Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus

BACKGROUND. The predilection of the left atrial appendage (LAA) for thrombus formation has long been known. METHODS AND RESULTS. We prospectively studied the two-dimensional echocardiographic and Doppler patterns of LAA function in 82 patients by transesophageal echocardiography. In the 63 patients in sinus rhythm, LAA area was measured during LAA diastole at the onset of the electrocardiographic (ECG) P wave (LAAmax) and after LAA systole at the ECG R wave (LAAmin) and LAA ejection fraction was calculated as (LAAmax-LAAmin)/LAAmax; peak Doppler velocity was recorded from the LAA outlet. The 58 patients in sinus rhythm without LAA thrombus were grouped according to left atrial size on transthoracic echocardiography; 39 patients had a left atrial size of less than 40 mm (group 1) and 19 had a left atrial size of 40 mm or greater (group 2). Five patients in sinus rhythm had LAA thrombus. In the 19 patients with atrial fibrillation or flutter LAAmax was measured independent of the ECG; three of these patients had LAA spontaneous contrast, four had thrombus, and one had both. Patients in sinus rhythm without LAA thrombus demonstrated a characteristic pattern of a contractile LAA apex and a noncontractile base with color flow and pulsed Doppler evidence of LAA emptying that coincided with the P wave. Patients in sinus rhythm with LAA thrombus had a mean +/- SD LAAmax (8.0 +/- 1.5 cm2) larger than that in group 1 (5.0 +/- 1.9 cm2) (p less than 0.01) but not group 2 (6.7 +/- 3.1 cm2), LAAmin (6.5 +/- 1.0 cm2) larger than that in both group 1 (2.3 +/- 1.5 cm2) and group 2 (4.2 +/- 2.7 cm2) (p less than 0.01), and LAA ejection fraction (17 +/- 11%) and LAA velocity (0.24 +/- 0.10 m/sec) less than those in both group 1 (55 +/- 21% and 0.48 +/- 0.24 m/sec, respectively) and group 2 (45 +/- 27% and 0.46 +/- 0.24 m/sec, respectively) (p less than 0.01). Patients with atrial fibrillation or flutter with LAA spontaneous contrast and/or thrombus had LAAmax (10.4 +/- 6.6 cm2) greater than that in patients with atrial fibrillation or flutter without LAA contrast and/or thrombus (6.8 +/- 3.0 cm2) (p less than 0.05). The LAA appeared as a static pouch in seven of eight of the former compared with in two of 11 of the latter. When attempted, Doppler demonstrated a recognizable fibrillatory LAA outflow velocity pattern in none of three in the former versus four of seven in the latter group. CONCLUSIONS. We conclude that the LAA has a characteristic pattern of emptying in sinus rhythm. LAA thrombus formation in sinus rhythm and atrial fibrillation is associated with both poor LAA contraction and LAA dilation.     

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy,after total knee arthroplasty

Background  

Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty.     

Multisensory integration of drumming actions: musical expertise affects perceived audiovisual asynchrony

We investigated the effect of musical expertise on sensitivity to asynchrony for drumming point-light displays, which varied in their physical characteristics (Experiment 1) or in their degree of audiovisual congruency (Experiment 2). In Experiment 1, 21 repetitions of three tempos × three accents × nine audiovisual delays were presented to four jazz drummers and four novices. In Experiment 2, ten repetitions of two audiovisual incongruency conditions × nine audiovisual delays were presented to 13 drummers and 13 novices. Participants gave forced-choice judgments of audiovisual synchrony. The results of Experiment 1 show an enhancement in experts’ ability to detect asynchrony, especially for slower drumming tempos. In Experiment 2 an increase in sensitivity to asynchrony was found for incongruent stimuli; this increase, however, is attributable only to the novice group. Altogether the results indicated that through musical practice we learn to ignore variations in stimulus characteristics that otherwise would affect our multisensory integration processes.     

Vision in autism spectrum disorders

Autism spectrum disorders (ASDs) are developmental disorders which are thought primarily to affect social functioning. However, there is now a growing body of evidence that unusual sensory processing is at least a concomitant and possibly the cause of many of the behavioural signs and symptoms of ASD. A comprehensive and critical review of the phenomenological, empirical, neuroscientific and theoretical literature pertaining to visual processing in ASD is presented, along with a brief justification of a new theory which may help to explain some of the data, and link it with other current hypotheses about the genetic and neural aetiologies of this enigmatic condition.     

老年人平衡能力特点及评估

学术背景:平衡能力是人体的一项重要生理机能,在人类生活中有非常重要的意义.特别是老年人平衡能力下降,直接影响老年人独立生活能力,严重的会引起老年人跌倒,诱发其他疾病.目的:总结老年人平衡能力的国内外研究现状,并展望未来老年人平衡能力研究的发展方向.检索策略:应用计算机检索PubMed数据库1990-12/2007-06有关老年人平衡能力方面的文章,检索词“elderly,balance“,限定文章语言种类为English,共检索到208篇文章.同时应用计算机检索中国期刊全文数据库、万方数据库1997-12/2007-06的相关文章,检索词“老年人、平衡能力“,限定文章语言种类为中文,共检索到85篇文章.对资料进行初审,选取符合研究要求的有关文章找全文.纳入标准:①平衡能力的研究.②老年人平衡特征.③平衡能力评价.④运动干预对平衡能力的研究.排除理由:①较陈旧的文献.②重复研究.文献评价:共19个研究满足全部纳入标准,予以纳入.其中6篇为老年人平衡特征的文献、8篇平衡评价的文献、5篇运动干预老年人平衡影响的文献.资料综合:①平衡能力是人体相关系统功能的集中表现,研究影响平衡能力的前庭系统、视觉系统、躯体感觉、神经系统及肌肉-骨骼等系统功能增龄性的变化趋势,探究导致平衡能力增龄性变化的主要因素是待解决的问题.②平衡测试是定量评定平衡能力的前提,针对老年群体的特殊性,逐步寻求安全、简捷能全面反映其平衡能力的测试方法.③国内专业人员日益提高了对平衡的关注,发表的论文也较多,但由于平衡评定方法不统一,对中国人民平衡能力增龄性变化的研究没有继承性,研究国民的平衡能力增龄性变化是必要的.④众多研究表明,体育锻炼可以延缓平衡能力的衰退.但研究比较分散,运动项目比较单一,探究利于干预的运动项目以及最佳时机是待解决的热点课题.结论:建立一整套适合中国国民平衡能力评价体系,研究国民的平衡能力增龄性变化是十分有必要的,为全民健身活动中的老年人科学地进行健身提供依据.     

Evidence for stunned myocardium in humans: a 2001 update

This article describes clinical situations in which stunning occurs and updates previous reviews on the topic. Stunning following angioplasty, angina and exercise-induced ischemia, infarction, and after cardiac surgery are described. In addition, newer concepts regarding stunning, including neurogenic stunned myocardium, are discussed. Left atrial stunning following cardioversion is a recently recognized phenomenon with important clinical implications, but differs from the original concept of post-ischemic stunning.     

Effect of cisapride on functional dyspepsia in patients with and without histological gastritis: A double-blind placebo-controlled trial

In the present double-blind placebo-controlled study the effect of cisapride on functional dyspepsia was evaluated in patients with and without histological gastritis. Patients with functional dyspepsia and whose symptoms persisted after a 2 week run-in period with antacid treatment were randomized to receive cisapride (10 mg) or matching placebo three times daily for 4 weeks. Symptoms of epigastric pain, bloating, nausea, belching, early satiety and heartburn were graded on a four-point scale based on patients’ feedback and diary card recording. A global response was also formulated by the investigators. One hundred and four patients entered the study and 76 completed the trial, comprising 36 patients with histological gastritis and 40 patients without gastritis. Symptom scores in both gastritis and non-gastritis groups were significantly improved by both cisapride and placebo; however, the improvement was not statistically different between the two treatment groups. Cisapride produced a good or better global response in 58% of subjects with histological gastritis and in 53% of subjects without gastritis compared with 47% and 52%, respectively, of patients on placebo; this difference was not statistically significant. Gastric histology did not influence the effect of cisapride on the symptoms of functional dyspepsia.