Multiresolution wavelet analysis of time-dependent physiological responses in syncopal youths

Our prior studies indicated that postural fainting relates to thoracic hypovolemia. A supranormal increase in initial vascular resistance was sustained by increased peripheral resistance until late during head-up tilt (HUT), whereas splanchnic resistance, cardiac output, and blood pressure (BP) decreased throughout HUT. Our aim in the present study was to investigate the alterations of baroreflex activity that occur in synchrony with the beat-to-beat time-dependent changes in heart rate (HR), BP, and total peripheral resistance (TPR). We proposed that changes of low-frequency Mayer waves reflect sympathetic baroreflex. We used DWT multiresolution analyses to measure their time dependence. We studied 22 patients, 13 to 21 yr old, 14 who fainted within 10 min of upright tilt (fainters) and 8 healthy control subjects. Multiresolution analysis was obtained of continuous BP, HR, and respirations as a function of time during 70 degrees upright tilt at different scales corresponding to frequency bands. Wavelet power was concentrated in scales corresponding to 0.125 and 0.25 Hz. A major difference from control subjects was observed in fainters at the 0.125 Hz AP scale, which progressively decreased from early HUT. The alpha index at 0.125 Hz was increased in fainters. RR interval 0.25 Hz power decreased in fainters and controls but was markedly increased in fainters with syncope and thereafter corresponding to increased vagal tone compared with control subjects at those times only. The data imply a rapid reduction in time-dependent sympathetic baroreflex activity in fainters but not control subjects during HUT.     

Increased vasoconstriction predisposes to hyperpnea and postural faint

Our prior studies indicated that postural fainting relates to splanchnic hypervolemia and thoracic hypovolemia during orthostasis. We hypothesized that thoracic hypovolemia causes excessive sympathetic activation, increased respiratory tidal volume, and fainting involving the pulmonary stretch reflex. We studied 18 patients 13-21 yr old, 11 who fainted within 10 min of upright tilt (fainters) and 7 healthy control subjects. We measured continuous blood pressure and heart rate, respiration by inductance plethysmography, end-tidal carbon dioxide (ET(CO(2))) by capnography, and regional blood flows and blood volumes using impedance plethysmography, and we calculated arterial resistance with patients supine and during 70 degrees upright tilt. Splanchnic resistance decreased until faint in fainters (44 +/- 8 to 21 +/- 2 mmHg.l(-1).min(-1)) but increased in control subjects (47 +/- 5 to 53 +/- 4 mmHg.l(-1).min(-1)). Percent change in splanchnic blood volume increased (7.5 +/- 1.0 vs. 3.0 +/- 11.5%, P < 0.05) after the onset of tilt. Upright tilt initially significantly increased thoracic, pelvic, and leg resistance in fainters, which subsequently decreased until faint. In fainters but not control subjects, normalized tidal volume (1 +/- 0.1 to 2.6 +/- 0.2, P < 0.05) and normalized minute ventilation increased throughout tilt (1 +/- 0.2 to 2.1 +/- 0.5, P < 0.05), whereas respiratory rate decreased (19 +/- 1 to 15 +/- 1 breaths/min, P < 0.05). Maximum tidal volume occurred just before fainting. The increase in minute ventilation was inversely proportionate to the decrease in ET(CO(2)). Our data suggest that excessive splanchnic pooling and thoracic hypovolemia result in increased peripheral resistance and hyperpnea in simple postural faint. Hyperpnea and pulmonary stretch may contribute to the sympathoinhibition that occurs at the time of faint.     

Response of plasma renin activity to postural change in vasovagal syncope in children, with observations on syncope

37 children aged 7-14 years with a history of repetitive fainting (vasovagal syncope) were studied. Plasma renin activity (PRA), blood pressure and heart rate were measured before and after standing for 15 min. Standing PRA was significantly higher in cases of fainting (n = 14) than in cases of nonfainting (n = 23). A significant positive correlation was observed between PRA and fall in systolic blood pressure on standing in cases of fainting, but not in cases of nonfainting. These findings suggest that the renin-angiotensin system may respond to the fall in blood pressure in children subject to fainting, unlike their adult counterparts previously reported.     

Respiration drives phase synchronization between blood pressure and RR interval following loss of cardiovagal baroreflex during vasovagal syncope

Loss of the cardiovagal baroreflex (CVB), thoracic hypovolemia, and hyperpnea contribute to the nonlinear time-dependent hemodynamic instability of vasovagal syncope. We used a nonlinear phase synchronization index (PhSI) to describe the extent of coupling between cardiorespiratory parameters, systolic blood pressure (SBP) or arterial pressure (AP), RR interval (RR), and ventilation, and a directional index (DI) measuring the direction of coupling. We also examined phase differences directly. We hypothesized that AP-RR interval PhSI would be normal during early upright tilt, indicating intact CVB, but would progressively decrease as faint approached and CVB failed. Continuous measurements of AP, RR interval, respiratory plethysomography, and end-tidal CO2 were recorded supine and during 70-degree head-up tilt in 15 control subjects and 15 fainters. Data were evaluated during five distinct times: baseline, early tilt, late tilt, faint, and recovery. During late tilt to faint, fainters exhibited a biphasic change in SBP-RR interval PhSI. Initially in fainters during late tilt, SBP-RR interval PhSI decreased (fainters, from 0.65±0.04 to 0.24±0.03 vs. control subjects, from 0.51±0.03 to 0.48±0.03; P<0.01) but then increased at the time of faint (fainters=0.80±0.03 vs. control subjects=0.42±0.04; P<0.001) coinciding with a change in phase difference from positive to negative. Starting in late tilt and continuing through faint, fainters exhibited increasing phase coupling between respiration and AP PhSI (fainters=0.54±0.06 vs. control subjects=0.27±0.03; P<0.001) and between respiration and RR interval (fainters=0.54±0.05 vs. control subjects=0.37±0.04; P<0.01). DI indicated respiratory driven AP (fainters=0.84±0.04 vs. control subjects=0.39±0.09; P<0.01) and RR interval (fainters=0.73±0.10 vs. control subjects=0.23±0.11; P<0.001) in fainters. The initial drop in the SBP-RR interval PhSI and directional change of phase difference at late tilt indicates loss of cardiovagal baroreflex. The subsequent increase in SBP-RR interval PhSI is due to a respiratory synchronization and drive on both AP and RR interval. Cardiovagal baroreflex is lost before syncope and supplanted by respiratory reflexes, producing hypotension and bradycardia.     

Enhanced slow caudad fluid shifts in orthostatic intolerance after 24-h bed-rest

To evaluate mechanisms of late orthostatic intolerance, slow fluid shifts along the body axis were studied during deconditioning by 24-h bed-rest and during 13-min upright tilts before and after this manoeuvre. In 11 healthy male subjects the fluid volumes of a thorax and a calf segment (impedance plethysmography) as well as tissue thickness at the forehead and the tibia (miniature ultrasonic plethysmograph) were recorded. Cardiovascular performance was monitored by recording heart rate (electrocardiogram), brachial and finger arterial pressure (by the Riva Rocci method and by the Finapres technique) as well as stroke volume (by impedance cardiography). Bed-rest led to a cephalad fluid shift with a mean interstitial leg dehydration of 2.2 ml·-100 ml^–1 with no changes in body mass and plasma volume. No syncope during the tilt occurred before bed-rest, while after bed-rest 8 subjects fainted between min 2.1 and 9.0 of the tilt. Bed-rest resulted in an augmented initial heart rate response to tilting which was similar in all subjects. In later orthostasis, bed-rest caused two- to threefold faster caudad fluid shifts with higher calf filtration rates in fainters (prior to hypotension) than in nonfainters. Through bed-rest the estimated extravasation within 10 min into general lower body tissue spaces increased by 192 ml in (late) fainters as opposed to only 23 ml in nonfainters. It was concluded that contributing factors to orthostatic intolerance may be slow transcapillary fluid shifts which are easily underestimated and whose quantity and time course call for further investigation after various deconditioning manoeuvres. In particular, the postflight fluid shifts in astronauts who will have markedly dehydrated legs, may impose a circulatory stress which needs to be evaluated. In general, the filtration rate in relevant areas appears to be an integrative and easily determined parameter, reflecting hormonal and neurogenic vascular as well as local interstitial control of the Starling forces.     

Cardiovagal regulation during combined hypoxic and orthostatic stress: fainters vs. nonfainters.

We tested the hypothesis that individual differences in the effect of acute hypoxia on the cardiovagal arterial baroreflex would determine individual susceptibility to hypoxic syncope. In 16 healthy, nonsmoking, normotensive subjects (8 women, 8 men, age 20-33 yr), we assessed orthostatic tolerance with a 20-min 60 degrees head-upright tilt during both normoxia and hypoxia (breathing 12% O(2)). On a separate occasion, we assessed baroreflex control of heart rate (cardiovagal baroreflex gain) using the modified Oxford technique during both normoxia and hypoxia. When subjects were tilted under hypoxic conditions, 5 of the 16 developed presyncopal signs or symptoms, and the 20-min tilt had to be terminated. These "fainters" had comparable cardiovagal baroreflex gain to "nonfainters" under both normoxic and hypoxic conditions (normoxia, fainters: -1.2 +/- 0.2, nonfainters: -1.0 +/- 0.2 beats.min(-1).mmHg(-1), P = 0.252; hypoxia, fainters: -1.3 +/- 0.2, nonfainters: -1.0 +/- 0.1 beats.min(-1).mmHg(-1), P = 0.208). Furthermore, hypoxia did not alter cardiovagal baroreflex gain in either group (both P > 0.8). It appears from these observations that hypoxic syncope results from the superimposed vasodilator effects of hypoxia on the cardiovascular system and not from a hypoxia-induced maladjustment in baroreflex control of heart rate.     

Correlates of psychosomatic stress symptoms among farm women: a research note on farm and family functioning

The relationship between self-reported psychosomatic stress symptoms and dimensions of family and farm functioning were examined in a sample of New York State dairy farm wives (N = 126). The farm women completed a questionnaire assessing home and farm task loads, farm complexity, intrapersonal role conflict, interpersonal role conflict, husband support, and marital satisfaction. The psychosomatic stress symptoms included nervousness, restlessness, insomnia, shortness-of-breath, and fainting. In general, stress symptoms showed little relationship to task loads, farm complexity, and intrapersonal role conflict. Much stronger relationships were found for interpersonal role conflict, husband support, and marital satisfaction. Thus, these findings point to the greater importance of family relationships in preventing or buffering stress in comparison with simple role-related task expectations of farm systems.     

Functional anatomy of the pigeon hand (Columba livia): A muscle stimulation study

The morphology and function of all muscles controlling the pigeon hand were analyzed. Muscle action was determined in situ by inducing contraction via silver wire electrodes in anesthetized birds. EMG electrodes were implanted in the test muscle and an adjacent muscle to monitor contraction and volume conduction respectively. Results indicate that pigeons have fine control of hand and digit movements. However, the directions of movement are restricted. Movements have been eliminated or severely limited in those directions that experience strong stress during flight. Such restrictions may reduce the amount of muscular activity required for stabilization of the hand and its components. Mobility is retained in directions not subject to large stresses and where movement is essential for the kinematics of flight to be executed properly. © 1995 Wiley-Liss, Inc.     

Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes.

This paper describes the relationship between knee extension force and EMG signals detected by multiple bipolar wire electrodes inserted into the human vastus lateralis muscle under isometric conditions. Six healthy male volunteers participated in this study. Eight pairs of bipolar wire electrodes were inserted into the right vastus lateralis muscle and the EMG data were simultaneously detected and analyzed. The EMG raw data and individual force-IEMG relations were influenced by the location of the electrode inserted into the muscle. The force and IEMG relationship averaged across subjects detected from the eight electrodes, however, showed almost the same linear correlation in spite of different electrode locations. No linear correlation was observed between MdF and the knee extension force. This result suggests that, if all of the muscle fibers participate in the same action at the same time, the averaged normalized IEMG from any places using wire electrodes could reflect the total activities of that muscle even if the muscle is large.     

Aspects of control of the cardiovascular-respiratory system during orthostatic stress induced by lower body negative pressure

This paper considers a model developed to study the cardiovascular control system response to orthostatic stress as induced by two variations of lower body negative pressure (LBNP) experiments. This modeling approach has been previously applied to study control responses to transition from rest to aerobic exercise, to transition to non-REM sleep and to orthostatic stress as produced by the head up tilt (HUT) experiment. LBNP induces a blood volume shift because negative pressure changes the volume loading characteristics of the compartment which is subject to the negative pressure. This volume shift induces a fall in blood pressure which must be counteracted by a complicated control response involving a variety of mechanisms of the cardiovascular control system. There are a number of medical issues connected to these questions such as orthostatic intolerance in the elderly resulting in dizziness or fainting during the transition from sitting to standing. The model presented here is used to study the interaction of changes in systemic resistance, unstressed venous volume, venous compliance, heart rate, and contractility in the control of orthostatic stress. The overall short term response depends on a combination of these physiological reactions which may vary from individual to individual. There remain open questions about which factors have greater importance. The model simulations are compared to experimental data collected for LBNP exerted from the hips to feet and from ribs to feet.     

A micromachined capillary electrophoresis chip with fully integrated electrodes for separation and electrochemical detection

A novel analytical microsystem with fully integrated electrodes for electrophoresis and amperometrical detection is described. With respect to the lab-on-a-chip concept a capillary electrophoresis (CE) microsystem has been fabricated with a total of six gold electrodes for sample injection, separation and electrochemical detection using standard microfabrication technologies. The device is a ready-to-use system that does not need any extra mechanical apparatus for electrode insertion. The CE-chip has successfully been tested by measuring hydrogen peroxide, ascorbic acid and uric acid simultaneously. All three oxidizable species could be detected in less than 70 s. Glucose was detected by performing an enzymatic reaction along the separation channel. The microsystem showed a very good reproducibility.     

Impedance electrodes positioned on proximal portions of limbs quantify fluid compartments in dogs

Body resistance and reactance to the conduction of an alternating electrical current were measured using electrodes attached to distal and proximal portions of limbs in anesthetized dogs. Body impedance was calculated from these measurements obtained at 30-min time intervals during a control period and after intravenous administration of 0.9% saline. Extracellular (ECW) and total body water (TBW) were determined by bromide and heavy water dilution techniques, respectively. Baseline impedance obtained from proximal electrodes was related to ECW (r = 0.95, P less than 0.001) and TBW (r = 0.80, P less than 0.02). After saline infusion, proximal electrodes detected a significant fall in impedance (P less than 0.001), whereas distal electrodes did not (P = 0.06). Furthermore, ECW and TBW could be estimated from the drop of proximal impedance after this bolus infusion (r = 0.82, P less than 0.02, and r = 0.86, P less than 0.01, respectively), but not from distal impedance measurements. Proximally placed impedance electrodes are superior to traditionally used distal electrodes for assessment of body fluid changes in the dog.     

Bilateral phrenic stimulation: a simple technique to assess diaphragmatic fatigue in humans

Transdiaphragmatic pressure (Pdi) and the rate of relaxation of the diaphragm (tau) were measured at functional residual capacity (FRC) in six normal seated subjects during single-twitch stimulation of both phrenic nerves. The latter were stimulated supramaximally with needle electrodes with square-wave impulses of 0.1-ms duration at 1 Hz before and after diaphragmatic fatigue produced by resistive loaded breathing. Constancy of chest wall configuration was achieved by monitoring the diameter of the abdomen and the rib cage with a respiratory inductive plethysmograph system. During control the peak Pdi generated during the phrenic stimulation amounted to 34.4 +/- 4.2 (SE) cmH2O and represented in each subject a fixed fraction (17%) of its maximal transdiaphragmatic pressure. After diaphragmatic fatigue the peak Pdi decreased by an average of 45%, amounting to 18.1 +/- 2.7 cmH2O 5 min after the fatigue run, and tau increased from 55.2 +/- 9 ms during control to 77 +/- 8 ms 5 min after the fatigue run. The decrease in peak Pdi and the increase in tau observed after the fatigue run persisted throughout the 30 min of the recovery period studied, the peak Pdi amounting to 18.4 +/- 2.8 and 18.9 +/- 3.3 cmH2O and tau to 81.3 +/- 5.7 and 88.7 +/- 10 ms at 15 and 30 min after the end of the fatigue run, respectively. It is concluded that diaphragmatic fatigue can be detected in man by bilateral phrenic stimulation with needle electrodes without any discomfort for the subject and that the decrease in diaphragmatic strength after fatigue is long lasting.     

An ultra-high common-mode rejection ratio (CMRR) AC instrumentation amplifier for laplacian electrocardiographic measurement

Laplacian electrocardiograms (LECGs) localize the moment of activation (MOA) of the heart noninvasively at a nearby point on the chest surface. Tripolar concentric ring (TCR) electrodes provide small, but well-defined, site-specific second spatial derivative signals of the potential on the chest surface for studying the activation sequence of the myocardium. A battery-powered, modified AC instrumentation amplifier (IA) was used as preamplifier to obtain signals with a high common-mode rejection ratio (CMRR). The authors' direct-coupled quasi-high-pass IA has high input impedance and high CMRR, without the need to match capacitors and resistors. The amplifier circuit and two lithium cells were integrated with the substrate for the TCR sensor to minimize inductive pickup by the leads. Combining the natural ability of the TCR electrodes to reject common-mode signals with the high CMRR of the IA made it possible to obtain LECG signals in real time with good signal-to-noise ratio (SNR). The authors observed and recorded the MOAs from 16 sites in a 4-by-4 matrix from the left side of the thorax of each subject. Beat-by-beat changes were observed from one subject showing episodes of bigeminal rhythm. The authors were able to obtain localized signals representing the right and left ventricles from surface TCR electrodes in real time.     

EMG signals detection and processing for on-line control of functional electrical stimulation.

The surface EMG signal detected from voluntarily activated muscles can be used as a control signal for functional neuromuscular electrical stimulation. A proper positioning of the recording electrodes in relation to the stimulation electrodes, and a proper processing of the recorded signals is required to reduce the stimulus artefact and the non-voluntary contribution (M-wave). Six orientations and six locations of the recording electrodes were investigated in the present work. A comb filter (with and without a blanking windowing) was applied to remove the signal components synchronously correlated to the stimulus. An operative definition of the signal to noise ratio and an efficiency index were implemented. It resulted that when the recording electrodes were located within the two stimulation electrodes the best orientation was perpendicular to the longitudinal line. However the best absolute indexes were obtained when the recording electrodes were located externally of the stimulation electrodes, and in that case the best orientation was longitudinal. Concerning the filtering procedure, the use of a blanking window before the application of the comb filter, gave the best performance.     

Comparison of plasma levels of lipid hydroperoxides and antioxidants in hyperlipidemic Nagase analbuminemic rats, Sprague-Dawley rats, and humans.

The levels of lipid hydroperoxides and antioxidants in plasma samples from Nagase analbuminemic rats (NAR) and control Sprague-Dawley rats (SDR) were measured in comparison with those from normal human subjects. Cholesteryl ester hydroperoxide (CE-OOH) was detected, but phosphatidylcholine hydroperoxide was not. The levels of CE-OOH and the ratios of CE-OOH/CE were found to increase significantly in the order of human < SDR < NAR, suggesting that oxidative stress increases in the same order. NAR have a significantly lower level of ascorbate and lower ratio of ubiquinol/ubiquinone concentrations than SDR. This also suggests that NAR are subject to more oxidative stress than SDR, since ascorbate and ubiquinol are the most effective plasma antioxidants against oxygen radicals.     

Evolution in impedance at the electrode-skin interface of two types of surface EMG electrodes during long-term recordings.

The evolution in impedance at the electrode-skin interface of Beckman and Red Dot electrodes was assessed during long-term recordings. Impedance was measured between each pair of electrodes, arranged in a bipolar configuration on tibialis anterior (n=13). A waveform constructed of sinusoids of known frequencies, evenly distributed on a log scale from 1-16,384 Hz, was applied through the electrodes, and the result recorded by a DAQ system. SEMG signals were recorded at 1000 Hz during isometric dorsiflexion contractions of 30 s, performed every 15 min for 2 h. Impedance data were acquired at 65,536 Hz immediately before and after SEMG recordings. Large individual differences in impedance levels were observed at low frequencies. At high frequencies, impedance values depended only on the electrode type. Impedance decreased steadily with time for Beckman electrodes (p < 0.05), but did not decrease significantly for Red Dot electrodes. The magnitude of the reduction over time varied widely between individuals, and was related to the initial impedance values. The impedance-bandwidth product remained constant for each electrode type (95% confidence intervals 146.2-148.2 and 126.1-127.8 for Beckman and Red Dot electrodes respectively). When skin impedance is electrically modelled with a simple network containing a resistor and a capacitor, the capacitance varies with the properties of the electrode used, whereas resistance is dependent on the subject. Furthermore, the EMG spectrum is unaffected by impedance provided skin preparation is sufficient to reduce the impedance below 55 komega.     

Role of catecholamines in hypotensive response to dieting.

The effect of dieting on blood pressure and catecholamine metabolism was assessed in 11 normotensive obese women by providing first a weight-maintenance regimen high in carbohydrate and then a low-energy diet. All dietary constituents other than carbohydrate were maintained constant throughout the 18-day study. The low-carbohydrate diet led within 48 hours to a 41% fall in the urinary output of 4-hydroxy-3-methoxy mandelate and a significant fall in systolic and diastolic blood pressure. Plasma noradrenaline concentrations also fell and the hypotensive effect of the diet continued despite a maintained total body sodium. Thus the fall in blood pressure appeared to be mediated by changes in catecholamine metabolism independent of sodium intake. This may explain both the usefulness of weight reduction in hypertensive patients and the fainting that occurs in some normotensive obese subjects taking slimming regimens low in carbohydrate.     

正常与水分胁迫下水稻叶片叶绿素含量的QTL分析

随着分子标记技术的发展,利用不同的遗传群体对叶绿素的分子遗传机理进行了一些探索,定位了一些控制叶绿素含量的数量性状基因座(Quantitative trait loci, QTL)。该研究着眼于当前干旱严重影响农业生产的形势,以水稻重组自交系‘珍汕97B’בIRAT109’ F₉代群体195个株系为材料,在正常与水分胁迫环境下研究叶片叶绿素含量与光合速率的变化及相关性,定位不同水分条件下影响叶绿素含量的QTL,为阐明干旱环境下水稻叶绿素含量的分子遗传机理、分子标记辅助育种和节水抗旱稻培育提供理论基础和依据。研究表明叶绿素含量与光合速率在正常供水下呈极显著正相关(r=0.185 7^**),但在干旱下则表现无关(r=0.076 6)。QTL定位共检测到13个影响叶绿素含量的主效QTL,分别位于第1、2、3、4、5、6、10染色体:其中在干旱处理下检测到6个,其联合贡献率为47.39%;在正常供水下检测到7个,联合贡献率达56.19%。检测到显著互作效应位点16对:其中干旱处理下有4对显著互作,联合贡献率为18.57%;正常供水下有12对显著互作,联合贡献率达38.49%。     

An EMG-driven biomechanical model of the canine cervical spine

Due to the frequency of cervical spine injuries in canines, the purpose of this effort was to develop an EMG-driven dynamic model of the canine cervical spine to assess a biomechanical understanding that enables one to investigate the risk of neck disorders. A canine subject was recruited in this investigation in order to collect subject specific data. Reflective markers and a motion capture system were used for kinematic measurement; surface electrodes were used to record electromyography signals, and with the aid of force plate kinetics were recorded. A 3D model of the canine subject was reconstructed from an MRI dataset. Muscles lines of action were defined through a new technique with the aid of 3D white light scanner. The model performed well with a 0.73 weighted R² value in all three planes. The weighted average absolute error of the predicted moment was less than 10% of the external moment. The proposed model is a canine specific forward-dynamics model that precisely tracks the canine subject head and neck motion, calculates the muscle force generated from the twelve major moment producing muscles, and estimates resulting loads on specific spinal tissues.