Intracranial compliance in type 2 diabetes mellitus and its relationship with the cardiovascular autonomic nervous control

The intracranial compliance in type 2 diabetes mellitus (T2DM) patients and the association with cardiovascular autonomic control have not been fully elucidated. The aim of this study was to assess intracranial compliance using the noninvasive intracranial pressure (niICP) and the monitoring of waveform peaks (P1, P2, and P3) and the relationship with cardiovascular autonomic control in T2DM patients. Thirty-two men aged 40-60 years without cardiovascular autonomic neuropathy (CAN) were studied: T2DMG (n=16) and control group CG (n=16). The niICP was evaluated by a noninvasive extracranial sensor placed on the scalp. Cardiovascular autonomic control was evaluated by indices of the baroreflex sensitivity (BRS), from temporal series of R-R intervals of electrocardiogram and systolic arterial pressure, during supine and orthostatic positions. The participants remained in the supine position for 15 min and then 15 min more in orthostatism. T2DMG presented a decrease of the P2/P1 ratio during the orthostatic position (P<0.001). There was a negative moderate correlation between the P2 peak with cardiovascular coupling (K2HP-SAPLF) in supine (r=-0.612, P=0.011) and orthostatic (r=-0.568, P=0.020) positions in T2DMG. We concluded that T2DM patients without CAN and cardiovascular complications presented intracranial compliance similar to healthy subjects. Despite preserved intracranial adjustments, T2DM patients had a response of greater magnitude in orthostatism. In addition, the decoupling between the heart period and blood pressure signal oscillations in low frequency appeared to be related to the worsening of intracranial compliance due to the increased P2 peak.

Development and application of sheet for postural change during painless colonoscopy / 医疗卫生装备

Objective To develop a sheet for postural change during painless colonoscopy.Methods The sheet was made of medical canvas whose body had a size of 110 cm (length) × 80 (width) cm.The body had a waistband at its each side,and the waistband had 5 nylon Velcro at each side to tie it to the patient's waist.There were 6 canvas handles at the back of the body,which were in parallel with the waistband for drawing the patient during postural change.A tearing mechanism with Velcro existed at the hip area to facilitate the hip exposure during colonoscopy.Two shoes covers were at right under the body to hold the feet when the patient bent his knees.Results The sheet significantly shortened operation time,increased working efficiency and protected the patient's privacy when compared with manual operation.Conclusion The sheet gains high safety,convenience and efficiency for postural change during painless colonoscopy,and thus is worthy promoting in the hospitals.

Adaptive responses of cardiac function to fetal postural change as gestational age increases

OBJECTIVE: The cardiovascular system maintains homeostasis through a series of adaptive responses to physiological requirements. However, little is known about the adaptation of fetal cardiac function to gravity, according to gestational age. In the present study, we aimed to evaluate the adaptive responses of cardiac function to postural changes, using Tei index measurements. METHODS: Fetal echocardiography and Doppler examination were performed on 114 women with vertex singleton pregnancies at 19 to 40 weeks' gestation. Participants were placed in an upright seated position, and the Tei index for fetal left ventricular cardiac function was measured. The women were then moved into a supine position and the Tei index was re-measured. RESULTS: The mean Tei index when measured in an upright seated position was significantly lower than that measured in a supine positioning for all fetuses (0.528±0.103 vs. 0.555±0.106, P=0.014, respectively). This difference was also noted in fetuses with a gestational age of 28–40 weeks (0.539±0.107 vs. 0.574±0.102, P=0.011, respectively). However, there was no difference in the Tei index between an upright seated and a supine position among fetuses with a gestational age of <28 weeks (0.505±0.091 vs. 0.516±0.103, P=0.571, respectively). CONCLUSION: Postural changes from an upright seated to a supine position result in an increased Tei index after a gestational age of 28 weeks. This appears to reflect maturation in the adaptive responses of the fetal cardiovascular system to postural changes.

Effects of Electro-Acupuncture Therapy to Lower Limbs on Chilly Constitution (‘Hie’Symptoms) —Comparison by the presence or absence of vasomotor dysfunction— / 日本温泉気候物理医学会雑誌

<B>Objective:</B> We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test.<br><B>Subjects and Methods:</B> Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition.<br><B>Results:</B> Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group.<br><B>Conclusions:</B> We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.

Effects of Electro-Acupuncture Therapy to Lower Limbs on Chilly Constitution (‘Hie’Symptoms) —Comparison by the presence or absence of vasomotor dysfunction— / 日本温泉気候物理医学会雑誌

Objective: We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test. Subjects and Methods: Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition. Results: Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group. Conclusions: We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.

Change in Forced Vital Capacity with Postures according to Neuromuscular Disease

OBJECTIVE: To evaluate the difference in forced vital capacity (FVC) between sitting and supine position in patients with amyotrophic lateral sclerosis (ALS), cervical spinal cord injury (SCI) and Duchenne muscular dystrophy (DMD). METHOD: FVC was measured in sitting and supine position for 32 patients with DMD, 32 patients with cervical SCI and for 28 patients with ALS. The highest value in three or more attempts in each position was chosen. RESULTS: FVCs measured in cervical SCI and ALS patients in the sitting and supine position were 1612.8+/-291.0 ml, 1393.2+/-286.7 ml and 2054.7+/-545.8 ml, 1104.3+/-425.4 ml respectively. Cervical SCI patients showed significantly higher value in the supine position (p<0.05). And ALS patients showed significantly higher value in the sitting position (p<0.05). FVCs measured in DMD patients were 1311.6+/-260.7 ml and 1213.8+/-378.9 ml respectively. There was no statistically significant difference between the measurements in both positions. CONCLUSION: Difference in postural change of FVC was observed in patients with different types of neuromuscular disorders. Such difference in FVC suggest that postural change of FVC should be considered in management of neuromuscular disease with respiratory muscle weakness.

Postural Change of Vital Capacity in Patients with Neuromuscular Disease

OBJECTIVE: To evaluate the difference in vital capacity (VC) between sitting and supine position in patients with amyotrophic lateral sclerosis (ALS) and Duchenne muscular dystrophy (DMD). METHOD: VC was measured in the sitting and supine position for 30 patients with DMD and for 30 patients with ALS. The highest value in three or more attempts in each position was chosen. RESULTS: VCs measured in ALS patients in the sitting and supine position were 1591.7+/-634.6 ml and 1290.0+/-580.3 ml respectively. The VC in the sitting position showed significantly higher value than the VC in the supine position (p<0.05). VCs measured in DMD patients were 903.7+/-518.1 ml and 795.3+/-505.6 ml respectively. There was no statistically significant difference between the measurements in both positions. CONCLUSION: Difference in postural change of VC was observed in patients with different types of neuromuscular disorders. Such difference in VC suggest that postural change of VC should be considered in management of neuromuscular disease with respiratory muscle weakness.

Effects of maximal running exercise on heart rate responses after standing up in adult men / 体力科学

The change in R-R interval (RRI) induced by rapid postural change from a squat posture to standing was analyzed in 8 healthy male students (20.3±1.2 years of age) before and immediately after maximal running exercise. We instructed subjects to stand up as quickly as possible, and to repeat the standing-up movement three times at intervals of 2 min. Heart rate responses and heart rate variability were analyzed by the change in RRI induced by standing up. Heart rate (HR) increased quickly at the onset of standing up. The time (T) until the maximal HR (Hmax) was reached 9.79±1.44 s after standing up, and then the HR after Hmax decreased rapidly with time. The maximal HR was 1.20 times higher while standing up than in the squat position. Maximal running exercise significantly delayed the time taken to reach Hmax after standing up, and significantly diminished the increased HR to 1.15 times. The Hmax/Hmin ratio, which expressed the magnitude of autonomic activity during standing up, was significantly lower following maximal exercise, indicating that the cardiac sympathetic nervous system seems to be in a state of hyperfunction immediately after maximal running exercise. These findings suggest that disturbance in the postural adjustment of the cardiovascular system immediately after intense exercise may be induced by the delayed response and decreased amplitude of the HR.

The effect of Postural Changes on Pleural Fluid Constituents / 결핵

BACKGROUND: Measurement of pleural fluid constituents are of value in the diagnosis of pleural effusions and in the seperation of exudates from transudates. The position of the patient (sitting or lying) prior to thoracentesis may result in difference in the measurement of these constituents. The purpose of this study is to determine whether postural differences in pleural fluid constituents exist, and if so, whether they are of any clinical significance. METHOD: 41 patients with pleural effusions on chest roentgenography were prospectively studied. The fluid cell counts, partial gas tension, and concentrations of chemical constituents were compared in the supine and upright positions. RESULTS: 1) A total of 10 patients were found to have an transudative effusion. In the transudates there was no significant difference in pleural fluid constituents according to posture change. 2) A total of 31 patients were found to have an exudative effusion. Statistically significant postural changes were noted in pH, WBC counts, protein, and LDH concentrations in the exudates. It may be due to postural sedimentary effect in the pleural space. 3) The PC02 measurements and glucose concentration were not affected by changes in position in exudates or transudates. CONCLUSION: Postural sedimentary effect occurs in the pleural space with reference to the measurement of certain pleural fluid constituents when an inflammatory process is present. Therefore it is recommended that thoracentesis after 30 minutes in the sitting position should be performed.

Unilateral Eyelid Retraction Induced by The Postural Change from Supine to Sitting position

Simultaneous contraction of various muscles with levator palpebrae have been reported as a phenomenon of the paradoxic synkinesis. The authors observed an unilateral eyelid retraction induced by the postural change from supine to sitting position in a 33-month-old girl and a 4-year-old boy. In both cases, the levator function of both eyes was normal and ptosis was not observed. These cases were presumed to be related with postural righting reflex, but the exact neurological basis is not fully defined yet.

Postural Response of Intraocular Pressure in Primary Open-angle Glaucoma Following Trabeculectomy

Forty-six eyes with primary open-angle glaucoma(POAG) and 34 eyes which had previously undergone trabeculectomy for POAG were studied and the postural response of the intraocular pressure(IOP) compared with that of 80 normal eyes, In all groups the increment in IOP occurred when the subject changed from the sitting to the lying position. The pressure increment when changed from the sitting to lying position, averaged 2.4 mmHg in normal eyes, 3.6 mmHg in the group who were treated medically and 3.8 mmHg in the group who had undergone trabeculectomy. There was greater postural response in primary open-angle glaucoma patient compared to normal subject. And also there was no statistically significant difference of postural response in intraocular pressure between the group who were treated medically and the group who had undergone trabeculectomy. It is suggested that abnormal postural response of intraocular pressure in POAG appears to be retained and to be unaffected in those eyes which had undergone trabeculectomy.

The Effect of beta-bocker on Postural Change of IOP

The intraocular pressures(IOP) were measured in both eyes of 30 healthy volunteers in sitting, supine, and 30 degrees head down positions One eye was pretreated with 1% carteolol or placebo(Tears naturale)applied in a masked, randomised fashion, while the other served as control. Although IOP changes in response to carteolol and to postural changes were significant(P<0.01), carteolol did not significantly alter relative changes in IOP from positional changes This results suggests that the overall pressure lowering effect may offer some protection to patients with glaucoma.