Reducing CPR artefacts in ventricular fibrillation in vitro

CPR creates artefacts on the ECG, and a pause in CPR is therefore mandatory during rhythm analysis. This hands-off interval is harmful to the already marginally circulated tissues during CPR, and if the artefacts could be removed by filtering, the rhythm could be analyzed during ongoing CPR. Fixed coefficient filters used in animals cannot solve this problem in humans, due to overlapping frequency spectra for artefacts and VF signals. In the present study, we established a method for mixing CPR-artefacts (noise) from a pig with human VF (signal) at various signal-to-noise ratios (SNR) from -10 dB to +10 dB. We then developed a new methodology for removing CPR artefacts by applying a digital adaptive filter, and compared the results with this filter to that of a fixed coefficient filter. The results with the adaptive filter clearly outperformed the fixed coefficient filter for all SNR levels. At an original SNR of 0 dB, the restored SNRs were 9.0+/-0.7 dB versus 0.9+/-0.7 dB respectively (P<0.0001).

Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health perception

In a study of 294 consecutive medical inpatients, the authors assessed a subsample of 157 patients for psychiatric diagnoses using an extensive semistructured interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients rated their health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A life-threatening condition increased odds for having a psychiatric diagnosis by 3.1 times (95% Confidence Interval (CI): 1.03-9.1), while a chronic medical disease had no such impact (OR=1.1; 95% CI: 0.5-2.3). In women, mental disorders were strongly associated with self-rated disability (OR=6.7; 95% CI: 1.6-27.8) and self-rated health (OR=9.4; 95% CI: 2.7-32.4). This association was absent in men (OR(disability)=0.7; 95% CI: 0.2-2.7; OR(health)=1.6; 95% CI: 0.6-4.7). Analyses included adjustment for age and gender.

Electrophysiological evidence of reinnervation of the transplanted human heart

Beat-by-beat heart rate (HR) changes during exercise were studied in two young and fit heart-transplanted humans at different time intervals following transplantation. Upon the start of the exercise, a slow gradual increase in HR was seen during the early experiments after the transplantation, whereas an immediate rapid increase in HR was observed during the later experiments. From standard ECGs obtained 32 months after transplantation, two P waves at somewhat different rates could be identified in both subjects, probably arising from donor and recipient sinoatrial nodes, respectively. The two P wave rate changes during and following exercise were very similar. We conclude that these changes in the HR pattern and ECG must be due to reinnervation of the donor hearts, most likely by parasympathetic cardiac fibers.

Development of oxygen sensitivity in infants of smoking and non-smoking mothers

AIMS

To assess the effect of prenatal cigarette smoke exposure on the postnatal resetting of oxygen sensitivity in term infants.

METHODS

15 healthy term infants of smoking mothers (median 10 cigarettes/day) and 16 controls were studied during quiet sleep 1, 3, and 10 days and 10 weeks postnatally. Strain-gauge respiratory trace was continuously recorded. Repeated 15-s challenges with 100% O2 and 15% O2 were presented in randomised order through a face mask. A median of six hyperoxic and six hypoxic challenges per recording were obtained. Breath-by-breath ventilation in a time-window from 20 s before onset of stimulus to 60 s after was extracted. For each infant at each age, the normalised coherently averaged response to hyperoxia and hypoxia was calculated. Mean ventilation at end of the 15-s stimulus was analysed with ANOVA, as were parameters describing a function fitted to each averaged response.

RESULTS

During air breathing, smoke-exposed infants had higher respiratory rates and lower tidal volumes than controls. Nicotine concentration in infant hair, measured by gas chromatography, was positively correlated with maternal level of smoking. A long-term development in oxygen sensitivity was demonstrated in both groups. However, neither the time-course nor the magnitude of O2 responses was affected by maternal smoking. Overall, hyperoxia reduced ventilation by 6.3% at day 1, 13.2% at day 3, 29.6% at day 10, and 40.0% at week 10. Transient hypoxia increased ventilation by 3.5%, 3.2%, 6.4%, and 8.8%, respectively, at the four ages studied.

Involvement of the human splanchnic circulation in pressor response induced by handgrip contraction

We have analysed the adjustment of blood flow and vascular conductance in the abundantly supplied splanchnic circulation to a generally released pressor reaction. Pressor responses were induced by 2-min periods of standardized, sustained handgrip in seven healthy students. The effects of handgrip tests were followed both in the fasting state and after the consumption of a substantial, mixed meal. In the first of the two sessions, changes in superior mesenteric artery blood flow were recorded and concomitant changes in local vascular conductance derived. In the other session, pressor released cardiac output changes were recorded and changes in total peripheral vascular conductance derived. Both types of flow changes were recorded using ultrasound Doppler technique. Typically, blood flow in the superior mesenteric artery increased two- to threefold after a meal. Handgrip contractions induced an initial rapid increase in heart rate, cardiac output and total peripheral conductance, followed by a gradual decline in total peripheral conductance and stroke volume and a gradual increase in heart rate and mean arterial pressure for the rest of the period. At the end of 2-min pressor periods, total peripheral conductance was only about 10% below the pre-handgrip level, whereas vascular conductance locally in the area of the superior mesenteric artery decreased by some 30%. Thus, it appears that the splanchnic vascular bed contributes markedly to the compound pressor response. Handgrips caused significantly less reduction in local vascular conductance in the post-prandial than in the pre-prandial state, indicating that blood flow to the digesting gastrointestinal tract retains a relatively high priority also in a pressor situation.

A method of assessing ventilatory responses to chemoreceptor stimulation in infants

Various methods of assessing infant chemoreceptor responses have been reported in the literature. However, equipment dead space, trigeminal stimulation and inherent respiratory variability may have affected the results. A method is presented which attempts to reduce the effect of these factors and thereby isolate the chemoreceptor response. Inspiratory gas was delivered into a lightweight face mask with a pliable rim, minimal dead space and a connected pneumotachograph. Ventilatory data were computed breath by breath. Computer-controlled electromagnetic valves allowed instantaneous switching between air and different gas mixtures, repeated in a randomized sequence. In 18 healthy term neonates, the mask increased ventilation by 12% (95% confidence interval 6-18%), measured by calibrated strain-gauge bands. The effect on respiratory frequency and tidal volume differed significantly between sleep states. Neonates were challenged with short-lasting hyperoxia, mild hypoxia, rebreathing and mild hypercapnia. Coherent averaging of several ventilatory responses from each sleep state reduced the variability while maintaining a high time-resolution.

Local constriction of arteriovenous anastomoses in the cooled finger

We have examined the influence of local cooling from 35 to 19 degrees C on spontaneous arterial blood velocity fluctuations in the acral skin of thermoneutral subjects. The skin temperature of one hand was gradually lowered in a water bath in two separate experimental runs. Simultaneous continuous blood velocity was measured from the third finger artery of both hands using ultrasound-Doppler. The large blood velocity fluctuations assumed to be caused by synchronous vasomotion of the arteriovenous anastomoses were invariably seen in the control finger artery throughout the two cooling periods, indicating that the subjects were in their thermoneutral zone. The velocity fluctuations on the cooled side remained nearly unchanged and closely correlated with those in the control finger artery during local cooling from 35 to approximately 21.5 degrees C. Below this temperature (range 23-20 degrees C) the velocity fluctuations ceased abruptly, and the velocity was nonfluctuating and continuously low. These results indicate a local thermal level below which there is abrupt, sustained closure of the arteriovenous anastomoses.

Effect of ultrasound contrast medium in color Doppler and power Doppler visualization of blood flow in canine kidneys

PURPOSE

To examine the effect of an ultrasound contrast medium (UCM) in the visualization of parenchymal blood flow by means of color Doppler and power Doppler sonography.

MATERIAL AND METHODS

Nonenhanced and UCM-enhanced Doppler images of canine kidneys were obtained in a transversal plane during various states of flow reduction in the anterior branch of the renal artery. The UCM consisted of air-filled shell-stabilized microballoons (half-life approximately 2 min). The images were evaluated blindly by 4 observers who rated the amount of flow signal in the cortex and medulla, and categorized the flow state (normal, reduced or no flow) in the anterior part of the kidney.

RESULTS

The UCM increased the area of Doppler signals in the cortex and outer medulla during normal or reduced blood flow. The border between nonperfused and normally perfused parenchyma was more distinct with the UCM. The categorization of the regional flow state was more correct with the UCM. Improvement with the UCM was greatest when the nonenhanced Doppler images had suboptimal intensity, but positive effects with the UCM were also seen in recordings with adequate precontrast intensity. Color blooming artifacts sometimes occurred on the side of the kidney facing away from the transducer.

CONCLUSION

The UCM improved the color Doppler and power Doppler visualization of the parenchymal blood flow in the canine kidney, and allowed a more correct categorization to be made of the regional blood flow state.

Short-term control of cardiovascular function: estimation of control parameters in healthy humans

In a previous study, we recorded short-term cardiovascular responses after a steep increase in arterial pressure in healthy humans [Am. J. Physiol. 266 (Heart Circ. Physiol. 35): H199-H211, 1994]. The aim of the present study was to develop a mathematical model of the baroreflex control of arterial pressure, to use this model with the previously recorded data to estimate unknown parameters in the reflex control loop, and then to analyze the overall open- and closed-loop performance of the system by model simulations with use of individual sets of optimal parameters. The mathematical model consists of a heart, a linear elastic arterial reservoir, and two parallel resistive vascular beds. The arterial baroreflex loop is modeled by two separate time domain processing objects, each with its own gain, time constant, and delay, to simulate the action of a sympathetic signal to the peripheral vascular bed and a parasympathetic signal to the heart. In repeated model simulations, the control parameters in the model were systematically adjusted by an automated algorithm that minimized the deviations between the time courses of the cardiovascular variables simulated by the model and the previously recorded responses in each individual. In all 10 subjects, the short-term cardiovascular responses were adequately simulated by using individual sets of parameters in the model. Open-loop transfer functions for arterial pressure control were obtained by using the individual sets of optimal model parameters in new simulation runs. Open-loop gain for arterial pressure control at nearly zero frequency (steady state) was between 0.9 and 4. Model simulations also indicated an underdampened response at 0.05-0.07 Hz in the closed-loop situation in four subjects, corresponding to peaks in the mean arterial pressor power spectra obtained from separate recordings of spontaneous variations in the resting situation.

Effect of local warming on hand and finger artery blood velocities

The effect of local heating on blood velocities in arteries supplying the skin of hand and fingers was studied in subjects kept in their thermoneutral zone. The temperature of one hand was steadily raised from 35 to 43 degrees C in 15 min, whereas the control hand was kept in the air or immersed in a water bath at 35 degrees C. Simultaneous blood velocity recordings from the two hands were made continuously using ultrasound Doppler. In the heated hand, a general rise in blood velocity level was seen. However, the spontaneous fluctuations in blood velocity assumed to be caused by synchronous vasomotor activity of the arteriovenous anastomoses (AVAs) remained unchanged and closely correlated with those in the control hand throughout the experiment. Thus the central nervous control of AVA vasomotion seems to be unaffected by local heating. The elevation of blood velocity in the heated hand is probably due to dilatation of other parts of the vascular bed, e.g., ordinary arterioles in the skin. Earlier investigators, using venous occlusion plethysmography, have reported vasoconstriction in the locally heated human finger. No sign of such heat-induced vasoconstriction was found in this study.

Spontaneous flow waves detected by laser Doppler in human skin

The contribution of spontaneous variations in sympathetic nervous activity and perfusion pressure to the laser Doppler flux signal in human skin was studied in nine healthy subjects. Simultaneous recordings were made of laser Doppler flux, mean blood pressure, and blood flow in the radial artery. In the skin of the palm and sole, there was a significant and strong correlation between fluctuations in flux and radial artery velocity, which indicated a high degree of neural control of microcirculatory blood flow. This correlation decreased progressively toward the trunk and face. In the skin of the nose and at scattered sites on the face, trunk, and extremities, there was correlation between flux and mean blood pressure that indicated a predominantly "passive" vascular bed. At other sites, multivariate regression analysis revealed contributions of both blood pressure and sympathetic activity. In skin on the ear and forehead, a characteristic pattern of regular oscillations in flux, uncorrelated with blood pressure and sympathetic activity, was demonstrated. The laser Doppler signal from different skin sites thus contains varying contributions from variations in perfusion pressure, sympathetic nervous activity, and local, myogenic arteriolar vasomotion.

A causal relationship between fluctuations in thermoregulatory skin perfusion and respiratory movements in man

The relationship between regular respiration with normal tidal volume and spontaneous fluctuations in blood flow through skin arteriovenous anastomoses (AVAs) was investigated. Laser Doppler measurements from skin areas known to contain arteriovenous anastomoses, ultrasound Doppler measurements from the radial artery and respiratory movements were recorded simultaneously in 7 supine human subjects in a thermoneutral environment. The phase relationship between respiration and the onset of sudden arteriovenous anastomoses vasoconstrictions was calculated in each subject. A few seconds before a vasoconstriction, there was a clear tendency towards synchrony in the respiration recordings, indicating that some respiration-phase-dependent event precedes the vasoconstrictions. Since arteriovenous anastomoses constrictions are accompanied by specific changes in heart rate and blood pressure, our findings link respiration to low-frequency heart rate and blood-pressure variability in humans.

Acute effects of indometacin on cerebral blood flow in man

Blood velocity changes in the internal carotid artery were estimated using Doppler ultrasound before, during and after injection of indometacin or placebo in 7 healthy adults. Upon injection of the active substance there was a rapid reduction in blood velocities in the internal carotid artery, increasing with increasing doses of indometacin. A fall in end-expiratory PCO2 was also observed, indicating a state of hyperventilation. The observed relative reduction in cerebral blood flow was much higher in all subjects than the expected reduction due to the accompanying drop in PCO2. Experiments in which arterial PCO2 was kept constant showed that indometacin also causes a reduction in blood velocity independent of changes in PCO2. We suggest that indometacin has both a direct effect on the cerebral microcirculation, and an additional effect mediated through induction of hyperventilation. The drug probably affects the respiratory center through an increase in intracerebral PCO2 due to reduced perfusion.

The status of local smoking regulations in North Carolina following a state preemption bill

OBJECTIVE

To determine the number and protectiveness of local smoking regulations adopted before the implementation of a preemptive statewide smoking control bill.

METHOD

Review of local smoking control regulations from all 100 counties and 85 municipalities with populations greater than 5000 in North Carolina.

MAIN OUTCOME MEASURES

Adoption of local smoking control regulations before and during the 3-month delay in enactment of the preemptive bill. Protectiveness of regulations was based on restrictions on smoking and requirements for separate ventilation systems at private work sites: none (smoking unrestricted); minimal (smoking restricted to designated areas); partial (smoking restricted to designated areas served by separate ventilation systems); and complete (smoking prohibited). Because some regulations would be phased in gradually over the next 5 years, we evaluated the requirements that will be in effect by January 1, 2000.

RESULTS

Between July 15 and October 15, 1993, the number of local smoking regulations in North Carolina increased from 16 to 105. By the year 2000, 59% of private employees still will not be guaranteed any protection from work site environmental tobacco smoke; 19% will have minimal protection, 22% will have partial protection, and none will have complete protection.

CONCLUSIONS

The 3-month delay in preemption created an unnatural time frame for communities to organize, debate, and adopt smoking restrictions. Despite the adoption of 89 new regulations, no private employees will be guaranteed complete protection from work site environmental tobacco smoke by the year 2000; new regulations can no longer be adopted. HB 957 has been a setback for public health in North Carolina.

Connection between skin arteriovenous shunt flow fluctuations and heart rate variability in infants

Large, spontaneous fluctuations in blood flow to acral skin, caused by synchronous opening and closing of arteriovenous anastomoses (AVAs), have been demonstrated in adults in a thermoneutral environment. Individual AVA constrictions were accompanied by a diphasic heart rate (HR) response, indicating the presence of an autonomic rhythm which affected both skin AVA activity and heart rate variability. In the present study, 24 neonates were examined on day 2 (range 1-3 days) and re-examined at 14 weeks (11-17 weeks). The presence of rhythmic, synchronous fluctuations in laser Doppler flux in the palm of the hand and sole of the foot in 20 of 24 neonates strongly indicated the presence of functional skin AVA at birth. Both neonates and 3-month-old infants showed a diphasic HR response in association with cutaneous AVA constrictions. The infant response differed from the adult response mainly by the longer duration of the secondary bradycardia. This may reflect different properties of the baroreceptor reflex in infants and adults.

Peripheral vasoconstriction shortly after onset of moderate exercise in humans

The immediate cardiovascular responses at the onset of supine dynamic leg exercise were studied by noninvasive methods in healthy humans. Total peripheral conductance (TPC), heart rate, and cardiac output increased very rapidly at the onset of exercise. Mean arterial pressure (MAP) showed a moderate anticipatory increase during a 10-s countdown to exercise and then decreased (but not below resting level) during the first 10 s of exercise. The TPC response was biphasic, and TPC started to fall from its peak value approximately 12 s after onset of exercise. This peripheral vasoconstriction increased MAP. After 25 s, the cardiovascular variables were stable for the rest of the 2-min exercise period. In the same subjects, cholinergic blockade was induced by atropine sulfate (0.035 mg/kg) and resting cardiac output, MAP, and TPC increased considerably. The exercise protocol was repeated after atropine, and the increase in heart rate at onset of exercise was slower and smaller. MAP decreased and remained depressed throughout the exercise period. A monophasic increase in TPC was seen. We suggest that, in the normal situation, the biphasic response in TPC reflects a baroreflex sympathetic vasoconstriction very shortly after onset of exercise and that this response is due to a rapid increase in set point for arterial pressure control at the onset of exercise. After cholinergic blockade, MAP was probably continuously well above the set point for arterial pressure control both before and during exercise and no reflex vasoconstriction was observed in this situation.

Thermoregulatory fluctuations in heart rate and blood pressure in humans: effect of cooling and parasympathetic blockade

The spontaneous fluctuations in acral skin blood flow, mean blood pressure (MAP), and heart rate (HR) were studied in 9 healthy supine volunteers in a thermoneutral and in a cool environment, and after parasympathetic blockade by atropine. In skin areas with a high density of arteriovenous anastomoses (AVAs), there were large, spontaneous fluctuations in blood flow in a thermoneutral environment. The fluctuations were nearly abolished in a cool environment, while they seemed unaffected by atropine administration. Power spectral analysis demonstrated a reduction in HR and MAP variability in the low- and mid-frequency (LF) (< 0.15 Hz) band after cooling, and a prominent reduction in HR variability in both the LF and the high-frequency (HF) (< 0.15 Hz) band after atropine administration. A sudden drop in skin vascular conductance was accompanied by diphasic HR changes and an increase in MAP. After atropine administration, the initial HR acceleration was delayed and reduced in magnitude. The secondary HR deceleration, which probably represents baroreceptor modulation, was abolished. Atropine administration caused a delayed, but augmented increase in MAP, which was probably related to the loss of baroreceptor control of HR. The presence of an autonomic rhythm, consisting of sympathetic vasoconstrictor impulses to skin AVAs, connected with reciprocal sympathetic and vagal impulses to the heart, is indicated. The HR changes were mainly determined by vagal activity. The rhythmic changes in skin blood flow, HR and MAP were suppressed in a cool environment.

Results of the Dutch community project "Healthy Bergeyk"

BACKGROUND

This article reports on the results of a community health project that was implemented in the Dutch municipality of Bergeyk. The major goal was to reduce four cancer-related risk behaviors: smoking, high fat consumption, excessive alcohol use, and exposure to artificial sunlight. A control community received no new intervention. Intervention methods included mass media messages, self-help materials, small group activities, lectures, and structural activities. Community organization principles such as a social network approach, community participation, and intersectoral cooperation were applied in the project.

METHODS

Data were collected from both communities among cohort research samples on three occasions using telephone interviews.

RESULTS

The results indicate a significant reduction in fat intake in the experimental community. No other significant behavioral effects were found. Further analysis among respondents in the experimental condition showed that those personally exposed to the project as indicated by familiarity with and discussion about the project, had a greater decrease in fat consumption between baseline survey and second post-test than those who were not. Also, the percentage of smokers who quit between baseline survey and second post-test was greater among those who knew about the project than among those who did not. Finally, discriminant analysis was used to further examine the determinants of project exposure. Community involvement, marital status, education, and sex were related to project exposure.

CONCLUSIONS

It is concluded that with the time limitations of the project in mind, the findings are encouraging.

Priority of blood flow to splanchnic organs in humans during pre- and post-meal exercise

Cardiac output and superior mesenteric arterial flow in five healthy young men were followed using Doppler ultrasound techniques at rest and during 4 min bouts of bicycle exercise in both a pre- and a post-meal situation. The meal given was mixed and heavy, with an energy content (related to body size) of about 1400-1600 kcal (5.9-6.9 MJ). Two levels of exercise, 50-65 W and 150-200 W (about 75% of VO2max), were tested, with the subjects cycling in a reclining position. Superior mesenteric arterial flow increased threefold, to about 1.1 l min-1, after the meal. During exercise in the fasting situation there were only modest changes in splanchnic vascular conductance, and moderate increases in superior mesenteric arterial flow were actually recorded. Exercise in the post-prandial state caused appreciable reductions in splanchnic vascular conductance, and a 38% reduction was observed during the most heavy exercise. However, not even such a decrease in conductance resulted in any definite reduction in superior mesenteric arterial blood flow, which was maintained at the pre-exercise level. Cardiac output increased by about 1.3 l min-1 after the meal. The exercise-induced increases in cardiac output were of the same order in the fasting and in the post-prandial state. Variance analyses showed the high cardiac output levels reached during post-prandial exercise to be no different from levels that would be reached by pure summation of the changes caused by eating alone and by exercise alone. It is concluded that blood flow to the splanchnic organs in reclining man retains its high pre- and post-prandial priority during short exercise bouts of up to 75% of VO2max.

Short-term cardiovascular responses to a step decrease in peripheral conductance in humans

A step decrease in total peripheral conductance (TPC) was introduced in 10 healthy volunteers by rapid inflation to suprasystolic pressure of bilateral thigh cuffs. This provoked a sudden statistically significant increase in mean arterial blood pressure (MAP) of 5 mmHg during supine rest and of 8 mmHg during moderate supine exercise by the quadriceps muscles. Central venous pressure was not changed by cuff inflation. The increase in MAP was blunted by a rapid but transient decrease in both heart rate (HR) and cardiac stroke volume. At rest, a gradual increase in TPC, starting after 4 s, nearly fully restored MAP to its original value at 10 s. During exercise, MAP was halfway corrected at 10 s but then started to increase again, probably as a result of an ischaemic muscle pressor response. After cholinergic blockade by atropine, the immediate HR response was eliminated, but HR decreased gradually after a delay of 3 s. The time development of the slow increase in TPC was not changed by atropine. In conclusion, the regulatory correction of a sudden increase in arterial pressure in supine unanesthetized healthy humans is achieved through an immediate transient parasympathetic bradycardia during the first few seconds and a more gradual sympathetic peripheral vasodilation after 4 s. After cholinergic blockade, a slow presumably sympathetic HR response was observed.

Respiration-synchronous fluctuations in stroke volume, heart rate and arterial pressure in humans

1. Simultaneous recordings of beat-to-beat left cardiac stroke volume (SV, pulsed ultrasound Doppler), mean arterial pressure (MAP) and heart rate (HR) were obtained in ten healthy young adults during spontaneous respiration at supine rest, before and after cholinergic blockade by atropine (0.035 mg kg-1). 2. Respiration-synchronous fluctuations in SV, HR, cardiac output (CO) and MAP were quantified by spectral analysis of the recordings of each of these variables. 3. Before atropine administration, respiration-synchronous fluctuations in HR and SV were prominent. The changes in HR and SV were inversely related and variation in SV was the main source of respiratory variability in CO. Respiration-synchronous fluctuations in MAP were mainly caused by variations in CO. 4. After cholinergic blockade, respiratory HR variations were eliminated, whereas the respiratory fluctuations in SV persisted. The fluctuations in CO and MAP increased. In this situation, mechanically induced variations in SV were not counteracted by inverse HR fluctuations and the influence on CO thus increased. 5. The main source of respiratory fluctuations in MAP in supine humans is thus variation in SV, while inverse, vagally mediated HR variations tend to reduce the fluctuations in CO and MAP.

The determinants of four cancer-related risk behaviours

This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self-efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed.

Fluctuations in blood flow to acral skin in humans: connection with heart rate and blood pressure variability

1. Spontaneous fluctuations in blood flow in arteries supplying acral skin were investigated with Doppler ultrasound in human subjects. Finger blood pressure, heart rate (HR) and cardiac output were measured simultaneously and noninvasively. 2. Synchronous fluctuations in flow were found in arteries supplying the hands and feet. The fluctuations were larger and more rapid than the flow variations which have been demonstrated with other methods. The magnitude of the total flow fluctuations in the hands and feet was estimated to be 5-10% of cardiac output in resting subjects. This range of flow fluctuations is made possible by spontaneous opening and closing of skin arteriovenous anastomoses (AVAs). 3. The fluctuations in skin blood flow were accompanied by inverse fluctuations in mean blood pressure (MAP). The power spectra of skin vascular conductance and MAP both contained maximum intensity at low frequencies, below 0.15 Hz, with high coherence. 4. The central circulatory events connected with the skin blood flow fluctuations were calculated from the experimental data with the use of transfer function analysis. There was a rise in HR, cardiac output and MAP starting 1-4 s before a cutaneous vasoconstriction. This indicates that the HR and MAP responses are not only passive effects of changes in peripheral resistance, but are the result of a simultaneous activation of the peripheral vascular and cardiac efferent branches of the autonomic nervous system. The HR and MAP responses are then modified, probably by baroreceptor activation.

Post-prandial cardiovascular responses in man after ingestion of carbohydrate, protein or fat

Changes in cardiac output and in superior mesenteric arterial flow were followed with Doppler ultrasound techniques in five young, healthy persons for 2 h after ingestion of medium-sized (4 MJ), fluid meals containing either carbohydrate, protein, fat or water only. Measurements were carried out before meals and at regular post-meal intervals, during which mean arterial blood pressure was also followed. All energy-containing meals caused marked and gradually developing post-prandial increases in cardiac output as well as in superior mesenteric arterial flow. The maximum flow levels were reached in the course of 30-60 min and maintained until the observations ended after 2 h. The intake of water caused no such flow increases. There were considerable interpersonal variations in the size and in the speed of development of the flow increases after the three types of energy-containing meals. The flow-increasing effects of the three meal types were not significantly different, even if the most marked increases (median values about 11 min-1 for both cardiac output and superior mesenteric arterial flow) occurred after carbohydrate meals. The marked effects on circulation of the three food components were also revealed in the calculated, integrated amounts of 'extra' cardiac output and superior mesenteric arterial flow observed in the course of the 2 h following the meal. Values of more than 100 1 for such 'extra' flows were seen after carbohydrate meals. The marked ingestion-released increase in blood flow to the splanchnic organs is apparently partly met by an increase in cardiac output, and partly by some redistribution of flow, which benefits the digestive system.

Effect of pulsatile arterial diameter variations on blood flow estimated by Doppler ultrasound

High-resolution measurements of common carotid and femoral arterial diameters have been performed by ultrasound echo devices. When combined with pulsed Doppler measurements of cross-sectional averaged velocity in the same vessels, exact calculations of flow were made possible. The median peak-to-peak pulsatile diameter variations were 0.19 mm (2.8 per cent) in the femoral artery and 0.49 mm (6.7 per cent) in the common carotid artery. Flow values were calculated either by taking the time-averaged diameter as a constant value, or by taking into account the dynamic variations in diameter. In comparing the two values, a quantification of the magnitude of error introduced by the averaging of the diameter was made possible. An error in the range 1.5-3.8 per cent was found for the femoral artery, whereas the error in the common carotid artery was in the range 0.4-3.6 per cent despite the larger amplitude of the pulsations in this vessel.

The effect of meal size on postprandial increase in cardiac output

Heart rate, stroke volume, cardiac output and mean arterial blood pressure were followed from the resting pre-meal situation and for 2 hours after intake of standardized meals in four healthy individuals. Continuous records of stroke volume and cardiac output were achieved with an improved method of Doppler ultrasonography. A smallish meal and one 2 1/2 times larger were both given twice and in random order to each of the four test persons. The consumption of a meal invariably resulted in a cardiac output increase, which developed gradually to reach a maximum level 30 to 60 min after end of the meal. The postprandial cardiac output increase resulted from significant increases in both heart rate and stroke volume. There were distinct and significant differences between the circulatory responses to small and large meals. The increase in cardiac output after a large meal was considerably larger and lasted for longer than the increase after a small meal. Two hours after a small meal cardiac output was nearly or fully back to pre-meal values, while cardiac output was still markedly elevated 2 hours after a large meal. Consequently, the total 'extra' amount of blood delivered by the heart over 2 post-meal hours was significantly--about 100%--larger after the large meal than after the small one. Mean arterial blood pressure either fell or remained almost unchanged in the hour after a meal, so that total peripheral resistance was consistently and significantly reduced in the postprandial period--and considerably more so after a large meal than after a small one.

Improved method for cardiac output determination in man using ultrasound Doppler technique

An existing ultrasound Doppler method for measuring cardiac output has been improved and refined, partly by locating the sampling volume higher up in the aorta while still using the aortic ring size as the effective transverse flow area. The basis for using this technique is the approximately rectangular systolic velocity profile in the aortic orifice in physiologically and anatomically normal subjects, and the fact that this profile velocity is conserved as the maximum velocity in the ascending aorta for some 3 to 4 cm above the valves. This higher location of the sampling volume improves Doppler signal quality, and does not reduce the accuracy of the method, as can be confirmed in each experimental subject. Together with automatic computer-based online signal analysis, the technique employed enables us to make continuous long-term beat-to-beat measurements of cardiac output in subjects without aortic valve disease or grossly deforming disease of the aortic root.

The effect of a meal on cardiac output in man at rest and during moderate exercise

Cardiac output at rest increased by 11-63% in a group of healthy individuals after the consumption of a medium-sized, mixed meal. The maximum post-prandial levels of cardiac output were reached from 10 to 30 min after termination of the meal. Cardiac output values at rest fluctuate around a mean level, and this fluctuation was considerably more marked after a meal, when changes in cardiac output from one 15-s period to another could be of the order of 1-1.5 l min-1. Recording of flow in the superior mesenteric artery before and also after a meal was successful in two subjects in whom anatomical conditions were favourable. Flow in the artery was approximately doubled from the fasting to the post-prandial situation, an augmentation that accounted for about 50% of the concomitant increase in cardiac output. The increases in cardiac output caused by 2-min bouts of standardized, moderate and rhythmic exercise were consistently larger in the post-prandial than in the fasting situation. It thus appears that any tendency for redistribution of blood flow, for example from the gastrointestinal tract to the working muscles, during moderately intense exercise is less marked after a meal than before.

Dynamics and dimensions of cardiac output changes in humans at the onset and at the end of moderate rhythmic exercise

1. An improved Doppler ultrasound technique was used to measure stroke volume (SV) and cardiac output (CO) on a beat-to-beat basis in a group of supine humans before, during and after periods of standardized, rhythmic exercise, involving the quadriceps muscle groups on both sides. The development of CO on such bouts of exercise was compared to Doppler ultrasound records of the simultaneous femoral arterial flow (FF) response. 2. Records of CO at rest revealed spontaneous fluctuations around a mean level, with differences between the minimal and maximal values of the order of 1 l min-1. The mean CO level at rest again varied considerably from one day to another and from test run to test run. 3. Upon start of exercise an immediate and rapid increase in heart rate (HR) and CO took place. The entire increase, the size of which varied appreciably from test run to test run, was completed within 10-15 s. No or only minor changes were seen in the mean SV level during the exercise periods. 4. The time course of the increase in FF was indistinguishable from that of the increase in CO, which occurred without any detectable delay relative to the changes in FF. These closely parallel developments indicate a tight regulatory coupling between the two types of flow changes. 5. In the majority of tests the total and two-sided increase in FF seen in the steady-state situation in the last part of an exercise period was significantly larger than the recorded increase in CO. This discrepancy implies that some redistribution of flow from tissues other than the working muscles might take place, even at this moderate level of work. 6. Upon the end of exercise a striking but transient increase in CO occurred, resulting from an increase in SV concomitant with a maintained HR. In the course of five to eight post-exercise cardiac cycles about 100 extra milliliters of blood were expelled from the heart. This cardiac outflow overshoot was found to occur during a post-exercise fall in mean arterial blood pressure (MAP).

An evaluation of the plethysmographic method of measuring cranial blood flow in the new-born infant

Cranial blood flow values obtained plethysmographically in the human new-born infant have been very variable and frequently very low. We have used a doppler ultrasound velocitymeter and skull compliance measurements to investigate whether the technique itself affects the cranial arterial inflow and whether the methods of calculation used introduce bias. Blood velocities were measured in intracranial and extracranial arteries during plethysmography, i.e. before, during and after jugular vein compressions of short duration. Skull expansion after tilting was used to estimate skull compliance. In about 10% of jugular vein compressions, arterial velocities decreased immediately, due to direct pressure on the carotid artery. In the remaining compressions a fall in arterial velocities was seen four or five heartbeats after the onset of the compression. This was probably caused by a decrease in the cranial perfusion pressure consequent on rising venous pressure. Some babies demonstrated very poor skull compliance and these babies had correspondingly low estimates of cranial blood flow. We conclude that jugular venous occlusion plethysmography is not a suitable method for use in the clinical field and is only useful as a research tool in carefully selected situations.

Impaired glucose tolerance and diabetes mellitus in elderly subjects

In a 10-yr prospective population study 406 subjects who were 70 yr old received an oral glucose tolerance test. Of these subjects 169 were retested at 80. Three sets of diagnostic criteria were evaluated, of which the WHO criteria are recommended for screening studies in this age group. The prevalences of diabetes mellitus (DM) and impaired glucose tolerance (IGT) according to the latter criteria were 10% and 26% at 70 and 12% and 35% at 80 in men and women. Excess 10-yr mortality was seen in both sexes when DM existed at 70, and in men also when IGT existed at this age. The excess mortality in men could solely--and in women partly--be explained by cardiovascular diseases. The 10-yr incidence of DM was 20% if IGT existed at 70, but only 4% when normal glucose tolerance was present at 70.