchanged thereafter. In the subgroup of infants studied also at one year of age, again no significant differences were found with increasing age in the frequency of either apnoeic pauses or desaturations. The data show that in healthy subjects no major changes occur between 6 weeks and 1 year of life in apnoeic pause frequency or arterial oxygenation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of endurance running on cardiac and skeletal muscle in rats

We studied the effect of resistance running on left cardiac ventricle size and rectus femoris muscle fiber composition. Ten male Wistar rats were trained on a treadmill 6 days per week for 12 weeks. Ten rats remained sedentary and served as controls. A higher endurance time (40%) and cardiac hypertrophy in the trained animals were indicators of training efficiency. Morphometric analysis of the left ventricle cross-sectional area, left ventricular wall, and left ventricular cavity were evaluated. The endurance-running group demonstrated a hypertrophy of the ventricular wall (22%) and an increase in the ventricular cavity (25%); (p<0.0001). Semi-quantitative analysis of rectus femoris fiber-type composition and of the oxidative and glycolytic capacity was histochemically performed. Endurance running demonstrated a significant (p<0.01) increase in the relative frequency of Type I (24%), Type IIA (8%) and Type IIX (16%) oxidative fibers, and a decrease in Type IIB (20%) glycolytic fibers. There was a hypertrophy of both oxidative and glycolytic fiber types. The relative cross-sectional area analysis demonstrated an increase in oxidative fibers and a decrease in glycolytic fibers (p<0.0001). Changes were especially evident for Type IIX oxidative-glycolytic fibers. The results of this study indicate that the left ventricle adapts to endurance running by increasing wall thickness and enlargement of the ventricular cavity. Skeletal muscle adapts to training by increasing oxidative fiber Type. This increase may be related to fiber transformation from Type IIB glycolytic to Type IIX oxidative fibers. These results open the possibility for the use of this type of exercise to prevent muscular atrophy associated with age or post-immobilization.