Specific Normal Values Research Articles

Determining cardiovascular fitness normative reference values in a university aged Canadian population using maximal exercise testing

Abstract Study aim: Maximal oxygen uptake (VO2max) is the greatest rate at which the body can use oxygen and is an indicator of aerobic power. Although aerobic fitness is such a valuable determinant of health, there is limited research with established normative values for a healthy young adult Canadian population. The purpose of the study was to develop normative reference values for a Canadian young-adult population. Material and methods: 550 undergraduate student (280 male and 270 female) participants, with a mean body mass (BM) of 72.08 ± 15.05 kg, mean age of 21.16 ± 1.26 years old and mean height of 171.95 ± 10.25 cm completed a VO2max test using the Bruce treadmill protocol. Male and female classifications were established for the total exercise time in minutes and for the measured VO2max using percentiles and a seven-category classification system. Results: There were statistically significant differences between the sexes for VO2max values (p < 0.001). The measured assessment for the healthy young Canadian adults showed a mean VO2max value of 40.90 ± 7.50 mL/kg/min for females and 49.89 ± 9.20 mL/kg/min for males. Females were able to withstand the exercise protocol for a mean of 11.92 ± 1.97 minutes, while males exercised for an average of 14.33 ± 2.40 minutes before the test was terminated. Conclusions: This study provides specific normative values for the aerobic fitness of a university aged Canadian population which can be used as reference values for cardiovascular health and fitness assessments.

4Dimensional XStrain Echocardiography: M-mode and Tissue Doppler Estimation of Age and Gender Specific Normative Values of Aortic Stiffness in Healthy Adults during Covid-19 Pandemic.

The elastic properties of the aorta are modified in numerous cardiovascular and non-cardiovascular diseases. Multiple studies have evaluated aortic stiffness in myriads of disease state, albeit only few Indian studies have estimated the normal values of aortic stiffness in healthy population. To the best of our knowledge, till date no research has been undertaken to determine the age and gender specific value ranges of aortic stiffness parameters in healthy subjects. Hence, in the present study we endeavoured to estimate these values in our distinctive study groups of healthy adults. This was a prospective observational study in which 58 healthy adults were enrolled during the turbulent corona pandemic. Study group was of the age group 18-60 years of either sex and was arbitrarily divided into six groups. Exhaustive M-mode and Tissue doppler Imaging was performed by 4Dimensional XStrain echocardiography system for extensive evaluation of multiple M-mode and Tissue Doppler imaging derived parameters of Aortic stiffness and superior wall velocities of ascending aorta. AOS, AOD, Aortic strain, and elasticity modulus were greater in males. On the contrary Aortic superior wall velocities (SAO, EAO, and AAO) were higher in females. Increasing age led to a decline in majority of stiffness parameters derived by M-mode echocardiography. Correspondingly EAO determined by TDI of superior wall of aorta, showed a deterioration with advancing age. The authors report a normal range of M-mode and TDI derived values of Aortic stiffness of ascending aorta, in healthy Indian adults. Difference in magnitude of aortic elasticity indices has been demonstrated in men and women, as well as in different subsets of the study group.

Normal Values of Left Ventricular Mass by Two-Dimensional and Three-Dimensional Echocardiography: Results from the World Alliance Societies of Echocardiography Normal Values Study

Although increased left ventricular (LV) mass is associated with adverse outcomes, measured values vary widely depending on the specific technique used. Moreover, the impact of sex, age, and race on LV mass remains controversial, further limiting the clinical use of this parameter. Accordingly, the authors studied LV mass using a variety of two-dimensional and three-dimensional echocardiographic techniques in a large population of normal subjects encompassing a wide range of ages. Transthoracic echocardiograms obtained from 1,854 healthy adult subjects (52% men) enrolled in the World Alliance Societies of Echocardiography (WASE) Normal Values Study, were divided into three age groups (young, 18-35years; middle aged, 36-55years; and old, >55years). LV mass was obtained using five conventional techniques, including linear and two-dimensional methods, as well as direct three-dimensional measurement. All LV mass values were indexed to body surface area, and differences according to sex, age, and race were analyzed for each technique. LV mass values differed significantly among the five techniques. Three-dimensional measurements were considerably smaller than those obtained using the other techniques and were closer to magnetic resonance imaging normal values reported in the literature. For all techniques, LV mass in men was significantly larger than in women, with and without body surface area indexing. These technique- and sex-related differences were larger than measurement variability. In women, age differences in LV mass were more pronounced and depicted significantly larger values in older age groups for all techniques, except three-dimensional echocardiography, which showed essentially no differences. LV mass was overall larger in black subjects than in white or Asian subjects. Significant differences in LV mass values exist across echocardiographic techniques, which are therefore not interchangeable. Sex-, race-, and age-related differences underscore the need for separate population specific normal values.

Systolic Blood Pressure Response to Exercise in Endurance Athletes in Relation to Oxygen Uptake, Work Rate and Normative Values.

Work rate has a direct impact on the systolic blood pressure (SBP) during aerobic exercise, which may be challenging in the evaluation of the SBP response in athletes reaching high work rates. We aimed to investigate the exercise SBP response in endurance athletes in relation to oxygen uptake (VO2), work rate and to recent reference equations for exercise SBP in the general population. Endurance athletes with a left-ventricular end-diastolic diameter above the reference one performed a maximal bicycle cardiopulmonary exercise test. The increase in SBP during exercise was divided by the increase in VO2 (SBP/VO2 slope) and in Watts, respectively (SBP/W slope). The maximum SBP (SBPmax) and the SBP/W slope were compared to the predicted values. In total, 27 athletes (59% men) were included; mean age, 40 ± 10 years; mean VO2max, 50 ± 5 mL/kg/min. The mean SBP/VO2 slope was 29.8 ± 10.2 mm Hg/L/min, and the mean SBP/W slope was 0.27 ± 0.08 mm Hg/W. Compared to the predicted normative values, athletes had, on average, a 12.2 ± 17.6 mm Hg higher SBPmax and a 0.12 ± 0.08 mm Hg/W less steep SBP/W slope (p < 0.01 and p < 0.001, respectively). In conclusion, the higher SBPmax values and the less steep SBP/W slope highlight the importance of considering work rate when interpreting the SBP response in endurance athletes and suggest a need for specific normative values in athletes to help clinicians distinguish physiologically high maximal blood pressure from a pathological blood pressure response.

A Systematic Review on Sonographic Evaluation of Renal Size in Apparently Healthy Adults

The normal size of a kidney is variable and is affected by both physiologic and pathological conditions. Since renal size is affected by various factors, it is necessary to establish population specific normative values. Ultrasonography has shown its usefulness as an essential tool in the evaluation of renal size. The study aimed at reviewing published articles in the evaluation of renal size and identifying gaps in order to make recommendation for further studies. All articles included in this review are prospective in design with the smallest sample size used being 100 participants and the largest 4,035 participants. The age of the participants ranged from 13 to 80 years. The overall mean renal size reported in this review ranged from 63±18.1 cm3 to 164.3±38 cm3 for the right kidney and 69.1±25.1 cm3 to 183.3±48.9 cm3 for the left kidney. Six of the reviewed articles reported a statistical significant difference between male and female mean renal size (p&lt;0.05), while two articles revealed no statistical significant difference between male and female mean renal sizes (p&gt;0.05). However, the remaining seven articles did not compare the mean renal size between male and female participants. Seven out of the articles reported a significant positive correlation between kidney dimensions and BMI, while other eight articles did not check the association between kidney dimensions and anthropometric parameters. This review showed only one article out of fifteen used a probability sampling method and only two articles used larger sample size. Eight of the reviewed articles did not perform creatinine clearance test before recruitment of their participants.

Sex- and age- specific normal values with threshold-based trabeculae quantification

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ÚNKP-19-3-II New National Excellence Program of the Ministry for Innovation and Technology National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program) Thematic Excellence Program (Tématerületi Kiválósági Program 2020-4.1.1-TKP2020) The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18-29, Group B: 30-39, Group C: 40-49, Group D: &amp;gt;50 years). The calculated parameters were indexed to body surface area (i). The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.

DSPECT-specific normal limits for LV measurements: a new approach to derivation

Abstract Funding Acknowledgements Type of funding sources: None. Background Differences in spatial resolution and image filtering between the solid-state DSPECT and traditional Anger SPECT (A-SPECT) cameras are likely to result in differences in LV measurements. However, DSPECT- specific normal values have not been systematically derived. We used healthy organ-donor subjects from our high-volume solid organ transplant center for derivation of normal values. Purpose To report DSPECT-specific LV measurements normal limits derived from a unique cohort of donor subjects. Methods Subjects were 92 consecutive kidney or liver donors who underwent single day rest (5 mCi)- stress (15mCi) Tc-99m sestamibi gated SPECT myocardial perfusion imaging (MPI) on the DSPECT for pre-operative evaluation. Exclusion criteria included any cardiac disease or medications. LV measurements were made on the post-stress supine stress images using QGS®. Results Of 92 subjects (mean age 54.4 ± 15.0 and 39% men), mean EF for women and men were 77.2 ± 14.1% and 70.0 ± 14.7%, respectively. Mean end-diastolic volume for women and men were 67.0 ± 32.2 ml and 99.6 ± 51.6 ml (indexed 38.3 ± 17.2 ml/m2 and 48.1 ± 25.9 ml/m2), respectively. Mean LV wall volume for women and men were 95.9 ± 26.0 ml and 112.0 ± 48.8 ml (indexed 55.0 ± 13.8 ml/m2 and 54.1 ± 24.6 ml/m2), respectively. Conclusion We report DSPECT-specific LV measurements from normal subjects from which limits of normality can be derived for clinic use. Organ-donors who undergo pre-operative MPI are a suitable cohort for the derivation of normal values.

Quantitative Assessment of Left and Right Atrial Strains Using Cardiovascular Magnetic Resonance Based Tissue Tracking.

Background: Left and right atrium (LA and RA) exert an essential and dynamic role in ventricular filling and hence affect heart performance. Strain quantification has been reported as a novel parameter to assess function. However, the assessment of bi-atrial strains with cardiovascular magnetic resonance (CMR) based techniques is still limited and gender- and age-specific normal values in a healthy population are missing.Methods: One hundred and fifty healthy volunteers (49.8 ± 17.3 years, 75 males) undergoing 1.5 Tesla CMR examination were retrospectively and consecutively recruited. LA and RA free wall (RAFW) radial and longitudinal strains (RS and LS) associated with atrial reservoir, conduit and booster pump functions were evaluated with CMR based tissue tracking (CMR-TT) technique.Results: The reservoir, conduit and pump LS resulted as 30.7 ± 10.2%, 19.5 ± 8.2%, 10.9 ± 3.7% for LA, and 52.2 ± 17.6%, 33.3 ± 14.2%, 19.1 ± 8.5% for RAFW, respectively. The amplitude of RA strains was significantly larger than that of LA strains, except for conduit RS. With the increase of age, the decrement of majority of reservoir and conduit strains were observed, while pump strains remained unaffected. Females presented with significantly larger RAFW strains compared with males, especially in the elderly. In addition to the positive correlation between atrial strains and emptying fraction, the negative correlation between atrial strains and volume index was also confirmed. Intra-observer reproducibility of LA strains was superior to RAFW strains (coefficient of variation: 10.12–17.04% vs. 10.80–27.36%, respectively), and the measurement of reservoir and conduit strains was more reproducible in comparison with pump strain.Conclusion: CMR-TT is a feasible and reproducible technique to quantify LA and RA strains and determine atrial phasic functions. The existence of age- and gender-related difference of strains suggests the necessity to establish specific normal values for individual populations.

Sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test in community-dwelling older adults aged 65\u201375\u2009years in Germany: results from the OUTDOOR ACTIVE study

BackgroundPhysical fitness is a key component of independent living and healthy ageing. For the measurement of physical fitness in older adults, the Senior Fitness Test is a commonly used tool. The objective of this study is to calculate sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test for older adults (65–75 years) in Germany.MethodsCross-sectional data of 1657 community-dwelling older adults residing in Bremen, Germany (53% female) were included in this study. Physical fitness was assessed using the following measurements of the Senior Fitness Test battery: 30s-chair stand test, 2 min-step test, sit-and-reach test, and back scratch test. In addition, handgrip strength was measured using a Saehan DHD-3 digital hand dynamometer SH1003. Sex- and age specific normative values were calculated for the 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th, and 99th percentile using the GAMLSS method.ResultsThe normative values show differences dependent on sex and age. For handgrip strength, the 30s-chair stand test and the 2 min-step test, normative values were higher for men, while women reached higher values in the sit-and-reach test and the back scratch test. For both, men and women, normative values declined with age.ConclusionsThis study provides sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test for older adults in Germany. They might be useful for future research and for the application in practice.

Cardiovascular magnetic resonance normal values for pulmonary arteries and ventricular volumes in paediatric patients with transposition of the great arteries after arterial switch operation

Abstract Funding Acknowledgements Type of funding sources: None. Background The anatomy of the pulmonary arteries (PA) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects and stenoses of the PA are known to occur. Cardiovascular magnetic resonance (CMR) imaging is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease specific normal values for PA size do not exist. Furthermore, the impact of pulmonary artery size, age and gender on ventricular volumes and function is unknown. Therefore, we sought to establish disease specific normative ranges for PA dimensions as well as biventricular volumes and function. Methods 70 CMR scans of paediatric patients with TGA after ASO with Lecompte manoeuvre (mean age 12.3 ± 3.6 years; range 5-18 years; 57 males) were included. Cine CMR sequences as well as contrast-enhanced magnetic resonance angiography (CE-MRA) data were used to measure pulmonary artery dimensions. Right and left PA were each measured at three locations during its course around the aorta. Ventricular volumes, mass and ejection fraction were measured from a stack of short axis cine images. Results Mean systolic and diastolic diameters of the MPA were 15.0 ± 2.3 mm (10.5 ± 2.7 mm/m²) / 13.2 ± 2.9 mm (9.2 ± 2.9 mm/m²) and mean cross-sectional MPA area was 286.7 ± 81.7 mm². Mean systolic and diastolic diameters for the RPA and LPA at the narrowest point were: RPA 10.5 ± 2.8 mm (7.8 ± 2.4 mm/m²) / 8.1 ± 2.2 mm (6.0 ± 1.9 mm/m²); LPA 8.4 ± 2.8 mm (6.2 ± 2.1 mm/m²) / 7.4 ± 2.3 mm (5.4 ± 1.6 mm/m²). Mean values for biventricular volumes, ejection fraction and mass were as follows: 1) left ventricular (LV) end-diastolic volume (EDV) 89.0 ± 20.3 ml/m² and end-systolic volume (ESV) 35.1 ± 11.7 ml/m², 2) right ventricular (RV) EDV 76.4 ± 15.4 ml/m² and ESV 32.4 ± 9.1 ml/m², 3) LV and RV ejection fraction 61.1 ± 6.5 % / 58.9 ± 6.1 % and 4) LV and RV mass 59.6 ± 15.2 g/m² / 23.3 ± 7.4 g/m². Separate centile charts for boys and girls for PA dimensions as well as biventricular volumes, mass and ejection fraction were created. Conclusion We established disease specific CMR normal values for the PA dimensions as well as for ventricular volumes, mass and ejection fraction in paediatric patients with TGA after ASO. Our data will improve CMR image interpretation and may serve as a reference in future studies.

Transthoracic echocardiography and cardiac biomarkers in healthy captive male and female squirrel monkeys (Saimiri spp.)

BackgroundEchocardiography is the most frequently used non -invasive diagnostic tool to evaluate cardiac anatomy and function in domestic species but increasingly also in non -domestic species, especially since cardiac disease is being recognized as an important cause of death in captive primates. The purpose of this cross -sectional study was to investigate the feasibility of transthoracic echocardiography in healthy squirrel monkeys as well as to provide species specific normal values for standard echocardiographic measurements. A secondary aim was to determine plasma and serum levels of the cardiac biomarkers, N -terminal pro -brain natriuretic peptide (NT -proBNP) and cardiac troponin T (cTnT). Furthermore, a commercial, non -invasive, smartphone -based ECG (AliveCor Vet TM) monitoring device was used to evaluate the heart rate and rhythm and to diagnose possible arrhythmias.ResultsIn this study, transthoracic echocardiography of 14 squirrel monkeys was performed in right and left lateral recumbency. Similar standard right parasternal and left apical images were obtained as in dogs and cats and normal values for routine two -dimensional, time motion mode and Doppler mode measurements were generated. Thirteen animals were considered healthy and one squirrel monkey was identified with significant aortic dilation and regurgitation and consequently values obtained from this animal were not used when species specific normal values were calculated. NT -ProBNP and cTnT concentrations were available for 7 of the 13 healthy monkeys with NT -proBNP concentrations below detection limit in all animals and a mean cTnT concentration of 0.049 ng/mL. Electrocardiography was performed in all squirrel monkeys. The mean heart rate was 172 bpm. Frequent supraventricular premature beats were diagnosed in the squirrel monkey suffering from significant aortic dilation and regurgitation.ConclusionThis study presents echocardiographic normal values and additional cardiovascular data in anaesthetised Saimiri monkeys, fundamental from both the perspective of zoo animal health care as well as scientific research, since the squirrel monkey is often used as an animal model for human disease.

Beck depression inventory, second edition, Czech version: demographic correlates, factor structure and comparison with foreign data

Objective We aimed to examine whether demographic characteristics (i.e., sex, age and education) correlate with total scores of the Czech version of the Beck Depression Inventory (BDI-II), understand the factorial structure of this scale, compare our results with findings of studies conducted in other countries and provide preliminary normative data for use in clinical practice. Methods Data of 450 participants were analysed using correlation analysis, non-parametric tests and confirmatory factor analysis (CFA). Results Women, and participants with lower education, tended to score higher than men, and participants with higher education. There was no significant relationship between age and total scores. CFA confirmed two factors: cognitive-affective and somatic. Czech participants scored lower than participants in other studies. Preliminary normative data are presented in the form of percentile values for the whole sample and stratified according to gender and education level. Conclusions We recommend the usage of the BDI-II total score while taking into account also the cognitive-affective and somatic factor subscores. The comparison of our results with other foreign findings shows the need for the development of locally specific normative values for self-reported depression scales. KEY POINTS Women scored higher in the BDI-II than men. Participants with lower education scored higher in the BDI-II than participants with higher education. CFA confirmed two factors: cognitive-affective and somatic. Preliminary normative data for the Czech version of the BDI-II are stratified according to gender and education.

Normative Values for Esophageal Motility Assessed in the Physiological Seated Position for 16-Channel Water Perfused High-resolution Esophageal Manometry System and Postural Variations in Healthy Volunteers.

Background/AimsConsensus guidelines for performance and analysis of high-resolution esophageal manometry (HREM) recommend use of equipment, population and posture specific normative values. To provide normative values for Chicago classification (CC) metrics in the physiological seated position for a 16-channel water perfused system (Dentsleeve HREM catheter, Advanced Manometry Systems, Melbourne, Australia) widely used in India and other countries with limited access to solid-state equipment. The results are compared with published CC metrics in supine position done using the same system and volunteers.MethodsHREM tracings of ten 5 mL water swallows in sitting posture were acquired in healthy volunteers and normative values for CC version 3.0 metrics calculated. Individual swallows were paired with previously reported supine swallows for postural variations (Wilcoxon sign rank test) and concordance of CC diagnoses (Pearson coefficient).ResultsAnalysis of 530 sitting posture water swallows (53 subjects) and comparison with their supine data revealed significantly higher integrated relaxation pressure (IRP; median 6.7 mmHg vs 6.1 mmHg) but lower distal latency (DL; mean 6.3 seconds vs 6.8 seconds) and distal contractile integral (DCI; mean 1224 mmHg sec cm vs 1456 mmHg sec cm). Sitting posture normal was defined as: IRP < 13.9, DL > 4.5, and DCI = 115–4500 (absent contractility: DCI < 30). CC diagnoses concordance using posture-specific cut-offs was moderate (k = 0.47).ConclusionsThis paper provides normative values for the Advanced Manometry Systems 16-channel water perfused system in the physiological seated position for CC metrics. Our findings of higher IRP and lower DCI in sitting posture than previously reported supine CC cut-offs, confirm the need to use posture-specific cut-offs for reporting HREM tracings.

Associations Of Cognition With Physical And Vascular Function In Patients With Chronic Kidney Disease.

Cognitive impairment is prevalent in patients with chronic kidney disease (CKD), but little is known about its relationship with physical and vascular function. PURPOSE: To investigate the relationship between cognitive function, and physical and vascular function in older adults with stage 3-4 CKD and preclinical cognitive impairment. We hypothesized that physical and vascular function would be related to cognitive function. METHODS: Participants (n=28) with CKD and preclinical cognitive impairment (57% female, 68% black, eGFR 43.7, age 68) completed the Trail Making Test (TMT-A: psychomotor speed, and TMT-B executive control), and digit symbol coding (DSC) (visuomotor speed/complex attention). These are standard measures that are sensitive to cognitive decline. Physical function was determined via the short physical performance battery test (SPPB) and the 6-minute walk test (6MWT). Vascular function was determined via brachial artery flow mediated vasodilation (FMD) following 5-minutes of forearm occlusion. Correlations were assessed via Pearson’s bivariate correlation. RESULTS: All participants scored below the fiftieth percentile of age and sex specific normative values on the TMT; 32% scored below the tenth percentile on the TMT-A and 50% scored below the tenth percentile for TMT-B. Age, years of education, sex, or race did not correlate with TMT-A, TMT-B, or DSC. TMT-A were inversely correlated with 6MWD (r=-.5, p=.007), SPPB score (r=-.65, p<.001), and FMD (r=-.4, p=.04). TMT-B was inversely correlated with 6MWD (r=-.39, p=.04), but not with SPPB, or FMD. DSC was correlated with 6MWD (r=.47, p=.01), but not with SPBB, or FMD. CONCLUSION: In patients with CKD, psychomotor speed is associated with indicators of physical function and fitness levels, and with vascular function. Executive control, visuomotor speed, and complex attention was associated with physical fitness levels. These results indicate a concomitance between higher levels of fitness, physical, and vascular function, and higher scores in psychomotor speed and executive control in patients with CKD. The clinical implications of our work remains to be further explored, but interventions to improve fitness levels, and physical and vascular function may contribute to lessening the impact of CKD-associated cognitive alterations.

Normal Values for Left Ventricular Mass in Relation to Lean Body Mass in Child and Adolescent Athletes

It has been demonstrated that regular sport activity in children leads to physiological changes in the heart including increased left ventricular (LV) myocardial thickness and mass (LVM). The aim of the study was to establish the first specific normal values of LVM for child and adolescent athletes. Parasternal long-axis, 2D-guided echocardiographic measurements were obtained from a group of 791 Caucasian child athletes (age 5–18 years, 58.7% boys). For the preparation of normative data, LVM-for-lean body mass (LBM) reference curves were constructed using the LMS method. Then, a simple correlation plot was constructed to analyse the concordant and discordant indications of left ventricular hypertrophy (LVH), defined as LVM-for-LBM above the 95th percentile, according to the newly created and previously published normative data on LVM-for-LBM in the general population of children. Reference scatter plots of LVM-for-LBM for boys and girls in the analysed group of children practicing sports were presented, showing mean values of LVM and z-scores. The application to the studied group of reference centiles established for the general population of children would lead to false positive misclassification of increased LVH in 5.8% of the girls and 17.0% of the boys. We present the first specific normative data for LV mass in relation to lean body mass in Caucasian children and adolescents engaged in regular sport activities. The application of specific normative data for LV mass results in fewer false positive findings of left ventricular hypertrophy in this group than that of reference values for general paediatric population.

Tympanometric profiles for Chinese older adults.

The current study aimed at obtaining and examining the normative tympanometric findings in the Chinese older adults (60 to 90 years). The tympanometric data was collected using the Interacoustics Titan IMP 440 clinical immittance meter. This included peak static acoustic admittance (Ytm); tympanometric peak pressure (TPP); tympanometric width (TW); and ear canal volume (ECV). 146 (228 ears) Chinese older adults with normal hearing or sensorineural hearing loss were included in the study. The mean and standard deviation of the tympanometric values include: Ytm 0.48±0.28mmho; TPP -5±11daPa; TW 74±27daPa; and ECV 1.06±0.29 cc. Factors such as ear, gender and age had a minimal effect on all the four-tympanometric parameters studied. Nevertheless, there were a few differences between the present study results and the previously published data. The study results warrant the need for population and age specific normative values for clinical use.

Establishment of Normative Clinical Reaction Times in a Pediatric Population

INTRODUCTION: The puck-drop (PD) test has been utilized to assess clinical reaction time (CRT) and has been proposed as a tool to aid in the management of sports related concussion. The simplicity of the test and low cost make it an attractive tool in the management of these injuries; however, no normative data has been established in children, making post-concussion testing in this population difficult to interpret. PURPOSE: The purpose of this study is to examine the use of the PD test in the pediatric and adolescent population: 1) to develop age specific normative values and 2) to examine the effect of sex and handedness on test performance. METHODS: Patients (ages 8-18) who presented to sports medicine clinics for evaluation and treatment of non-concussive injuries and whose presenting complaint would not confound completion of the PD test (LE injury, recovered injury, etc.) were recruited for baseline assessment. Testing was conducted in accordance to protocols previously described in the literature. Two practice trials were conducted. The distance of stick transversal was recorded to the nearest 0.5 cm, as well as the number of drops and failed attempts. The test was completed when 8 successful trials for each hand were recorded. Children with hands too small to circumvent the puck diameter were accommodated by starting at 10 cm above the puck base at the discretion of the test administrator. RESULTS: 463 subjects completed the study (n = 178 male, n = 285 female, average age 13.04 +/- 2.57 years). Regression analysis of baseline CRT indicated a strong effect of age on overall CRT for both right and left hands (R2 = 0.21, p < 0.001, Figure 1). The estimates (SE) of right hand CRT ranged between 255.51 (4.66) to 216.15 (4.97) ms, and those of left hand ranged from 257.41 (4.71) to 219.08 (5.02) ms across 8-18 years of age. There were no differences in performance on CRT based on handedness (p = 0.78) or sex. (p = 0.84). CONCLUSION: As a result of this study, normative values for the PD test were established for the pediatric population. Test performance varied with age. Test performance did not vary based on hand, preliminarily indicating hand dominance does not affect performance during this evaluation, Future studies should evaluate the effect of concussion on performance.

Carotid Intima-Media Thickness Score, Positive Coronary ArteryCalcium Score, and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis.

BackgroundCommon carotid artery and internal carotid artery intima‐media thicknesses (IMT) are associated with coronary heart disease (CHD) and increase with age. Using age, sex, and race/ethnicity IMT percentiles may improve CHD prediction when added to Framingham risk factors and coronary artery calcium score. We study these possibilities in the Multi‐Ethnic Study of Atherosclerosis (MESA), a multi‐ethnic cohort of whites, Chinese, blacks, and Hispanics.Methods and Results IMT data were acquired in the age range 45 to 84 years. Common carotid artery and internal carotid artery IMT, sex, and race/ethnic specific normative values were calculated for each MESA participant and combined as an IMT score. Multivariable Cox‐proportional hazards models and logistic regression models were generated with CHD as outcome adding the IMT score to (1) a base model with Framingham risk factors, sex, race/ethnicity and (2) the base model with coronary artery calcium added. Harrell's C‐statistics and area under the curve were estimated. Median follow‐up was 10.2 years (interquartile range: 9.7, 10.7 years) with 429 first‐time CHD events. Mean age was 62.1 years and 52.6% of participants were women. IMT score increased the base area under the curve from 0.7210 to 0.7396 (P=0.0008) and with positive coronary artery calcium score added to the model, from 0.7627 to 0.7714 (P=0.02).ConclusionsA carotid IMT score based on normative data incrementally adds to Framingham risk factors and a positive calcium score in predicting first‐time CHD in an ethnically diverse cohort.

An Assessment Of Population-based Norms In Child And Adolescent On The King-devick

The King-Devick test (KD) has been utilized to assess visual motor deficits associated with sports related concussions. The utility of the assessment has been investigated in adults, but clinical usefulness has not been established in children and adolescents. As most concussion patients present to clinical settings without a baseline score, comparative normative data may be useful to help identify visual motor deficits associated with sports related concussion and support clinical management of return to sport. PURPOSE: To determine age specific normative values and potential learning effects associated with repeat administration of the KD test. METHODS: Patients, ages 11-18, who presented to two Sports Medicine Clinics for evaluation and treatment of non-concussive injuries and whose presenting complaint was not believed to confound test administration (LE injury, recovered injury, etc.) were recruited for baseline testing. Testing involved the reading of numeric sequence of up to three cards while the time to completion and number of errors were recorded. Two trials were conducted for each participant, with about 15-30 seconds between trials. Paired t-tests were performed to compare Subject’s Trial 1 (KD1) to their Trial 2 (KD2) to examine for the potential of an immediate learning effect. Results were then aggregated into 4 age groups (11-12, 13-14, 15-16, and 17-18). RESULTS: 312 patients (114 male, 198 female) were enrolled in the study. There was a significant effect of time (KD1 vs KD2; p < 0.001, d = 1.575s) for the full cohort. In addition, each subgroup, except 11-12 (p < 0.211, d = 0.665s), showed a significant learning effect between tests: 13-14 (p < 0.000, d = 1.888s), 15-16 (p < 0.000, d = 1.892s), and 17-18 (p < 0.000, d = 2.226s). Regression analysis indicated a strong effect of age on the overall KD time (R2 =.91). CONCLUSION: Significant improvements of KD baseline test were noted with age and with repeat administration indicating the need for age specific normative values. Future studies are needed to determine the number of KD baseline tests necessary to negate the immediate learning effect.

Correlation of facial profile and dental arches in a population of Yucatan

Soft tissue facial profile is one of the most important elements for orthodontic diagnosis and treatment. It is influenced by genetic factors, heritage, race, ethnicity, environmental factors (mouth breathing, atypical swallowing habits) sagittal maxillo-mandibular position, facial biotype, type of muscles among others. Objective: To correlate facial profi le with dimensions and shape of the dental arches in a school population of Yucatan. Material and methods: An observational, prospective, analytical, cross-sectional study of models and photographs from 6-8 year-old scholars enrolled as regular students in two schools of southern Yucatan. Results: The study group consisted of 88 models and photographs: 52.27% were from male subjects and 47.72% from females. The predominant facial profile was convex for both genders. OrthoForm III arch shape was the most observed. The association between facial profi le and upper and lower arch shape was determined by χ2 test, showing a statistically significant relationship (p < 0.05). Conclusions: It would be convenient to establish specific normal values for each geographic region, taking into consideration environmental, genetic and nutritional factors as well as race, ethnicity, gender and age.