Biphasic Waveform Research Articles

Posteroanterior cervical transcutaneous spinal stimulation targets ventral and dorsal nerve roots

ObjectiveWe aim to non-invasively facilitate activation of spared neural circuits after cervical spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). We developed and tested a novel configuration for cervical transcutaneous spinal stimulation (cTSS). MethodscTSS was delivered via electrodes placed over the midline at ~T2-T4 levels posteriorly and ~C4-C5 levels anteriorly. Electromyographic responses were measured in arm and hand muscles across a range of stimulus intensities. Double-pulse experiments were performed to assess homosynaptic post-activation depression (PAD). Safety was closely monitored. ResultsMore than 170 cTSS sessions were conducted without major safety or tolerability issues. A cathode-posterior, 2 ms biphasic waveform provided optimal stimulation characteristics. Bilateral upper extremity muscle responses were easily obtained in subjects with SCI and ALS. Resting motor threshold at the abductor pollicis brevis muscle ranged from 5.5 to 51.0 mA. As stimulus intensity increased, response latencies to all muscles decreased. PAD was incomplete at lower stimulus intensities, and decreased at higher stimulus intensities. ConclusionsPosteroanterior cTSS has the capability to target motor neurons both trans-synaptically via large-diameter afferents and non-synaptically via efferent motor axons. SignificancePosteroanterior cTSS is well tolerated and easily activates upper extremity muscles in individuals with SCI and ALS.

Portal hypertension evolving from sickled hepatopathy: Could hepatic venous Doppler ultrasound be beneficial in its evaluation?

PurposeSickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound. MethodsThis is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19–43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities. ResultsAll the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18–25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney. ConclusionDoppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

Pre-clinical assessment of a prototype non-invasive diagnostic device to detect aortic aneurysms.

We have developed a non-invasive diagnostic device for treating thoracic aortic aneurysm that can be applied at a peripheral artery. This study aimed to examine how configuration and size of an aneurysm as well as endoluminal pressure affect our diagnostic device's ability to detect an aneurysm, using a pulsatile mock circulation. We created three different-sized (12, 16, and 20mm) saccular and fusiform aneurysm models using silicone and incorporated them in a pulsatile perfusion circuit to evaluate vertical vessel wall velocity wave form at a location apart from the aneurysm. We also varied the pressure condition to evaluate the changes in the detected wave forms. In both fusiform and saccular aneurysm models, biphasic wave forms indicating the presence of aneurysm within the circuit were observed. Regarding aneurysm diameter, biphasic wave forms were observed in all aneurysm models. However, in the 12-mm model, which is relevant to the minimum diameter of clinical diagnostic criteria for an aneurysm relative to normal size, no biphasic waveform was detected when the endoluminal pressure was relatively low. In the 16- and 20-mm models, biphasic waveform was detected without being affected by the configuration and endoluminal pressure. The detectability of aneurysms within a pulsatile mock circulation using our non-invasive diagnostic device was not affected by the clinically relevant configuration and size of the aneurysm under slightly hypertensive endoluminal pressure condition. Low endoluminal pressure may lower the diagnostic sensitivity for relatively small saccular aneurysm.

Charge-Balanced Electrical Stimulation Can Modulate Neural Precursor Cell Migration in the Presence of Endogenous Electric Fields in Mouse Brains.

Electric fields (EFs) can direct cell migration and are crucial during development and tissue repair. We previously reported neural precursor cells (NPCs) are electrosensitive cells that can undergo rapid and directed migration towards the cathode using charge-balanced electrical stimulation in vitro. Here, we investigate the ability of electrical stimulation to direct neural precursor migration in mouse brains in vivo. To visualize migration, fluorescent adult murine neural precursors were transplanted onto the corpus callosum of adult male mice and intracortical platinum wire electrodes were implanted medial (cathode) and lateral (anode) to the injection site. We applied a charge-balanced biphasic monopolar stimulation waveform for three sessions per day, for 3 or 6 d. Irrespective of stimulation, the transplanted neural precursors had a propensity to migrate laterally along the corpus callosum, and applied stimulation affected that migration. Further investigation revealed an endogenous EF along the corpus callosum that correlated with the lateral migration, suggesting that the applied EF would need to overcome endogenous cues. There was no difference in transplanted cell differentiation and proliferation, or inflammatory cell numbers near the electrode leads and injection site comparing stimulated and implanted non-stimulated brains. Our results support that endogenous and applied EFs are important considerations for designing cell therapies for tissue repair in vivo.

Cardioversion of Atrial Fibrillation and Flutter: Comparative Study of Pulsed vs. Low Energy Biphasic Truncated Exponential Waveforms.

Despite the widespread use of biphasic waveforms for cardioversion and defibrillation, the efficacy and safety of shocks has only been compared in a few studies. This retrospective study aims at comparing the efficacy and safety of biphasic truncated exponential (BTE) pulsed energy (PE) waveform with a BTE low energy (LE) waveform for cardioversion of atrial fibrillation (AF) and atrial flutter (AFL). The treatment energies were following an escalating protocol for PE waveform (120-200-200J in AF and 30-120-200J in AFL) and LE waveform (100-200-200J in AF and 30-100-200J in AFL). The protocol was stopped at successful cardioversion (sinus rhythm at 1 minute post-shock), otherwise after the 3rd shock. If the 3rd BTE shock failed, a monophasic shock of 360J was delivered. From May 2008 to November 2017, 193 patients (153 PE, 40 LE) were included in the study. Both groups significantly differed in a few characteristics, including chest circumference (p<0.05). After adjustment, the success rate was not significantly different for the two waveforms (94.5% PE vs 92.5% LE, Odds Ratio [95% Confidence Interval] = 0.25 [0.03-2.2]).There was no difference in safety: post-shock changes in Hsc-TnI levels were similar (p=0.25). The efficient cumulative energy was particularly related with BSA (β = 131.5, p=0.05), AF/AFL duration (β = 0.24, p=0.01) and gender (β = 61.8, p=0.05). The major clinical implications of this study concern the high success rate of cardioversion with both biphasic pulses and no superiority of LE over PE waveform with an excellent safety profile without post-shock myocardial injuries.

Comparison between clot waveform analysis (CWA) of normal and abnormal aPTT of sepsis patients in Dr. Hasan Sadikin Hospital Bandung

Sepsis is a clinical syndrome caused by the entry of harmful pathogens toxins into the blood vessels, which will cause the immune system response and ultimately will also interfere with hemostasis system including coagulation system which can end up with DIC. Therefore, monitoring of coagulation in sepsis becomes very important. The examination of coagulation such as PT and aPTT by mechanical methods only provide information about the timing of the coagulation and completely unknown how the coagulation process occurs. The Currently available coagulometer tool that checks the coagulation system with photo optical method to visualize the waveforms clot (Clot Waveform Analysis). This study was to determine the difference between CWA of normal and abnormal aPTT in sepsis patients. It was conducted at the Laboratory of Clinical Pathology, RSUP Dr. Hasan Sadikin Bandung. The subjects were all patients diagnosed with sepsis based on SOFA sepsis criteria, in the period of May 1, 2016, until August 31, 2016, were examined aPTT by CS2100i. The CWA were obtained from the examination of aPTT with the tool. Waveform of aPTT in sepsis was a biphasic waveform if the value of slope_ 1> -0.25% T / sec. The waveform were found in normal aPTT (83.33%) and prolonged aPTT group (100%). It were occured in the most normal aPTT groups and in all subjects with prolonged aPTT.This finding was useful for the treatment of sepsis patients when aPTT is normal because it proved that in sepsis patients with normal aPTT shows a biphasic waveform.

Somatosensory Cortex Microstimulation: Behavioral Effects of Phase Duration and Asymmetric Waveforms.

Intracortical microstimulation has proven to be effective in a variety of sensory applications, such as returning touch percepts to paralyzed patients. The parameters of microstimulation play an important role in the perception quality of the stimulus. Eliciting naturalistic percepts is essential for the adaptability and functionality of this technology. Compared to the typical biphasic symmetric waveforms, asymmetric waveforms enhance activation selectivity by preferentially activating cell bodies. Behavioral studies have shown that asymmetric waveforms can elicit behavioral responses, but these require higher charges than typical symmetric waveforms. Here, we investigated the effects of phase duration and waveform asymmetry for somatosensory cortex intracortical microstimulation of freely-behaving rats. Detection thresholds were obtained using a conditioned avoidance behavioral paradigm. Our results indicate that phase duration has significant effects on threshold regardless of symmetry, polarity, and phase order of the waveform. Specifically, shorter phase durations tend to elicit lower behavioral thresholds. Analogous to studies in the auditory cortex, asymmetric waveforms in which the short pulse was cathodic were more effective than those with short-anodic pulses. With short phase durations, these short-cathodic waveforms are capable of evoking behavioral responses at low charges (<; 5 nC/Phase). Altogether, these results suggest the possibility of cell body selective microstimulation at safe thresholds, as well as the potential translatability of neuromodulation parameters across distinct sensory cortical areas.

A Wireless Neurostimulator System with an Embedded ARM™ Microprocessor.

In this study, a novel multi-layer printed circuit board (PCB)-based neurostimulator system with an embedded microprocessor is presented for applications in neuroprosthesis. The system integrates rechargeable batteries, a power management block, adjustable constant-current waveforms, voltage transient monitoring, and evoked neural response recording. The system can be configured to select channels among the 16 stimulation channels via Bluetooth communication wirelessly. Bench top measurements demonstrated that the system generated biphasic current waveforms with various stimulation parameters with approximately 407 mW of power consumption. Additional testing and validation with microelectrodes are underway.

P26-S Left and right motor cortical excitability and relationship to motor functions in healthy adolescents

Background The interhemispheric difference in cortical excitability and its relationship to motor functions is unclear. Aim We examined the relationship between handedness, left and right motor cortex excitability and fine and gross motor functions in adolescence. Methods 28 healthy adolescents (age 16–19 years, 19 girls) were studied. Handedness was determined by the Waterloo Handedness Questionnaire. Motor threshold (MT) of the abductor pollicis brevis was measured on both hemispheres using biphasic stimulation, and on the left hemisphere also with monophasic stimulation. Box and block test (BBT) was used for manual dexterity, line run and standing long jump for gross motor tasks. Spearman correlations and paired samples t -test were used. Results All subjects were right-handed; handedness score varied between 16 and 40. MT of the left hemisphere assessed with monophasic stimulation correlated with handedness (−0.516, p = 0.006) and remained a trend with biphasic waveform (−0.353, p = 0.065). MT was not different between hemispheres (40.3 in the left vs. 41.3% in the right hemisphere). BBT result was better with right hand (76.7 vs 73.9, p = 0.008). MT of the right hemisphere correlated with the BBT of the right hand ( r = −0.383, p = 0.044). MTs and gross motor tasks did not correlate. Discussion On the right, non-dominant hemisphere, higher excitability was associated with better ipsilateral performance. Gross motor functions may be more strongly related to muscle force and therefore do not correlate with cortical excitability. Clearly established right-handedness is related to higher excitability in the dominant hemisphere. Interestingly, this seems to partly depend on the stimulation type.

Ascending Defibrillation Waveform Significantly Reduces Myocardial Morphological Damage and InjuryCurrent.

This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model. Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival. An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion withamplitudes of 20J (ASC 20J) and 25J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6of 14 pigs (p<0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6h post-shock. Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTEwaveform.

Using Chronopotentiometry to Better Characterize the Charge Injection Mechanisms of Platinum Electrodes Used in Bionic Devices.

The safe charge injection capacity and charge density of neural stimulating electrodes is based on empirical evidence obtained from stimulating feline cortices. Stimulation induced tissue damage may be caused by electrochemical or biological mechanisms. Separating these mechanisms requires greater understanding of charge transfer at the electrode-tissue interface. Clinical devices typically use a biphasic waveform with controlled current. Therefore, the charge injection mechanism and charge injection capacity of platinum was assessed on a commercial potentiostat by chronopotentiometry (controlled current stimulation). Platinum is a non-ideal electrode, charge injection by chronopotentiometry can be passed via capacitive and Faradaic mechanisms. Electrodes were tested under a variety of conditions to assess the impact on charge injection capacity. The change in electrode potential (charge injection capacity) was affected by applied charge density, pulse length, pulse polarity, electrode size, polishing method, electrolyte composition, and oxygen concentration. The safe charge injection capacity and charge density could be increased by changing the electrode-solution composition and stimulation parameters. However, certain conditions (e.g., acid polished electrodes) allowed the electrode to exceed the water electrolysis potential despite the stimulation protocol being deemed safe according to the Shannon plot. Multiple current pulses led to a shift or ratcheting in electrode potential due to changes in the electrode-solution composition. An accurate measure of safe charge injection capacity and charge density of an implantable electrode can only be obtained from suitable conditions (an appropriately degassed electrolyte and clinically relevant electrode structure). Cyclic voltammetric measurement of charge storage capacity can be performed on implantable electrodes, but will not provide information on electrode stability to multiple chronopotentiometric pulses. In contrast, chronopotentiometry will provide details on electrode stability, but the minimum time resolution of typical commercial potentiostats (ms range) is greater than used in a clinical stimulator (μs range) so that extrapolation to short stimulation pulses is required. Finally, an impedance test is typically used to assess clinical electrode performance. The impedance test is also based on a biphasic chronopotentiometic waveform where the measured potential is used to calculate an impedance value. Here it is shown that the measured potential is a function of many parameters (solution composition, electrode area, and surface composition). Subsequently, impedance test results allow electrode comparison and to indicate electrode failure, but use of Ohm’s law to calculate an impedance value is not valid.

Development of a miniature device for emerging deep brain stimulation paradigms.

Deep brain stimulation (DBS) is a neuromodulatory approach for treatment of several neurological and psychiatric disorders. A new focus on optimising the waveforms used for stimulation is emerging regarding the mechanism of DBS treatment. Many existing DBS devices offer only a limited set of predefined waveforms, mainly rectangular, and hence are inapt for exploring the emerging paradigm. Advances in clinical DBS are moving towards incorporating new stimulation parameters, yet we remain limited in our capacity to test these in animal models, arguably a critical first step. Accordingly, there is a need for the development of new miniature, low-power devices to enable investigation into the new DBS paradigms in preclinical settings. The ideal device would allow for flexibility in the stimulation waveforms, while remaining suitable for chronic, tetherless, biphasic deep brain stimulation. In this work, we elucidate several key parameters in a DBS system, identify gaps in existing solutions, and propose a new device to support preclinical DBS. The device allows for a high degree of flexibility in the output waveform with easily altered shape, frequency, pulse-width and amplitude. The device is suitable for both traditional and modern stimulation schemes, including those using non-rectangular waveforms, as well as delayed feedback schemes. The device incorporates active charge balancing to ensure safe operation, and allows for simple production of custom biphasic waveforms. This custom waveform output is unique in the field of preclinical DBS devices, and could be advantageous in performing future DBS studies investigating new treatment paradigms. This tetherless device can be easily and comfortably carried by an animal in a back-mountable configuration. The results of in-vitro tests are presented and discussed.

AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures.

AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures.

Increased Hip Intracapsular Pressure Decreases Perfusion of the Capital Femoral Epiphysis in a Skeletally Immature Porcine Model.

Increased intracapsular hip pressure is thought to be one of the possible etiologies of femoral head avascular necrosis after intra-articular proximal femoral fractures or acute slipped capital femoral epiphysis. The purpose of this study was to evaluate the relationship between intra-articular hip pressure (IAP) and epiphyseal perfusion pressure (EPP), and its dependency on skeletal maturity using a porcine model. Seven female Yorkshire-hybrid pigs were used to study the direct relationship between IAP and EPP. A needle inserted into the capsule provided both IAP monitoring and saline infiltration until IAP was above mean arterial pressure (MAP). Video simultaneously documented IAP, EPP, MAP. Parameters for all trials in each hip were averaged and compared between the 2 age groups. Significance was P<0.05. Four young hips (in pigs 10.3±1.0 wk, 27.4±2.0 kg) and 5 older hips (21.1±0.1 wk, 89.4±7.1 kg) were studied. There was no significant difference in the MAP (50.0±11.8 and 55.5±7.0 mm Hg respectively, P=0.411) between the 2 age groups. In the older hips, biphasic EPP persisted despite increasing IAP to an average of 177 mm Hg over MAP. In the young pigs, the biphasic EPP waveform ceased with increased IAP to an average of 28 mm Hg over MAP. Biphasic waveforms returned once IAP fell to an average of 5 mm Hg over MAP. Increased IAP resulted in tamponade of epiphyseal perfusion in the young, but not in the older hips. An intact physis may preclude intraosseous metaphyseal vessels from penetrating the epiphysis, leaving it vulnerable to retinacular artery tamponade. The IAP and EPP relationship has direct clinical practice implications. Hip capsulotomy and decompression in young patients with intra-articular proximal femoral fractures and increased intracapsular pressure may decrease avascular necrosis risk.

Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension.

Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD.

The impact of tubing on biphasic inspiratory waveforms in non‐invasive ventilation in simulated lung models

The impact of tubing on biphasic inspiratory waveforms in non‐invasive ventilation in simulated lung models

Biphasic Waveform External Defibrillation Starting Energy and In-Hospital Cardiac Arrest Survival: Retrospective Cohort Study From the Get With the Guidelines-Resuscitation Registry

ABSTRACT Biphasic waveform defibrillators permit effective defibrillation of ventricular tachycardia and ventricular fibrillation (VT/VF) at lower energies. Little data is available on trends in th...

Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter.

The relevance of transthoracic impedance (TTI) to electrical cardioversion (ECV) success for atrial tachyarrhythmias when using biphasic waveform defibrillators is unknown. TTI is predictive of ECV success with contemporary defibrillators. De-identified data stored in biphasic defibrillator memory cards from ECV attempts for atrial fibrillation (AF) or atrial flutter (AFL) over a 2-year period at our center were evaluated. ECV success, defined as arrhythmia termination and ≥ 1 sinus beat, was adjudicated by 2 blinded cardiac electrophysiologists. The association between TTI and ECV success was assessed via Cochrane-Armitage trend and Spearman rank correlation tests, as well as simple and multivariable logistic regression. The influence of TTI on the number of shocks and on cumulative energy delivered per patient was also examined. 703 patients (593 with AF, 110 with AFL) receiving 1055 shocks were included. Last shock success was achieved in 88.0% and 98.2% of patients with AF and AFL, respectively. In patients with AF, TTI was positively associated with last shock failure (Ptrend =0.019), the need for multiple shocks (Ptrend <0.001), and cumulative energy delivered (ρ = 0.348; P < 0.001). After adjusting for first shock energy, 10-Ω increments in TTI were associated with odds ratios of 1.36 (95% CI: 1.24-1.49) and 1.22 (95% CI: 1.09-1.37) for first and last shock failure, respectively (P < 0.001 for both). Although contemporary defibrillators are designed to compensate for TTI, this variable continues to be associated with ECV failure in patients with AF. Strategies to lower TTI during ECV for AF may improve procedural success.

Low Frequency Microstimulation Is Locally Excitatory in Patients With Epilepsy.

Deep brain stimulation (DBS) could become a palliative treatment for patients with drug-resistant epilepsy for which surgery cannot be proposed. The objective of this study was to perform microstimulation to measure the effects of DBS in epilepsy locally at the level of a few neurons, with microelectrode recordings, for the first time in patients with epilepsy. Microelectrode recordings were performed before, during and after microstimulation in nine patients with refractory epilepsy. Neuronal spikes were successfully extracted from multi-unit recordings with clustering in six out of seven patients during hippocampal and in one out of two patients during cortical dysplasia microstimulation (1 Hz, charge-balanced biphasic waveform, 60 μs/ph, 25 μA). The firing rates increased in four out of the six periods of microstimulation that could be analyzed. The firing rates were found higher than before microstimulation in all eight periods with increases reaching significance in six out of eight periods. Low-frequency microstimulation was hence sufficient to induce neuronal excitation lasting beyond the stimulation period. No inhibition was observed. This report presents the first evidence that microstimulation performed in epileptic patients produced locally neuronal excitation. Hence neuronal excitation is shown here as the local mechanism of action of DBS. This local excitation is in agreement with epileptogenic effects of low-frequency hippocampal macrostimulation.

An Evaluation of Hemostatic Abnormalities in Patients With Hemophilia According to the Activated Partial Thromboplastin Time Waveform.

The usefulness of the waveform of activated partial thromboplastin time (APTT) in various diseases has been evaluated in recent years. The APTT waveform was examined in patients with hemophilia and patients positive for lupus anticoagulant (LA). The correlation with the FVIII activity was highest for the height of acceleration peak. The peak time of acceleration, velocity, and ½ fibrin formation, and the width of acceleration and velocity were significantly long and the height of acceleration was significantly low in patients with hemophilia. The height of velocity was significantly low in patients with hemophilia with inhibitor. There were no significant differences in the APTT waveform between patients with hemophilia and patients with LA, but the peak of acceleration and ½ fibrin formation were significantly longer and the height of acceleration and velocity were significantly lower in patients with hemophilia with inhibitor than in the patients with LA. Wave changes in the APTT were observed in all 22 patients positive for LA, while a biphasic waveform was observed in patients with hemophilia with FVIII activity <10.0%. The APTT waveform is useful for the analysis of hemostatic abnormalities in patients with hemophilia.