Age-matched Normal Subjects Research Articles

Reversible Right Ventricular Regional Non-Uniformity Quantified by Speckle-Tracking Strain Imaging in Patients With Acute Pulmonary Thromboembolism

The aim of this study was to evaluate the effects of acute right ventricular (RV) pressure overload (RVPO) on RV systolic function and its regional uniformity using speckle-tracking strain analysis in patients with acute pulmonary thromboembolism (APTE). Twenty-three patients with APTE (mean age, 59 +/- 16 years) and 23 age-matched and gender-matched normal subjects (the control group) were examined using echocardiography. Global and segmental longitudinal RV peak systolic strain (PSS) was analyzed using speckle-tracking strain echocardiography. The heterogeneity of RV regional function was assessed by calculating the standard deviation from 6-segmental PSS divided by the absolute value of global PSS. The standard deviation of the heart rate-corrected intervals from QRS onset to PSS for the 6 segments was used to quantify RV dyssynchrony. Patients with APTE had reduced regional PSS, resulting in reduced global PSS and augmented regional heterogeneity, and had delayed myocardial contraction in the basal and mid RV lateral walls, resulting in large dyssynchrony (global PSS, -14 +/- vs -25 +/- 3%; heterogeneity, 0.54 +/- 0.26 vs 0.24 +/- 0.09; dyssynchrony, 91 +/- 38 vs 25 +/- 10 ms; P < .05 vs controls for all comparisons). After the amelioration of acute RVPO by primary treatment, both RV heterogeneity and dyssynchrony returned to normal values. Speckle-tracking strain echocardiography can effectively quantify reversible RV regional nonuniformity caused by acute RVPO and can characterize the pattern of RV regional impairment in patients with APTE.

CFTR (TG)m(T)n polymorphism in patients with CBAVD in a population expressing low incidence of cystic fibrosis

As it is well established that an association exists between congenital bilateral absence of the vas deferens (CBAVD) and cystic fibrosis gene mutations, we investigated CFTR(TG)m(T)n polymorphism within a Taiwanese population that exhibits a very low incidence of CF. Sixty-three patients with CBAVD and 86 age-matched normal control subjects were evaluated. Temporal temperature gradient gel electrophoresis was used for CFTR mutational analysis. No major CFTR mutation was found in the patient series. A single prominent CFTR mutation, IVS8-5T, was present; however, (50.8% of 63 cases and 33.3% of 126 alleles), and exhibited a high prevalence of 12 or 13 TG repeats (93.8% of 32 cases and 95.2% of 42 alleles with IVS8-5T). Although these results are similar to those of Japanese CBAVD patients, they are higher than the common frequency (about 21%) found among Caucasian CBAVD patients. The very high percentage (42.9%) of patients with no CFTR mutations is also an ethnic characteristic. We concluded that CBAVD patients from Taiwan, who express a very low incidence of CF, were less affected by CFTR mutations, with the exception of IVS8-5T linked to either 12 or 13 TG repeats, which does exhibit a high prevalence among CBAVD patients tested.

Amyloid-β42 Plasma Levels are Elevated in Amnestic Mild Cognitive Impairment

Amnestic mild cognitive impairment (aMCI) is considered a prodromal stage of Alzheimer's disease (AD). We measured plasma levels of amyloid-beta40 (Abeta40) and Abeta42 in 191 subjects with aMCI. Seventy-nine of them were clinically followed for two years. In the total cohort of aMCI cases, the average level of Abeta42, as well as the Abeta42/Abeta40 ratio, was significantly higher than those of the 102 cognitively normal age-matched subjects. The aMCI cases that converted to probable AD within 2 years had higher levels of Abeta42 and, to a lesser extent, Abeta40 than the stable cases. However the large variability of measured values indicates that plasma Abeta is not a suitable marker of incipient AD.

Peripheral Vascular Endothelial Dysfunction in Glaucomatocyclitic Crisis: A Preliminary Study

Glaucomatocyclitic crisis (GCC) is a syndrome of recurrent unilateral increased intraocular pressure associated with mild cyclitis and few clinical symptoms. This study was undertaken to assess brachial artery endothelium-dependent flow-mediated vasodilation (FMD) as an indicator of vascular endothelial function, to describe the association between GCC and endothelial dysfunction excluding age effects. This prospective study was conducted from January 2007 to April 2009 and included 12 patients with GCC and 15 age-matched normal control subjects. Detailed clinical parameters were reviewed, including highly sensitive C-reactive protein (hs-CRP), homocysteine, anti-SSA, anti-cardiolipin antibodies, and HLA type. Brachial artery FMD and endothelium-independent, nitroglycerin-mediated vasodilation (NMD) were studied by using high-resolution, two-dimensional (2-D) ultrasonic imaging. Twelve patients with GCC were evaluated. The mean age of the patients was 36.3 years including 5 (41.6%) women and 7 (58.4%) men. There were no significant differences between patients with GCC and control subjects with regard to basal data, including body mass index, smoking, blood pressure, complete blood count, and routine blood biochemistries. Homocysteine and hs-CRP were within normal limits. Two (16.7%) patients were positive for HLA-B27, anti-SSA, and anti-cardiolipin antibodies. The nitroglycerin-mediated vasodilation in the patients with GCC was not significantly different from that of the control group. The FMD was much lower in the GCC group than in the control groups (mean 4.81% vs. 7.89%, P < 0.01). The significantly lower FMD in patients with GCC implies peripheral vascular endothelial dysfunction. However, in the 16.7% positive for the HLA-B27, anti-SSA, and anti-cardiolipin antibodies, these parameters are associated with GCC and abnormal FMD.

Decreased Cutaneous Resonance Running Time in Cured Leprosy Subjects

Background/Objectives: Leprosy prominently involves both the skin and peripheral neural tissues and some symptoms persist after microbial cure. Because alterations in the dermis also occur in leprosy, we assessed here whether there were changes in cutaneous resonance running time (CRRT), a parameter that is influenced by collagen properties, in cured leprosy subjects. Methods: A reviscometer was used to measure the CRRT at various directions on the dorsal hand and the flexural forearms of 76 cured leprosy subjects aged 50–85 years and 68 age-matched normal subjects. Results: In comparison to normal subjects, CRRTs on the hands and the forearms were significantly reduced in all directions in cured leprosy, except at the 1–7, 2–8 and 3–9 o’clock directions on the forearms. CRRTs were reduced significantly at both the 4–10 and 5–11 o’clock directions on the forearm in lepromatous (73.33 ± 4.19 at 4–10 o’clock and 67.44 ± 2.71 at 5–11 o’clock direction) and borderline lepromatous types (77.58 ± 5.84 at 4–10 o’clock and 79.85 ± 6.81 at 5–11 o’clock direction) as compared with normal (143.10 ± 7.75 at 4–10 o’clock and 125.18 ± 8.14 at 5–11 o’clock direction). On the hand, CRRTs at all directions, except that at 4–10 o’clock direction, were also significantly reduced in lepromatous and borderline lepromatous types in comparison with normal. Significant differences in CRRT at some directions were found among the various subtypes of leprosy. Conclusion: CRRTs were abnormal in the cured leprosy subjects as a whole, but varied with leprosy subtypes, which suggested that the extent of reduction of CRRTs correlates with the severity of immune alteration. These results suggest that CRRT measurements could be a useful approach to quantify the extent of some residual abnormalities in cured leprosy and perhaps could also be used to evaluate the efficacy of treatment.

Model-Based Assessment of Cardiovascular Autonomic Control in Children with Obstructive Sleep Apnea

To quantitatively assess daytime autonomic cardiovascular control in pediatric subjects with and without obstructive sleep apnea syndrome (OSAS). Respiration, R-R intervals, and noninvasive continuous blood pressure were monitored in awake subjects in the supine and standing postures, as well as during cold face stimulation. Sleep disorders laboratory in a hospital setting. Ten pediatric patients (age 11.4 +/- 3.6 years) with moderate to severe OSAS (obstructive apnea-hypopnea index = 21.0 +/- 6.6/1 h) before treatment and 10 age-matched normal control subjects (age 11.5 +/- 3.7 years). Spectral analysis of heart rate variability revealed that high-frequency power was similar and the ratio of low- to high-frequency power was lower in subjects with OSAS vs control subjects. The closed-loop minimal model allowed heart rate variability to be partitioned into a component mediated by respiratory-cardiac coupling and a baroreflex component, whereas blood pressure variability was assumed to result from the direct effects of respiration and fluctuations in cardiac output. Baroreflex gain was lower in subjects with OSAS vs control subjects. Under orthostatic stress, respiratory-cardiac coupling gain decreased in both subject groups, but baroreflex gain decreased only in controls. The model was extended to incorporate time-varying parameter changes for analysis of the data collected during cold face stimulation: cardiac output gain increased in controls but remained unchanged in OSAS. Our findings suggest that vagal modulation of the heart remains relatively normal in pediatric subjects with OSAS. However, baseline cardiovascular sympathetic activity is elevated, and reactivity to autonomic challenges is impaired.

Senile changes of crystalline lens: effects on the delayed latency of pattern visually evoked potentials in phakic and pseudophakic eyes

We recorded visually evoked cortical potentials to pattern stimuli (PVECPs) in 22 patients who received a posterior chamber intraocular lens implant. The mean latency of the P100 obtained from patients was not significantly different from that of age-matched normal phakic subjects. Furthermore, we found that both groups showed a similar increased delay of the P100 latency with age. The results of this study indicated that the senile opacity of the crystalline lens does not contribute to changes of PVECPs with age. These alterations may be due to senile changes of the neural pathway.

Contrast sensitivity deficits in subjects with glaucoma-like discs using an oscilloscope-based method

The central visual function of 20 subjects with glaucoma-like discs, normal intraocular pressures and normal visual fields and 20 age-matched normal subjects was assessed by measuring contrast sensitivity using an oscilloscope technique. The subjects with glaucoma-like discs exhibited a significant reduction in contrast sensitivity compared to the age-matched normal; these differences were greatest at spatial frequencies of 2 and 4 cdeg-1.

Biometric and corneal topographic characteristics in patients with Weill-Marchesani syndrome

To determine the biometry of ocular structures and corneal topographic characteristics in patients with Weill-Marchesani syndrome. Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran. Patients with Weill-Marchesani syndrome (syndrome group) and age-matched normal subjects (control group) were evaluated. All had a complete ocular examination including refraction and analysis using Fourier transformation, slitlamp biomicroscopy, pachymetry, keratometry, and ocular biometry. The following A-scan parameters were measured: anterior chamber depth (ACD), lens thickness, axial length (AL), lens-AL factor, and relative lens position (RLP). Corneal topography examinations were performed in the syndrome group only. The syndrome group comprised 7 female patients and the control group, 20 female subjects. The syndrome group had statistically significantly higher myopia and corneal astigmatism than the control group (P<.0001). Oblique astigmatism was common in the syndrome group, showing a strong right-left specificity (right eyes' axes in the 135-degree meridian, left eyes' axes in the 45-degree meridian). The syndrome group had a statistically significantly shorter AL, shallower ACD, thicker lens, higher calculated lens power, and a higher lens-AL factor (P<.0001). However, there was no statistically significant difference in RLP (P = .32). The syndrome group also had statistically significantly thicker corneas and higher keratometry values (P<.0001). Characteristic ocular findings in patients with Weill-Marchesani syndrome were a steep, thick cornea with a strong right-left specificity of corneal astigmatism; a thick lens; a short AL; and a shallow ACD.

Integration deficiencies associated with continuous limb movement sequences in Parkinson's disease

The present study examined the extent to which Parkinson's disease (PD) influences integration of continuous limb movement sequences. Eight patients with idiopathic PD and 8 age-matched normal subjects were instructed to perform repetitive sequential aiming movements to specified targets under three-accuracy constraints: 1) low accuracy (W = 7 cm) – minimal accuracy constraint, 2) high accuracy (W = 0.64 cm) – maximum accuracy constraint, and 3) mixed accuracy constraint – one target of high accuracy and another target of low accuracy. The characteristic of sequential movements in the low accuracy condition was mostly cyclical, whereas in the high accuracy condition it was discrete in both groups. When the accuracy constraint was mixed, the sequential movements were executed by assembling discrete and cyclical movements in both groups, suggesting that for PD patients the capability to combine discrete and cyclical movements to meet a task requirement appears to be intact. However, such functional linkage was not as pronounced as was in normal subjects. Close examination of movement from the mixed accuracy condition revealed marked movement hesitations in the vicinity of the large target in PD patients, resulting in a bias toward discrete movement. These results suggest that PD patients may have deficits in ongoing planning and organizing processes during movement execution when the tasks require to assemble various accuracy requirements into more complex movement sequences.

Polypoidal choroidal vasculopathy and late geographic hyperfluorescence on indocyanine green angiography

Background/aims:To report the clinical significance of late geographic hyperfluorescence (LGH) on indocyanine green angiography (ICGA) in cases of polypoidal choroidal vasculopathy (PCV).Methods:The medical records of 43 eyes with PCV, all...

Left Ventricular Systolic and Diastolic Dyssynchrony in Asymptomatic Hypertensive Patients

Diastolic and systolic dyssynchrony are common in patients with heart failure. However, the presence of dyssynchrony in asymptomatic patients with hypertension who are susceptible to the development of heart failure is not well understood. The aims of this study were (1) to evaluate the prevalence of systolic and diastolic dyssynchrony and (2) to identify the main determinants of left ventricular (LV) dyssynchrony in asymptomatic patients with hypertension. One hundred ten patients with hypertension consecutively enrolled were compared with 55 age-matched and gender-matched normal control subjects. Comprehensive echocardiography was performed, including conventional and Doppler tissue imaging parameters. LV end-systolic wall stress was calculated using a hemodynamic and echocardiographic M-mode data set. For the assessment of LV dyssynchrony, both the standard deviation of the time from QRS onset to peak systolic velocity and the maximal difference of the time from QRS onset to peak systolic velocity from 6 basal segments at the apical views were used and were compared between the two groups. Both systolic and diastolic dyssynchrony indexes were significantly higher in patients with hypertension than in the normal controls (P < .001), with no significant correlation between the systolic and diastolic dyssynchrony indexes. The proportions of patients with hypertension who had LV systolic and diastolic dyssynchrony were 24% and 21%, respectively. Multivariate analysis showed that the E/E' ratio (P < .001) was independently associated with LV systolic dyssynchrony, whereas LV mass index (P = .001) and E/E' (P < .001) were major determinants of LV diastolic dyssynchrony. LV systolic and diastolic dyssynchrony are not uncommon in asymptomatic patients with hypertension and are significantly associated with LV filling pressure. The determinants of LV systolic dyssynchrony are not the same as those of diastolic dyssynchrony, implying that different mechanisms are involved in the development of LV systolic and diastolic dyssynchrony in asymptomatic patients with hypertension.

Cerebellar activation during ataxic gait in olivopontocerebellar atrophy: a PET study.

To investigate the possible abnormal regional brain metabolism during ataxic gait in olivopontocerebellar atrophy (OPCA), and to evaluate the response of the cerebellar subregions to instability during bipedal gait. On 9 patients with OPCA in early phase and on 10 age-matched normal subjects, we performed positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) under two different conditions: supine resting and 30 min treadmill walking. Both in normals and in patients with OPCA, the FDG uptake in the walking state (Uwalk) was significantly greater than that in the resting state (Urest) in the pyramis, declive-folium-tuber and culmen of the cerebellar vermis, and in the thalamus. In the patients, the Uwalk was also significantly greater than the Urest in the posterior lobe of cerebellar hemisphere and in the pons and midbrain. In the pyramis, the activation ratio (= Uwalk/Urest) of the patients was significantly lower than that of the normals. We considered that these findings reflect the pathophysiology of ataxic gait in OPCA patients and the compensatory mechanism for the instability during ataxic gait.

Skin nerve sympathetic activity reflex latency in Parkinson's disease

Using a microneurographic method, skin nerve sympathetic activity (SSA) reflex latency was measured in 16 patients suffering from idiopathic Parkinson's disease (PD) and 11 age-matched normal subjects. The mean latency in patients with PD was significantly delayed (0.821 s, p less than 0.01), when compared with that in normal subjects (0.676 s). Reflex latency showed a significant positive linear correlation with arm length. By determining the SSA reflex latency, conduction velocities in post-ganglionic skin sympathetic nerve were measured indirectly. Averaged conduction velocities in PD and normal subjects, 1.76 m/s and 1.86 m/s, respectively, did not differ significantly (p greater than 0.1). This data suggests that the reflex pathway of SSA is disturbed in patients with PD and that the increased reflex latency is caused by a central/preganglionic delay.

Gait Analysis after Initial Nonoperative Treatment for Clubfeet: Intermediate Term Followup at Age 5

We conducted gait analysis following initial nonoperative clubfoot treatment to compare lower extremity kinematic (eg, ankle motion) and kinetic (eg, ankle power) characteristics between patients treated as infants with Ponseti casting or French physical therapy. This is a followup report of gait characteristics at age 5 years in patients who had previously been tested at age 2 years. One hundred-twenty five clubfeet in 90 patients (34 feet only Ponseti treatment, 40 only French PT, and 51 feet initial nonoperative treatment followed by surgery) were included. The gait characteristics were compared to those of age-matched normal control subjects. Ankle equinus during gait occurred in 5% of feet treated with the French method and none of those treated by the Ponseti method. Increased stance phase ankle dorsiflexion persisted in 24% of feet treated by the Ponseti method. Intoeing was seen in 1/3 of both the French and Ponseti methods. Ankle push-off power was decreased compared to normal in patients treated by both methods, and even more so in operated feet. The presence or absence of Achilles tenotomy did not affect ankle power. Gait characteristics of feet that did not have surgery and maintained correction were superior to those of operated feet.

Impaired myocardial oxidative metabolism in the remote normal region in patients in the chronic phase of myocardial infarction and left ventricular remodeling

BackgroundLeft ventricular (LV) remodeling occurs in the remote normal region in the LVs after myocardial infarction (MI) and is closely involved in heart failure. MethodsWe assessed myocardial oxygen consumption using a clearance rate constant Kmono for the time activity curves of 11C-acetate in 15 patients with a prior anterior wall MI, 8 with a prior inferior wall MI, and 10 age-matched normal control subjects. LV end-systolic volume index (ESVI) was determined by echocardiography. ResultsThe LVESVI was significantly greater in patients with an anterior and inferior MI than in control subjects. The heart rate systolic pressure product did not differ among the groups. Kmono in the remote normal region in patients with an anterior MI was significantly less than that in the corresponding area in control subjects (0.055 ± 0.005 vs 0.065 ± 0.008 min−1, P < .001). Kmono in the remote normal region in those with an inferior MI was also significantly less compared with controls (0.054 ± 0.007 vs 0.069 ± 0.010 min−1, P < .01). ConclusionIn patients with a prior MI and LV remodeling, myocardial oxidative metabolism is apparently impaired in the remote normal region where augmented myocardial energy production is needed against the increased end-systolic wall stress caused by LV dilatation.

The limits of stability in patients with Ménière's disease

Objective. To determine the ability of patients with unilateral Meniere's disease (MD) to reach the corresponding limits of stability and to define the existence of directional constraints. Patients. 112 patients with unilateral MD and 30 normal age-matched subjects with no history of equilibrium problems. Methods. A computerized dynamic posturography system was used to test the ability of subjects to displace their centre of pressure (COP) to the corresponding limits of stability. The eight targets used were separated by 45° to form a circle around the subject who had to displace their COP to the target. Reaction time, velocity, accuracy and an overall evaluation of the intended movement towards and away from the target were analysed. Other characteristics of the patients were also assessed. Results. A small but significant correlation was found between auditory and vestibular deficit and the different variables studied in the limits of stability test. Three factors were derived from variables obtained with short displacements, and the results are significantly different between patients and controls and are correlated with the period since the last vertigo spell, the level of disability, hearing loss and vestibular deficit. Conclusions. Dynamic balance is moderately impaired in patients with Meniere's disease.

Low serum BDNF and food intake regulation: A possible new explanation of the pathophysiology of eating disorders

Background Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays an important role in weight regulation and eating behavior, and poorly balanced diets lead to a decrease in blood BDNF levels. However, studies regarding BDNF blood levels in eating disorders (ED) have yielded inconsistent results. We measured serum concentrations of BDNF and assessed behavior and cognition related to eating in ED patients and control subjects. Methods Forty female drug-free patients [19 with anorexia nervosa (AN), 21 with bulimia nervosa (BN)], who did not meet the diagnostic criteria for depressive disorder, and 24 age-matched normal control subjects were enrolled in the current study. We evaluated eating-related psychopathology and depressive symptoms using the Eating Disorder Inventory-2 (EDI-2), Eating Attitude Test-26 (EAT-26) and the Hamilton Depression Rating Scale (HDRS), and measured serum BDNF levels by an enzyme-linked immunosorbent assay. Results Compared to normal controls, serum levels of BDNF were significantly reduced in AN, but not in BN. There was a significant positive correlation between serum BDNF levels and BMI in both AN patients ( r = .649, p = .003) and BN patients ( r = .626, p = .002). However, no correlation between serum BDNF levels and BMI was detected in the controls. Furthermore, there was a significant negative correlation between serum BDNF levels and the oral control subscale scores of EAT in both AN patients ( r = − .506, p = .027) and BN patients ( r = − .511, p = .018); whereas, no correlation was detected in normal controls. Conclusion Our study demonstrated that individuals showing more extreme food intake regulation were those with lower serum BDNF levels. This finding is contrary to that in mice where mice with reduced BDNF levels showed aberrant eating behavior. This result suggests that BDNF is no longer functioning appropriately in ED patients, which could be an important factor in the pathophysiological of ED.

Diffusion tensor tractography can predict hemiparesis in infants with high risk factors

Diffusion tensor tractography (DTT) is known to be useful in detecting white matter lesions. In the current study, we report on two hemiparetic patients with risk factors who showed abnormalities of the corticospinal tract (CST) on diffusion tensor tractography (DTT) prior to the manifestation of hemiparesis. Two hemiparetic patients with risk factors (preterm, low birth weight) and six age-matched normal control subjects were enrolled to this study. Diffusion tensor imaging (DTI) was performed at the age of 43 weeks (patient 1) and 33 weeks (patient 2) using 1.5-T with a Synergy-L Sensitivity Encoding (SENSE) head coil. We measured fractional anisotropy (FA), apparent diffusion coefficients (ADCs), and fiber counts of the CST. There were no definite asymmetric findings on physical examination and conventional brain MRI. By contrast, DTT showed a unilateral CST disruption at the periventricular white matter, low FA values, and low CST fiber counts compared with those of the unaffected CST and controls. These patients were diagnosed with hemiparetic cerebral palsy when we re-evaluated these patients at the age of 6 years (patient 1) and 3 years of age (patient 2), respectively. In these two patients, DTT revealed abnormalities of the CST prior to the manifestation of hemiparesis. Therefore, it seems that DTT would be a useful modality in detecting CST abnormalities in advance of clinical manifestation in infants with high risk factors.

The Differences in Gait Pattern Between Dancers and Non-Dancers

AbstractStudents in dancing department routinely perform hours of dancing every day. Extreme ankle posture can subject the ankle of the dancers to high stress and can significantly increase the mobility of the ankle. This causes ankle sprain which occurs frequently during daily walking. Measurements of the ground reaction force (GRF) and the center of pressure (CoP) provide useful variables to analyze the walking patterns of dancers, which might help understand the causes of ankle sprain. The aims of this work were (1) to investigate the differences in gait patterns between dancers and non-dancers and (2) to explore the gait characteristics in dancers. Thirteen students in dancing department and twenty age-matched normal healthy subjects were recruited. All subjects were requested to walk along a 10-meter walkway. Results showed that the dancers have greater medial shear force of the GRF, and decreased the CoP velocity during the pre-swing phase, delayed peak-CoP velocity occurrence during the mid-stance, and straighter CoP trajectory through the forefoot at push off. The intense and demanding dancing activities change the walking pattern of dancers, which may lead to higher chance of getting ankle sprain.