Usefulness of thoracic electrical bioimpedance in detection of ejection fraction changes.

The aim of this study was to evaluate a usefulness of thoracic electrical bioimpedance (TEB) in following adaptive haemodynamic adjustments to postural change and isometric exercise. Sixteen subjects with intact cardiovascular system took part in this study. Haemodynamic parameters were obtained in recumbency and after taking up erect posture. Besides, TEB was performed during handgrip test and the results were compared with baseline resting data. Each time the radionuclide ventriculography (RV) was performed concurrently with TEB to obtain an independent measurement of ejection fraction (EF). Active orthostasis was associated with a change in stroke volume, cardiac output and total vascular resistance by -29.7%, -3.4%, +3.9%, respectively. The handgrip produced a significant increase in cardiac output by 16.3%, however it was not associated with an enhancement of stroke volume. Although there was a moderate correlation between EF calculated by TEB and RV in supine position (r=0.66; p < 0.001), TEB failed to reflect changes of EF in orthostasis and isometric exercise. In conclusion, our results suggest that TEB offers in subjects with normal cardiovascular function a valuable alternative to cardiovascular monitoring of stroke volume and cardiac output, but calculation of EF is associated with a risk of serious error.     

13—18岁正常人上、中面部对称性生长发育的纵向研究

本文运用13— 18岁正常纯纵向样本资料 ,头颅定位后前位 X线头影测量法 ,分析正常人上、中面部的对称性与变异 ,探讨其随生长发育的变化趋势 ,为客观区分对称性的正常变异和不对称畸形提供依据。结果表明 :正常人上、中面部骨骼存在对称性的正常变异 ,其范围在13—18岁保持稳定 ,水平向小于8% ,垂直向不超过9mm;在其相对于颅底的位置关系及其骨骼各对应部位之间 ,有较好对称性 ;面部骨骼的生长发育具有潜在的优势特点。     

Error and individual difference in cardiovascular responses to orthostatic stress in humans

Variations in cardiovascular responses to orthostatic stress were investigated in terms of physiological polymorphism. Variations of physiological measurements are subdivided into individual differences and measurement errors. However, individual differences are often considered to be an error in statistical analysis due to its limitations in experimental design. In order to discuss about the relative contribution of individual difference in cardiovascular responses to postural changes, percent contribution (PC) was estimated using the Taguchi method. Six healthy male adults (age range: 21-27) were subjected to orthostatic stress by inducing a postural inclination of 60 degrees head-up-tilting to the horizontal, and the responses were measured thrice in each subject on different days. The respective changes of heart rate (HR) and stroke volume (SV) in the period from the resting supine to the head-up-tilt position were significantly increased (p < 0.01) and decreased (p < 0.01) without affecting the mean blood pressure (MBP). The PC of individual difference in HR showed a significantly higher ratio of individual difference during the head-up-tilt (71.4-76.2%) compared with supine rest (0.0-50.4%). While the main variations of HR during supine rest were not the individual differences between the subjects, the day-to-day differences within the subject were significant. The PC of individual differences in MBP and SV constantly displayed a significant difference between the subjects. These results suggest that the strategy for maintaining stable cardiovascular regulation may be different even in normal subjects. In the perspective of physiological parameters, PC monitoring may serve as an empirical approach to evaluate physiological polymorphism.     

Pleural pressure as a function of body position in rabbits

Pleural pressure was measured at end expiration in spontaneously breathing anesthetized rabbits. A liquid-filled capsule was implanted into a rib to measure pleural liquid pressure with minimal distortion of the pleural space. Capsule position relative to lung height was measured from thoracic radiographs. Measurements were made when the rabbits were in the prone, supine, right lateral, and left lateral positions. Average lung heights in the prone and supine positions were 4.21 +/- 0.58 and 4.42 +/- 0.51 (SD) cm, respectively (n = 7). Pleural pressure was -2.60 +/- 1.87 (SD) cmH2O at 50.2 +/- 7.75% lung height in the prone position and -3.10 +/- 1.22 cmH2O at 51.4 +/- 6.75% lung height in the supine position. There was no difference between the values recorded in the prone and supine positions. Placement of the capsule into the right or left chest had no effect on the magnitude of the pleural pressure recorded in rabbits in right and left lateral recumbency (n = 12). Measurements over the nondependent lung were repeatable when rabbits were turned between the right and left lateral positions. Lung height in laterally recumbent rabbits averaged 4.55 +/- 0.52 (SD) cm.     

Volume-related and volume-independent effects of posture on esophageal and transpulmonary pressures in healthy subjects.

Ventilator management decisions in acute lung injury could be better informed with knowledge of the patient's transpulmonary pressure, which can be estimated using measurements of esophageal pressure. Esophageal manometry is seldom used for this, however, in part because of a presumed postural artifact in the supine position. Here, we characterize the magnitude and variability of postural effects on esophageal pressure in healthy subjects to better assess its significance in patients with acute lung injury. We measured the posture-related changes in relaxation volume and total lung capacity in 10 healthy subjects in four postures: upright, supine, prone, and left lateral decubitus. Then, in the same subjects, we measured static pressure-volume characteristics of the lung over a wide range of lung volumes in each posture by using an esophageal balloon catheter. Transpulmonary pressure during relaxation (PLrel) averaged 3.7 (SD 2.0) cmH2O upright and -3.3 (SD 3.2) cmH2O supine. Approximately 58% of the decrease in PLrel between the upright and supine postures was due to a corresponding decrease in relaxation volume. The remaining 2.9-cmH2O difference is consistent with reported values of a presumed postural artifact. Relaxation volumes and pressures in prone and lateral postures were intermediate. To correct estimated transpulmonary pressure for the effect of lying supine, we suggest adding 3 cmH2O (95% confidence interval: -1 to +7 cmH2O). We conclude that postural differences in estimated transpulmonary pressure at a given lung volume are small compared with the substantial range of PLrel in patients with acute lung injury.     

Supine position decreases the ability of the nose to warm and humidify air.

We tested the hypothesis that decreasing nasal air volume (i.e., increasing nasal turbinate blood volume) improves nasal air conditioning. We performed a randomized, two-way crossover study on the conditioning capacity of the nose in six healthy subjects in the supine and upright position. Cold, dry air (CDA) was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before it entered and after it exited the nasal cavity. The total water gradient (TWG) across the nose was calculated and represents the nasal conditioning capacity. Nasal volume decreased significantly from baseline without changing the mucosal temperature when subjects were placed in the supine position (P < 0.01). TWG in supine position was significantly lower than that in upright position (P < 0.001). In the supine position, nasal mucosal temperature after CDA exposure was significantly lower than that in upright position (P < 0.01). Our data show that placing subjects in the supine position decreased the ability of the nose to condition CDA compared with the upright position, in contrast to our hypothesis.     

Specificity of the monocular crescents of the visual field in postural control.

Postural reactions elicited by monocular visual stimulation in the temporal crescent of the visual field were studied in adult subjects in dynamic balance on a rocking platform. Circular translation of a visual scene was induced in the temporal crescent by the rotation of membrane prisms placed laterally to the stimulated eye. In anteroposterior balance, postural reactions are identical whichever eyes is stimulated: ventral extension of the body when the visual scene moves upwards and dorsal extension when it moves downwards. In lateral balance, postural reactions vary with the stimulated eye: extension of the right side of the body when the right eye is stimulated by an upward displacement of the visual scene, extension of the left side when the left eye is stimulated. This difference, which contrasts with the similarity of reactions elicited by the stimulation of either para-foveal fields, suggests that the most peripheral part of the nasal retina has a specific role in head and body stabilisation.     

Direct measurement of immunoreactive renin during changes of posture in man.

For several years, it has been possible to determine renin by a direct RIA. In the present study, plasma active renin concentration (PRC) was related to plasma renin activity (PRA) and aldosterone as a function of a standardized posture test. Using PRC, our target was to define the shortest necessary test duration. The three parameters were examined in 10 healthy male subjects (22-34 years old). Salt balance was determined in 24-hour urine, and plasma potassium and sodium were measured. Volunteers were hospitalized for 1 night, and at 8 a.m. the next morning they were subjected to the following postural changes: 3 h active orthostasis and 3 h recumbency. Frequent blood samples were taken. Orthostasis induced a significant rise in PRC, PRA and aldosterone already after 15 min. PRC and PRA reached a maximum level after 90 min of orthostasis and remained relatively stable, while aldosterone reached its highest level already after 30 min and then gradually decreased. Significant correlations were found between PRA and PRC (p < 0.001), between PRC and aldosterone (p < 0.001), and between PRA and aldosterone (p < 0.001). The PRC/PRA ratio changed during the course of the test, especially in supine subjects. When subjects returned to the supine position, all the parameters measured began a continual decrease. There were no significant changes in serum potassium and sodium levels throughout the duration of the test.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postural shock in pregnancy

Signs and symptoms of shock may be produced in some patients in late pregnancy by putting them in the dorsal recumbent posture. Change from this position will relieve the condition. The features of the supine hypotensive syndrome can be duplicated by applying pressure to the abdomen with the patient in a lateral position. The postural variations of venous pressure, blood pressure, and pulse appear to be due to obstruction of venous return from the lower portion of the body caused by the large uterus of late pregnancy compressing the vena cava. When shock is observed in a woman in late pregnancy, she should be turned to a lateral position before more active measures of treatment are begun.     

Pathophysiology of orthostatic hypotension after bed rest: paradoxical sympathetic withdrawal

Although orthostatic hypotension is a common clinical syndrome after spaceflight and its ground-based simulation model, 6 degrees head-down bed rest (HDBR), the pathophysiology remains unclear. The authors' hypothesis that a decrease in sympathetic nerve activity is the major pathophysiology underlying orthostatic hypotension after HDBR was tested in a study involving 14-day HDBR in 22 healthy subjects who showed no orthostatic hypotension during 15-min 60 degrees head-up tilt test (HUT) at baseline. After HDBR, 10 of 22 subjects demonstrated orthostatic hypotension during 60 degrees HUT. In subjects with orthostatic hypotension, total activity of muscle sympathetic nerve activity (MSNA) increased less during the first minute of 60 degrees HUT after HDBR (314% of resting supine activity) than before HDBR (523% of resting supine activity, P < 0.05) despite HDBR-induced reduction in plasma volume (13% of plasma volume before HDBR). The postural increase in total MSNA continued during several more minutes of 60 degrees HUT while arterial pressure was maintained. Thereafter, however, total MSNA was paradoxically suppressed by 104% of the resting supine level at the last minute of HUT (P < 0.05 vs. earlier 60 degrees HUT periods). The suppression of total MSNA was accompanied by a 22 +/- 4-mmHg decrease in mean blood pressure (systolic blood pressure <80 mmHg). In contrast, orthostatic activation of total MSNA was preserved throughout 60 degrees HUT in subjects who did not develop orthostatic hypotension. These data support the hypothesis that a decrease in sympathetic nerve activity is the major pathophysiological factor underlying orthostatic hypotension after HDBR. It appears that the diminished sympathetic activity, in combination with other factors associated with HDBR (e.g., hypovolemia), may predispose some individuals to postural hypotension.     

Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure.

To partition the central and peripheral airway resistance in awake humans, a catheter-tipped micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a 3-mm-ID bronchus in 5 normal subjects, 7 patients with chronic bronchitis, 8 patients with emphysema, and 20 patients with bronchial asthma. We simultaneously measured mouth flow, transpulmonary pressure, and intra-airway lateral pressure during quiet tidal breathing. Total pulmonary resistance (RL) was calculated from transpulmonary pressure and mouth flow and central airway resistance (Rc) from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (Rp) was obtained by the subtraction of Rc from RL. The technique permitted identification of the site of airway resistance changes. In normal subjects, RL was 3.2 +/- 0.2 (SE) cmH2O.l-1.s and the ratio of Rp to RL was 0.24 during inspiration. Patients with bronchial asthma without airflow obstruction showed values of Rc and Rp similar to those of normal subjects. Although Rc showed a tendency to increase, only Rp significantly increased in those patients with bronchial asthma with airflow obstruction and patients with chronic bronchitis and emphysema. The ratio of Rp to RL significantly increased in three groups of patients with airflow obstruction (P less than 0.01). These observations suggest that peripheral airways are the predominant site of airflow obstruction, irrespective of the different pathogenesis of chronic airflow obstruction.     

POSTURAL SHOCK IN PREGNANCY

Signs and symptoms of shock may be produced in some patients in late pregnancy by putting them in the dorsal recumbent posture. Change from this position will relieve the condition.The features of the supine hypotensive syndrome can be duplicated by applying pressure to the abdomen with the patient in a lateral position.The postural variations of venous pressure, blood pressure, and pulse appear to be due to obstruction of venous return from the lower portion of the body caused by the large uterus of late pregnancy compressing the vena cava.When shock is observed in a woman in late pregnancy, she should be turned to a lateral position before more active measures of treatment are begun.     

Regional blood volume and peripheral blood flow in postural tachycardia syndrome

Variants of postural tachycardia syndrome (POTS) are associated with increased ["high-flow" POTS (HFP)], decreased ["low-flow" POTS (LFP)], and normal ["normal-flow" POTS (NFP)] blood flow measured in the lower extremities while subjects were in the supine position. We propose that postural tachycardia is related to thoracic hypovolemia during orthostasis but that the patterns of peripheral blood flow relate to different mechanisms for thoracic hypovolemia. We studied 37 POTS patients aged 14-21 yr: 14 LFP, 15 NFP, and 8 HFP patients and 12 healthy control subjects. Peripheral blood flow was measured in the supine position by venous occlusion strain-gauge plethysmography of the forearm and calf to subgroup patients. Using indocyanine green techniques, we showed decreased cardiac index (CI) and increased total peripheral resistance (TPR) in LFP, increased CI and decreased TPR in HFP, and unchanged CI and TPR in NFP while subjects were supine compared with control subjects. Blood volume tended to be decreased in LFP compared with control subjects. We used impedance plethysmography to assess regional blood volume redistribution during upright tilt. Thoracic blood volume decreased, whereas splanchnic, pelvic, and leg blood volumes increased, for all subjects during orthostasis but were markedly lower than control for all POTS groups. Splanchnic volume was increased in NFP and LFP. Pelvic blood volume was increased in HFP only. Calf volume was increased above control in HFP and LFP. The results support the hypothesis of (at least) three pathophysiologic variants of POTS distinguished by peripheral blood flow related to characteristic changes in regional circulations. The data demonstrate enhanced thoracic hypovolemia during upright tilt and confirm that POTS is related to inadequate cardiac venous return during orthostasis.     

The awakening cortisol response: no evidence for an influence of body posture

It has recently been reported that the orthostatic challenge associated with postural change from sitting to an upright position is stimulatory to the hypothalamic-pituitary-adrenal axis as evidenced by increased salivary free cortisol. This stimulatory influence is potentially a confound for the many psychoneuroendocrine studies for which salivary free cortisol is the main dependent variable. This particularly relates to laboratory psychosocial stress procedures in which subjects are invited to stand in order to deliver public speech and the studies which have explored the cortisol response to awakening in which postural shift has not been controlled for. We therefore examined, in a balanced cross over design whether the awakening cortisol response was influenced by standing, shortly after awakening or remaining supine during the response study period. In addition and in the same subjects we measured the cardiovascular response and saliva cortisol response to the orthostatic challenge of shifting from a supine to a standing position later in the diurnal cortisol cycle. The expected cortisol response to awakening was demonstrated but there was no evidence that the postural shift, supine to standing, confounded the response. This same postural shift later in the day induced the expected increase in heart rate but cortisol simply followed the circadian decline. Under the conditions of the present study we found no evidence that the postural shift supine to standing could induce a cortisol secretory episode such as to contribute towards the awakening response.     

The effects of branches on prepartum nest building in gilts with access to straw

Sows farrowing in a semi-natural environment terminate nest building 1-7 h prior to parturition after having built a nest for which a variety of materials are used. No nest-building behaviour occurs during parturition and the sows remain lying in the nest throughout most of the farrowing. In contrast, many intensively housed sows are restless during farrowing. To investigate whether gilts housed indoors would use branches for nest building and whether access to branches would affect the termination of nest building and parturient behaviour, we studied gilts housed individually in pens designed to stimulate natural nest building. The control group (n=21) had unlimited access to straw and the experimental group (n=21) had unlimited access to straw and branches. During nest building all the gilts used straw and all the experimental gilts also used branches. In the experimental group the interval from termination of nest building to birth of the first piglet (BFP) was significantly longer than in the control group (132 versus 58 min, P=0.04). In the experimental group, nest-building behaviour was also performed by fewer individuals during the interval from BFP until 2 h after than in the control group (38% versus 71% of the gilts, P=0.03). Gilts that performed nest building during this interval carried out more postural changes (P<0.001) and spent less time in lateral recumbency (P=0.001) than gilts which did not perform nest building. On average, gilts that performed nest building behaviour after BFP (n=26) spent 54% of the first 2 h of parturition in lateral recumbency and carried out 16 postural changes. Gilts that did not perform nest building behaviour during this interval (n=16) spent 85% of the time in lateral recumbency and carried out five postural changes. In 10 gilts that were selected randomly from the experimental group nest building was studied in more detail. In these gilts nest building peaked between 17 and 6 h prepartum. There was no difference in amount of behaviour directed towards straw and amount of behaviour directed towards branches.The results indicate that the termination of nest building in sows is under environmental feedback control. When only straw was provided the nests did not have much of a lasting structure. However, when gilts had access to straw and branches more structured and functional nests could be built. These nests may have been more effective in reducing the motivation for nest building prior to the onset of parturition.     

Obesity alters regional ventilation in lateral decubitus position

Alterations of regional ventilation were determined as a function of body position in five morbidly obese subjects using 81mKr to assess ventilation (V) and 127Xe at equilibrium to determine lung volume (V). With subjects in seated and supine positions, the left lung contributed an average of 43% of the total V/V. When the apical-basal gradient within each lung was examined in subjects in the seated position, V/V was greatest in the dependent (basal) regions in half of the subjects, whereas the others showed greater V/V near the upper lung regions. All obese subjects preferentially ventilated the nondependent lung in both the left and right lateral decubitus positions. In a control group of three nonobese subjects, V/V was found to be equally distributed between left and right lungs in both the seated and supine positions. In contrast with the results in the obese group, V/V was slightly greater in the dependent lung in both lateral decubitus positions. Although the combination of 127Xe images and He-dilution measurement of functional residual capacity in the lateral decubitus positions indicated a reduction in the volume of the dependent lung of the obese when compared with values in the seated position, other factors affecting the mechanical function of either the diaphragm or the intercostal muscles could also have produced these positional alterations of ventilation.     

Dominant side in single-leg stance stability during floor oscillations at various frequencies

Background

We investigated lateral dominance in the postural stability of single-leg stance with anteroposterior floor oscillations at various frequencies.

Methods

Thirty adults maintained a single-leg stance on a force platform for 20 seconds per trial. Trials were performed with no oscillation (static condition) and with anteroposterior floor oscillations (2.5-cm amplitude) at six frequencies: 0.25, 0.5, 0.75, 1.0, 1.25 and 1.5 Hz (dynamic condition). A set of three trials was performed on each leg in each oscillation frequency in random order. The mean speed of the center of pressure in the anteroposterior direction (CoP_ap) was calculated as an index of postural stability, and frequency analysis of CoP_ap sway was performed. Footedness for carrying out mobilizing activities was assessed with a questionnaire.

Results

CoP_ap speed exponentially increased as oscillation frequency increased in both legs. The frequency analysis of CoP_ap showed a peak <0.3 Hz at no oscillation. The frequency components at 0.25-Hz oscillation included common components with no oscillation and those at 1.5-Hz oscillation showed the maximum amplitude among all conditions. Postural stability showed no significant difference between left- and right-leg stance at no oscillation and oscillations ≤1.25 Hz, but at 1.5-Hz oscillation was significantly higher in the right-leg stance than in the left-leg stance. For the lateral dominance of postural stability at individual levels, the lateral difference in postural stability at no oscillation was positively correlated with that at 0.25-Hz oscillation (r = 0.51) and negatively correlated with that at 1.5-Hz oscillation (r = -0.53). For 70% of subjects, the dominant side of postural stability was different at no oscillation and 1.5-Hz oscillation. In the subjects with left- or right-side dominance at no oscillation, 94% or 38% changed their dominant side at 1.5-Hz oscillation, with a significant difference between these percentages. In the 1.5-Hz oscillation, 73% of subjects had concordance between the dominant side of postural stability and that of mobilizing footedness.

Conclusion

In static conditions, there was no lateral dominance of stability during single-leg stance. At 1.5-Hz oscillation, the highest frequency, right-side dominance of postural stability was recognized. Functional role in supporting leg may be divided between left and right legs according to the change of balance condition from static to dynamic.     

Stance stability with unilateral and bilateral light touch of an external stationary object

Unilateral light fingertip touch of a stationary object has a significant stabilizing effect on postural sway during stance. The purpose of this study was to find out if this effect is enhanced by bilateral light touch of parallel stationary objects. The postural sway of 54 healthy subjects was tested in four stance conditions: no touch; unilateral left light touch of the left handle of a walker; unilateral right light touch of the right handle of the same walker; and bilateral light touch of the two handles. During testing, subjects stood blindfolded on two foam pads placed on the left and right force plates of the Tetrax balance system. Testing in each condition lasted 45 s and was executed twice in a random order. As expected, postural sway was significantly reduced by unilateral left or right light fingertip touch. It was significantly further decreased by bilateral light touch. In addition, light touch conditions were associated with a reduction in pressure fluctuations between the heel and forefoot of the same foot as well as those of the contralateral foot, with a concomitant increase in weight shift fluctuations between the two feet. The decrease in postural sway with bilateral light touch suggests cortical modulation of the bilateral touch inputs, with enhancement of the stabilizing response.     

Quantification of regional V/Q ratios in humans by use of PET. II. Procedure and normal values

Regional measurements of tissue isotope concentration, made using positron emission tomography (PET), allow tracer models to be used in a quantitative manner to provide topographic distributions of many structural and functional parameters, each derived for the same well-defined lung element. In this paper we describe a technique to measure regional ventilation-perfusion ratios (V/Q), in absolute units, by use of PET and the continuous intravenous infusion of an inert gas isotope, 13N, and report on measurements made in 12 normal subjects (4 smokers). Data were obtained from a single lung section (slice thickness, 1.7 cm full width at half-maximum response to a line source) at the level of the right ventricle in the supine posture during quiet breathing. For the 12 subjects, volume-weighted mean values of V/Q, averaged over individual right and left lung fields, ranged from 0.50 to 1.29. Analysis of these means showed no difference between lungs: right, 0.80 +/- 0.23 SD; left, 0.76 +/- 0.20 SD. Topographically, a systematic fall of V/Q in the ventrodorsal direction was observed in eight of the subjects (mean ventrodorsal difference 0.39, range 0.19-0.90), whereas two showed a clear increase toward dependent lung regions (range 0.16-0.26). Seven of the subjects with a falling ventrodorsal V/Q gradient also exhibited discrete regions of low V/Q at the dorsal lung border. We conclude that, in normal subjects, ventilation and perfusion are generally well matched in the supine posture, but isolated mismatching often occurs in dependent lung regions.     

Postural hypotension and diuretic therapy in the elderly.

Blood pressures were recorded in 319 ambulatory subjects, largely men, age 50 to 99 years. The mean systolic pressures were maximal in the seventh and eighth decades (136.0 and 132.1 mm Hg with the subjects supine and erect, respectively), whereas the mean diastolic pressures fell progressively after age 69. The distribution of postural changes in mean blood pressure was similar in each decade; a decrease of 20 mm Hg on more was noted in 3.4% of the subjects aged 80 to 99 years and in 4.1% of those aged 50 to 79 years. The frequency of postural hypotension was 4.6% in subjects treated with diuretics and 3.4% in those not so treated. Blood pressures and the frequency of postural hypotension did not progressively increase in age in this elderly population.