Relaxation Techniques

Staying Relaxed

Staying Relaxed

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Brain Evolution System

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Brain Evolution System Overview


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Integrating The Relaxation Response Into Health Care

The relaxation response has been associated with improvements in many medical conditions including hypertension, cardiac arrhythmias, chronic pain, insomnia, side effects of cancer therapy, side effects of AIDS therapy, infertility, and preparation for surgery and X-ray procedures. It is also important to indicate that more recently, the overall implications of integrating relaxation response in routine clinical treatments has been examined. Some relevant examples will be discussed. The effect of a behavioral group intervention that included relaxation response training on chronic pain Meditation and the Relaxation Response patients. One hundred and nine patients who were members of an HMO participated in the study. The average duration of pain among the patients was 6.5 years. The interventions consisted of 90-minute group sessions, which were held once a week. At the end of the 10-week intervention period, participants in the group showed decreases in negative psychological symptoms...

Biofeedback Relaxation Training and Stress Management

The question has been raised as to the difference in effectiveness of outcome between biofeedback and relaxation training in reducing stress. This has been a controversial question as many clinicians and researchers argue that you can get the same benefits from relaxation strategies as from biofeedback for most problems. Furthermore, they point out that the relaxation strategies are not as costly nor do they require knowledge of complicated equipment. Only a few large-scale controlled outcome studies on the efficacy of biofeedback as compared to other behavioral techniques in the management of physiological disorders have been reported. Most of these do not find that biofeedback provides a distinct advantage over other behavioral procedures. The selectivity of physiological control often achieved by biofeedback methods would suggest that the methods would have a unique advantage in disorders in which the symptom is quite specific, for example, cardiac arrhythmias, seizure disorders,...

Physiology Of Stress And The Relaxation Response

The behavioral and physiological opposite of the fight-or-flight response is the relaxation response which is believed to be an integrated hypothalamic response that depresses SNS activity in a generalized manner. Forty years ago, Hess described this effect as the trophotropic response. By electrically stimulating the anterior hypothalamus of cats Hess was able to elicit signs of reduced sympathetic nervous system arousal including decreases in muscle tension, blood pressure, and respiration. This response was the opposite of what he termed ''ergotropic'' responses, which corresponded to the heightened state of SNS activity described by Cannon as the fight-or-flight response. The early experimental work of Cannon and Hess, combined with the more recent observations of Benson and his colleagues, suggests that these two responses are actually symmetrical. Although both involve central and peripheral nervous system changes, the fight-or-flight response prepares the organism for action...

Meditation and the Relaxation Response

Physiology of Stress and the Relaxation Response III. Meditation, the Relaxation Response, and Physiological Changes IV. Rationale and Technique for Elicitation of the Relaxation Response V. The Relaxation Response in Psychotherapy VI. The Relaxation Response and Behavior Change VII. Integrating the Relaxation Response into Health Care Peripheral Nervous System Neural activity that occurs outside the brain and spinal cord including the sympathetic branch of the autonomic nervous system. Relaxation Response An integrated physiological response that is the opposite of the fight-or-flight response i.e., it reduces physiological arousal. The relaxation response is elicited by two simple steps (1) focusing attention on a word, sound, prayer, phrase, image, or physical activity, and (2) passively ignoring distracting thoughts and returning to the repetition. Sympathetic Nervous System A branch of the human body's autonomic nervous system. In response to stress, sympathetic nervous...

Meditation The Relaxation Response And Physiological Changes

Meditation and the Relaxation Response tion, respiratory rates, minute ventilation (the amount of air inhaled and exhaled in a 1-minute period), and arterial blood lactate levels (an indication of anaerobic metabolism) were reduced. These acute changes are all compatible with reduced SNS activity and were not evident when the subjects simply sat quietly. Since these initial demonstrations, others have documented that elicitation of the relaxation response results in important physiological changes that are mediated by reduced SNS activity. In addition to the SNS effects of the relaxation response, its central nervous system effects have been dramatically illustrated in a controlled study of frontal EEG beta-wave activity. Novice subjects listened to either a tape designed to elicit the relaxation response or a control tape that provided a discussion of the relaxation response and its benefits. Using topographic EEG mapping, researchers found that elicitation of the relaxation response...

The Relaxation Response In Psychotherapy

For many patients with psychological disturbances, who might be hesitant to enter therapy, relaxation-response training is a nonthreatening intervention that can be introduced prior to other more rigorous forms of therapy such as cognitive therapy or medication. Meditation and other modes of eliciting the relaxation response can be a means of preparing for standard psychotherapy by allowing the patient to observe thoughts and mental events. ages and lifestyle changes. Much of what occurs in psychotherapy is intended to bring about these changes. While meditation alone cannot obviate skilled therapy and is no substitute for a therapeutic alliance, it may be the case that the CNS changes that occur when meditation is used to elicit the relaxation response set the stage for more rapid and persistent psychotherapeutic change. For many types of disorders such as anxiety and other stress-related disorders, elicitation of the relaxation response via meditation or other techniques can help...

The Relaxation Response And Behavior Change

Relaxation-response training can be used to facilitate behavior modification goals. Most patients who begin a diet or a smoking cessation program are able to stay with the program for short periods of time. When stresses arise, however, it generally becomes more difficult to maintain the new routine. Coping with stress and anxiety has a psychic cost that takes the form of a diminished capacity for self-regulation. Presum Meditation and the Relaxation Response ably, the cause of this stress disinhibition effect'' is a depletion in the cognitive and emotional resources required to maintain self-regulation. Increased stress and anxiety lead to immediately gratifying, but ultimately damaging behaviors, such as dietary indiscretions, alcohol or drug abuse, and an increase in smoking. Relaxation training has proved to be effective as an acute coping strategy to reduce anxiety. See Coping with Stress. The extent to which stress-related relapses are prevented is directly related to the degree...

Rationale And Technique For Elicitation Of The Relaxation Response

A variety of techniques can be used to elicit the relaxation response, including meditation, progressive muscle relaxation, autogenic training, yoga, exercise, repetitive prayer, and the presuggestion phase of hypnosis. Although all of these strategies result in the same physiological response, two components appear to be essential to achieving the relaxation response mental focusing and adopting a passive attitude toward distracting thoughts. The following is an instructional set developed by Benson and his colleagues for elicitation of the relaxation response. Regular practice at eliciting the relaxation response has been shown to produce chronic physiological changes by at least two research groups. With repeated practice, patients can experience the benefits of relaxation throughout the day not only during actual practice periods. Figure 2 O2 consumption during sleep and the relaxation response. Figure 2 O2 consumption during sleep and the relaxation response. Meditation and the...


Active transport pumps in the sarcoplasmic reticulum (SR) begin to pump Ca2+ from the cytosol back into the cisternae. Here, the calcium binds to a protein called calsequestrin (CAL-see-QUES-trin) and is stored until the fiber is stimulated again. Since active transport requires ATP, you can see that ATP is needed for muscle relaxation as well as for muscle contraction (see insight 11.2).

Clinical Examples Make It Relevant

Cranial Nerves Fake Brain

Smooth muscle exhibits a reaction called the stressrelaxation (or receptive relaxation) response. When stretched, it briefly contracts and resists, but then relaxes. The significance of this response is apparent in the urinary bladder, whose wall consists of three layers of smooth muscle. If the stretched bladder contracted and did not soon relax, it would expel urine almost as soon as it began to fill, thus failing to store the urine until an opportune time. 29. Explain why the stress-relaxation response is an important factor in smooth muscle function.

Management options

The significance of this is disputed. Uterine relaxation has been achieved by using one or more of volatile agents, magnesium sulphate or glyceryl trinitrate. Fetal monitoring may be difficult but pulse oximetry, ultrasonography and cardio-tocography have been used. Bleeding may be excessive in prolonged open procedures.

Management options Termination for maternal indications

An anaesthetic technique suitable for day-case anaesthesia should be employed, e.g. induction with propofol followed by nitrous oxide oxygen and maintenance with propofol or a volatile anaesthetic agent. There has been concern about concentrations of volatile anaesthetic agents greater than one minimum alveolar concentration causing uterine relaxation unresponsive to oxytocics. For a termination of pregnancy at less than 15 weeks, standard concentrations of volatile anaesthetic agents do not appear to pose a risk and may be used to maintain anaesthesia. Analgesia may be provided by intravenous fentanyl or alfentanil with rectal diclofenac 100 mg.

Oxyhemoglobin Saturation and Fluorescence

Oxygen is able to diffuse rapidly, and will react with many molecules. It can be detected by spectroscopic techniques because of its capacity for modifying the relaxation times of excited species. Spectroscopy (cryospectroscopy and near-infrared spectros-copy) is based on the spectral differences between oxygenated and deoxygenated hemo

Joseph Wolpe and Systematic Desensitization

Wolpe's most popular treatment maneuver was called systematic desensitization. It is a combination of deep muscular relaxation and an effective technique of emotive imagery. The latter had been formulated and tested by Arnold A. Lazarus, then a psychologist, student colleague of Wolpe and later a behavior therapist of international acclaim. A typical treatment session is an hour in which patient clients first self-induce a state of deep muscle relaxation, followed by the therapist verbally pacing them in imagining events on a prepared list of feared objects or events. Starting with the least fearful event, patient clients are to maintain their initial state of deep muscular relaxation as the therapist verbally paces them up the list to the target fear. If, however, the patient client becomes noticeably anxious during the session, he or she is to terminate that imagery and focus on reestablishing their former relaxed state before resuming those images.

Radiographic Endoscopic Examinations

In addition to defining the functional abnormality, this procedure also allows for evaluation of the efficacy of various compensatory dietary modifications, postures, and swallowing maneuvers in improving swallowing dysfunction. Intraluminal manometry can complement videoflu-oroscopy by providing information on the strength of pharyngeal contraction, the completeness of UES relaxation, and the relative timing of these events. This may provide useful information regarding UES dysfunction and may help distinguish impaired UES function from weak pharyngeal contractions.

Treatment Structural Etiologies

Dysphagia, halitosis, postswallow regurgitation, or even aspiration of material from the pharyngeal pouch. The most frequent site of herniation is Killian's dehiscence between the oblique fibers of the inferior pharyngeal constrictor and the cricopharyngeus muscle in the midline posteriorly, this being the location of a Zenker's diverticulum. Other locations of acquired pharyngeal diverticula can be found at sites of potential weakness of the muscular lining of the hypopharynx. Hypopharyngeal diverticula have been hypothesized to result from either delayed UES relaxation, failure of relaxation, or premature contraction. However, more current data suggest that the development of these diverticuli is the result of a restrictive myopathy associated with diminished compliance of the cricopharyngeus muscle. The muscle relaxes normally during swallowing, but it cannot distend normally, resulting in the appearance of a cricopharyngeal indentation, or bar, during a barium swallow. The...

Problemsspecial considerations

Increased circulating progesterone associated with pregnancy relaxes smooth muscle and causes relaxation of the lower oesophageal sphincter, whereas placental gastrin increases the volume and decreases the pH of gastric contents. The enlarging uterus increases intragastric pressure and there is an increase in small and large bowel transit time. However, evidence suggests that gastric emptying per se is not affected by pregnancy though it may be decreased in labour if opioids are given.

Supplemental Reading

Kim MS, Holloway R, Dent J, Utley DS. Radiofrequency energy (RFC) delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxations and gastroesophageal reflux in dogs. Gastrointest Endosc 2003 57 17-22. Mittal RK, Holloway RH, Penagini R, et al. Transient lower esophageal sphincter relaxation. Gastroenterology 1995 109 601-10. Tam WCE, Schoeman MN, Zhang Q, et al. Delivery of radiofrequency energy to the lowest oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease. Gut 2003 57 479-85.

Historical Survey of Biofeedback Development

Psychophysiology is the scientific study of the interrelationships between cognitive, emotional, behavioral, and physiological processes. Biofeedback techniques and applications grew out of the research in psycho-physiology. Biofeedback research became widespread in the 1960s, when studies reported that a variety of presumable nonvoluntary responses could be brought under operant control. Many studies using electroen-cephalographic feedback were reported which indicated that alpha brain activity could be brought under voluntary control. As these studies gained the attention of clinicians, soon biofeedback was applied to treating various disorders such as migraine headache and hypertension. The growing body of research on stress also provided support for the use of biofeedback as a research tool as well as a treatment approach. Research on the effects of relaxation, meditation, and hypnosis in producing the relaxation response to counteract the effects of stress provided further...

Field Strength Dependence ofTROSY for 15N1H Groups

For the amide proton of a 15N-1H moiety, the two interfering relaxation mechanisms used in TROSY are DD relaxation between the proton and nitrogen spins and CSA relaxation of the proton. In general, DD and CSA relaxation are not equal in magnitude and cannot compensate each other. However, the DD interaction does not depend on the strength of the static magnetic field, whereas the CSA relaxation increases with larger magnetic fields, tte optimal TROSY effect for one doublet component can thus be obtained by choosing the appropriate field strength, where its relaxation rate will be near zero. For amide protons in polypeptides, this magic field is about 23.5 T, corresponding to a proton resonance frequency of approximately 1,000 MHz. tte 15N nucleus in an amide moiety shows a similar interference between 15N-1H DD interaction and its CSA, with a minimal transverse relaxation rate at magnetic field strengths corresponding to a proton resonance frequency of approximately 900 MHz,...

The Foundations ofTROSY

Tte TROSY technique (Pervushin et al. 1997) is based on the interference of at least two different relaxation pathways that contribute to the relaxation of a particular nucleus, tte interference can be additive or subtractive, resulting in increased or reduced relaxation, respectively. In addition to the omnipresent relaxation due to DD coupling, chemical shift anisotropy (CSA) of 1H, 15N, and 13C can be a significant source of transverse relaxation at the high magnetic fields typically used for studies of biological macromolecules. ttis effect can be nicely illustrated in a correlation spectrum of 15N and nuclei of amide groups in a polypeptide backbone (Fig. 5.2). Each nucleus couples to its directly attached 15N nucleus by scalar coupling, tte XH NMR spectrum of such an amide moiety thus consists of two lines representing the protons attached to 15N nuclei with spin up and those protons attached to 15N nuclei with spin down relative to the external magnetic field, tte same effect...

Mellowing Your Muscles

One of the most thoroughly researched methods for teaching your body to relax is called progressive muscle relaxation. It sounds scientific and complicated, but you can find easy techniques for muscle relaxation in a variety of books, tapes, CDs, and on the Internet. Flat out Muscle relaxation works. That's why, in this section, we give you one of our favorite muscle relaxation strategies. In the beginning, this technique will take you about 15 or 20 minutes. As you practice the exercise, you'll be able to accomplish relaxation in a shorter period of time. After a while, some people are able to relax their bodies within just two or three minutes To get the most out of this relaxation exercise, find a quiet place where you're unlikely to be disturbed. Turn off phones and pagers. Wear comfortable clothing, take off your shoes, and loosen any tight belts or restrictive clothing. The following relaxation procedure is excerpted from our book, Overcoming Anxiety For Dummies (Wiley)....

Relaxing the Heart and Soul

Knowing what relaxation can do for you Practicing different relaxation strategies Rooting out things that ruin sleep Capturing pleasurable sleep In this chapter, we look at the benefits of relaxation. We give you some quick, effective strategies for teaching your body to chill out, even when you find yourself in stressful situations. Finally, we show you how to enhance the quality of your sleep, which increases your ability to cope with stress. Relaxation What's in It for Me We know your life is probably hectic and stressed, and time is hard to come by. Learning to relax takes some time, so why in the world would you want to devote precious minutes to the task of relaxation We can think of a few pretty good reasons 4. Take stock of your life, and reflect on whether you need to do something about your approach to relaxation. Personal Relaxation Review Although rather rare, some people report that relaxation techniques sometimes actually induce a sense of panic and loss of control. If...

Anorectal Physiology in Health and with Inflammation

The complex physiology of the anorectum is adversely influenced by inflammation with increased sensitivity to sensation and an amplification of muscular responses stimulated by stool in the rectum. Tenesmus is the sensation of incomplete evacuation of the rectum or nonproductive straining to defecate. It occurs when rectal contraction is accompanied by internal anal sphincter relaxation. In the presence of inflammation, there is sensitivity to lower than normal volumes of balloon distention and exaggerated relaxation of the internal anal sphincter (IAS). The sensations accompanying this response are perceived rectal fullness, urgency to defecate and a sense of incomplete evacuation. Occasionally, tenesmus continues when visible inflammation is no longer present. When this occurs, treatment for microscopic inflammation or pharmacologic manipulation of rectal contractility and IAS relaxation improves these symptoms. In addition to the influence of rectal inflammation on anorectal...

Electroencephalographs Biofeedback

Electroencephalographic (EEG) biofeedback is another frequently used biofeedback training method with children and adults. EEG biofeedback gives information about the brain's electrical activity. Brain waves have been classified into four states beta, which occurs when the individual is wide awake and thinking alpha, which is associated with a state of calm relaxation theta, which reflects a deep reverie or light sleep and delta, which is associated with deep sleep. In the typical procedure the subject is provided with feedback about the presence or absence of some specified amplitude and or frequency of brain electrical activity. Often the goal of EEG biofeedback is to produce alpha waves because they are associated with relaxation.

For Studies of Very Large Structures

In most of the heteronuclear NMR experiments, magnetization between the different nuclei is transferred on the basis of their scalar spin-spin couplings using insensitive nuclei enhanced by polarization transfer (INEPT) elements (Morris and Freeman 1979 Burum and Ernst 1980). During INEPT transfers, TROSY is not active since the slowly and fast relaxing transitions are mixed. For very large structures with molecular masses above approximately 150kDa, rapid transverse relaxation during the INEPT periods leads to a virtually complete loss of intensity for most signals, ttis limitation can be alleviated by cross-correlated relaxation-enhanced polarization transfer (CRINEPT) (Riek et al. 1999, 2002). In this technique, INEPT and cross-correlated relaxation-induced polarization transfer (CRIPT) (Dalvit 1992) are combined. In contrast to INEPT, the transfer efficiency of CRIPT increases proportional to the size of the molecule, so that it becomes an efficient magnetization transfer...

NMR and Molecular Size

When studying large molecules by solution NMR methods, usually three major difficulties arise (1) signal overlap, (2) fast transverse relaxation, and (3) limited solubility 2. tte transverse magnetization in larger molecules relaxes faster, which leads to line broadening and poor sensitivity in the spectra, and eventually no NMR signals can be detected at all (Fig. 5.1, case B). ttis effect becomes especially bothersome when performing long and relatively complex heteronuclear multidimensional NMR experiments. In such experiments, multiple nuclei are correlated by their mutual scalar couplings over several chemical bonds. For larger systems, fast transverse relaxation (equivalent to short transverse relaxation times) reduces the signal intensities beyond the detection limit before the desired signal can be measured. ttis short discussion indicates that the limitations caused by nuclear transverse relaxation poses the severest technical challenge for studies of larger biological...

Interaction Between Phospholamban Depletion and pAdrenoceptor Stimulation

Basal contraction and relaxation (23). A residual effect of catecholamines on relaxation is observed, and this is probably due to phosphorylation of troponin I, because crossing of PLB-KO mice with a strain having mutant or slow skeletal troponin abolishes the lusitropic effect of -adrenoceptor stimulation completely (24,25). In rabbit myocytes transfected with phospholamban antisense, it is possible to eliminate the effect of tonic stimulation of contraction by selecting a frequency (see Fig. 1) at which basal amplitude is unchanged. At this frequency, overexpression of SERCA2a or phospholamban downregu-lation does not alter the contractile response to isoproterenol, with both maximal effect and concentration dependence unchanged (16). This suggests that cAMP-dependent phosphorylation of the L-type Ca2+ channel predominates in mediating the positive inotropic effect of catecholamines. Relaxation, however, is accelerated by SERCA2a and phospholamban antisense adenoviruses at all...

Acute microvascular effects of growth factors

Microvascular reactivity studies after 4 wk of vascular endothelial growth factor (VEGF) treatment in a porcine model of myocardial ischemia with (B,C) or without (A) hypercholesterolemia-induced endothelial dysfunction. Graphs show percent relaxation to increasing concentrations of vasodilating agents following preconstriction with U46619. SNP, sodium nitroprusside ADP, adenosine diphosphate. From ref. 146. Fig. 7. Microvascular reactivity studies after 4 wk of vascular endothelial growth factor (VEGF) treatment in a porcine model of myocardial ischemia with (B,C) or without (A) hypercholesterolemia-induced endothelial dysfunction. Graphs show percent relaxation to increasing concentrations of vasodilating agents following preconstriction with U46619. SNP, sodium nitroprusside ADP, adenosine diphosphate. From ref. 146. eral vasodilation. The angiogenic potential of FGF-2 is largely independent of the release of NO, whereas VEGF-induced vessel formation is potently coupled to...

TROSY for Studies of Dynamic Processes

In addition to structural data, NMR is able to provide information on dynamic processes at atomic resolution over a wide range of time scales (Kay et al. 1989 Palmer 2004), which potentially can help understanding structure and function relationships (Mulder et al. 2001 Eisenmesser et al. 2002). Key experiments for dynamic studies measure Ti and T2 relaxation times and heteronuclear 15N 1H NOEs of the 15N nuclei in amide groups. For these important experiments, pulse sequence using 15N,1H -TROSY were developed (Zhu et al. 2000). Recently, these experiments were extended to three dimensions based on a 3D TROSY-HNCO sequence, which can be applied to resolve signal overlap in the 2D spectra (Xia et al. 2002). Please note that TROSY does not change the 15N-spin relaxation parameters typically measured. A few examples of the application of 15N,1H -TROSY experiments for the study of protein dynamics are given in Sect. 5.5. Not only the 15N,1H -TROSY effect can be used to obtain relaxation...

TROSY for NMR Studies of Large Biological Macromolecules

Although collection of high-quality data for structure determination of proteins with molecular masses up to approximately 100 kDa is now technically feasible, the complexity of the NMR spectra generally increases with the size of the molecule studied and the concomitant signal overlap may limit spectral analysis, tterefore, the preferred current use of relaxation-optimized NMR techniques is with large structures that yield relatively simple spectra compared with spectra of monomeric globular proteins of the same molecular size, such as homo-oligomeric proteins, individual small or medium-sized subunits in large molecular complexes, and membrane proteins in detergent micelles (W thrich 1998 Fern ndez and Wider 2003).

Nuclear magnetic resonance

NMR signals can be characterized by intensity, frequency, line shape and relaxation times. All these characteristics are affected by the physical and chemical environment of the magnetic nucleus and can be used to obtain information of biological interest such as the state of water, intracellular pH and membrane dynamics. Signal intensity is related to the number of molecules that produce the signal. In relaxation experiments, the intensity depends on the time of signal registration and on the rate of magnetization decay. For quantitative estimation of peaks in NMR spectra, integration of the lines should be used because of the different relaxation times of the signals. The limits of integration are determined by the signal-to-noise ratio of the signal and the overlapping with other signals in a spectrum. The T1 (spin-lattice or longitudinal) and T2 (spin-spin or transverse) relaxation times characterize the magnetization decay because of the interaction of the nuclear magnetic...

Antisense Strategies in Human Myocytes

Myocardial cells from failing human hearts are characterized by abnormal calcium handling, a negative force-frequency relationship, and decreased SR Ca2+ ATPase (SERCA2a) activity. In a study by del Monte et al. (22), ventricular myocytes isolated from nine patients with end-stage heart and 18 donor nonfailing hearts were infected with adenoviruses encoding for either the antisense sequence of phospholamban (Ad.asPL), SERCA2a gene (Ad.SER-CA2a), or the reporter genes p-galactosidase and green fluorescent protein (Ad.pgal-GFP). Adenoviral gene transfer with Ad.asPL decreased phospholamban expression over 48 h, increasing the velocity of both contraction and relaxation. Compared to cardiomyocytes infected with Ad.asPL, human myocytes infected with Ad.pgal-GFP had enhanced contraction velocity and relaxation velocity, as shown in Fig. 2. The improvement in contraction and relaxation velocities was comparable to that of cardiomyocytes infected with Ad.SERCA2a. Failing human cardiomyocytes...

Healing and energy work

The best available evidence suggests that reiki and spiritual healing may contribute to pain relief, promote relaxation, to improve sleep patterns, reduce tension, stress and anxiety, to provide emotional and or spiritual support, contribute to a sense of wellbeing, reduce side effects of chemotherapy and radiotherapy, and support the patient in the dying process

Anaesthetic problems

Prolonged neuromuscular blockade after vecuronium has been reported (Flusche et al 1987), but the reason for this is obscure since an inflammatory myopathy should not affect the neuromuscular junction. However, neuromuscular monitoring in two patients receiving atracurium (Ganta et al 1988), one having vecuronium (Saarnivaara 1988), and another having both suxamethonium and atracurium (Brown et al 1992), did not suggest sensitivity. However, one child had an abnormal response to suxamethonium. Before muscle relaxation occurred, fasciculations were followed by a short period of muscle contraction (Johns et al 1986). Nevertheless, marked increases in muscle tone following suxamethonium may occur in some normal patients, so the significance of this is uncertain (Leary & Ellis 1990).

Skin Temperature Biofeedback

Skin temperature monitoring is useful because skin temperature tends to become cooler as one experiences greater sympathetic nervous system (SNS) arousal and stress. Peripheral vasoconstriction and reduced blood flow to the tiny capillaries in the skin are what causes the skin temperature to decrease. During SNS arousal, changes in blood flow takes blood from the skin and sends it to the skeletal muscles, allowing large muscles to respond to the flight or fight challenge. This response in turn protects the peripheral parts of the body, by reducing blood flow to the hands or feet in order to reduce bleeding if these body parts were injured. Thus, it is suspected that when the person experiences greater parasym-pathetic nervous system arousal, changes in blood flow return the blood to the skin and smooth muscles. Increased blood flow to the skin causes increases in skin temperature, and this may reflect relaxation.

Research Investigations on How Biofeedback Works

Biofeedback training with relaxation only and found that in both conditions, decreases in ANS arousal can be achieved. Other researchers are now examining the role of cognitions in the biofeedback process. The bottom line is that we are not sure how it works but studying this question allows for a fascinating journey into the mind-body research arena.

Magnetic Resonance Imaging and Spectroscopy

The proton is the element responsible for the signal generation in proton MRI, and can be viewed as a minimagnet due to the spinning single electron. MRI utilizes two energies, a strong magnetic field and pulses of radio frequency (RF) electromagnetic energy. RF energy is not ionizing, and a trillion times less in magnitude than X-rays. The sensitivity of the technology is related to the large number of protons that are present in water and fat, the primary constituents of a human or animal. When protons are placed in a magnetic field, they become aligned with, or opposed to, the external field. Excitation with a precise resonance frequency (MHz) results in excited-state protons, all of which are in phase, but tilted away from the direction of the external magnetic field. The in-phase aspect is unique to the excited state, since ground-state protons are not in phase. Therefore, to summarize, absorption of a resonance RF energy by the proton results in an excited state, where all the...

Mechanical Refolding of Proteins

As mentioned, pulling experiments occur far from equilibrium. Unfolding rates along the force-unfolding pathway can be estimated, although refolding rates along the same pathway cannot be typically measured because the high forces applied often prevent the folding of proteins. Still, it is possible to measure refolding rates following relaxation of a polyprotein, although these measurements are still difficult to make (Carrion-Vazquez et al. 1999a). ttese experiments use the length-clamp mode of SMFS as follows. Once a stretch of a single protein molecule has been trapped between the tip and the substrate it can be held there by setting the retraction distance at less than that of the unfolded polyprotein. Ms prevents its detachment from the tip or the substrate, and allows repeated cycles of extension and relaxation using a length-clamp protocol of double pulse (Carrion-Vazquez et al. 1999a). Force-clamp SMFS has recently enabled a protein molecule to be stretched under a constant...

Uniform Isotope Labeling

Groups, where typically random 10 13C-labeling is used (Neri et al. 1989 Hilty et al. 2003). In contrast to this situation, deuteration levels should be tailored to the desired applications, mainly depending on the size of the protein studied and the types of experiment performed, ttere has to be a compromise between the decreased 1H, 13C, and 15N transverse relaxation times and the decreased effective proton concentration in the samples. In perdeuterated samples only the exchangeable protons, such as the amide and hydroxyl protons, are potentially visible in the spectra. Although these samples are useful for resonance assignments in the polypeptide backbone, crucial structural information from the side chains of the proteins is not accessible. Random fractional deuteration has thus been used to obtain both backbone and side-chain information. Deuteration levels of about 50 have been found to provide a good compromise (Nietlispach et al. 1996), and seem to work well for both triple...

Properties of the Coronary Microcirculation

The initial studies demonstrating abnormal endothelium-dependent vascular relaxation in various disease models were performed in larger vessels. Subsequent experiments have shown that most, if not all, of these disease processes also affect the coronary microcirculation in a similar fashion. This is of particular interest in the case of hypercholesterolemia and atherosclerosis. One of the first examples of an alteration in coronary microvessels in atherosclerosis was made in vessels from monkeys fed a high-cholesterol diet for 18 mo (131). These animals developed advanced atherosclerotic lesions in larger vessels, and had abnormal vasodilation in response to acetylcholine, the calcium iono-phore A23187, and thrombin in those vessels. On the other hand, coronary microvessels from the same animals had dramatically impaired relaxations to the same acetylcholine, bradykinin, and the calcium iono-phore A23187, and in some cases, these agents produced paradoxical constrictions (Fig. 5)....

Psychological Interventions

Patients with the IBS who actively seek care by a physician have a high incidence of psychological disorders, specifically depression and anxiety. Because of this, a variety of psychological interventions have been used to treat the symptoms of IBS. Despite methodological flaws in most studies, there are some data to support the use of relaxation exercises, biofeedback, cognitive therapy, hypnotherapy, and psychotherapy (Talley et al, 1996). The IBS-related symptoms most likely to respond to psychological intervention include abdominal

Considerations regarding the coronary venules in modulation of overall coronary vascular responsiveness

Not only is vasomotor regulation differentially controlled between the venous and arterial microcirculations, but certain reactions to pathologic stimuli occur preferentially on one side of the capillary bed. For example, postcapillary venules are the initiating site of neutrophil adherence and transmigration (94), whereas arterioles seldom manifest these initial changes in the inflammatory response. In addition, complement fragment C5a causes neutophil adherence in venules but not in arterioles, suggesting that different mechanisms mediate neutrophil-endothelial adherence in the two vessel types. The mechanism of C5a-induced neutrophil adherence has recently been shown to involve the activation of Src kinase, Src p-catenin association, and P-catenin phosphorylation (95). Neutrophil adherence, in turn, causes dysfunction of the endothelial cell barrier leading to hyperpermeability which is seen in ischemia and other inflammatory disease states (96). While ischemia-reperfusion has been...

Neurohumoral Control of the Circulation

Tion results in is rather potent vasodilation of all sized coronary microvessels, predominantly as a result of a release of endothelium-derived NO. -Adrenergic stimulation produces a potent relaxation of all coronary arteries, but especially small resistance vessels (62). In vitro, the p2-adrenergic receptor-subtype predominates in vessels less than 100 microns in diameter (62). In vivo, however, mixed pr or p2-adrenergic receptor population controls vascular resistance. Larger coronary vessels are regulated by a mixed pr and p2-adrenoceptor subtype population, or a predominant P1-adrenergic mechanism.

Vascular Endothelial Growth Factors

The efficacy of periadventitial delivery of VEGF was tested in a porcine ameroid model (64,67). Treatment with VEGF was associated with better preservation of coronary flow in the ameroid zone during pacing. Magnetic resonance imaging (MRI) demonstrated not only significantly better perfusion of the compromised territory, but also a reduction in size of this territory in VEGF-treated animals (65). The number of collateral vessels were increased nearly fourfold in the VEGF-treated animals (66). Analysis of microvascular function demonstrated significantly better restoration of endothelium-mediated, receptor-dependent relaxation in VEGF-treated animals (66,68).

Tissue Characterization The Need for Multiple Contrast Weighting

Recent studies have shown that a combination of different contrast weightings is necessary for noninvasive characterization of plaque morphology 82, 102 . T1-, T2-, PD-, gradient echo, and other contrast schemes have all been evaluated for plaque tissue characterization. Different contrast weightings reveal different features of the plaque. For example, the MR signal intensity of hemorrhage is dependent on the structure of hemoglobin and its oxidation state 83 . Recent hemorrhage with short T1 and long T2 shows a hyperintensive signal intensity on all contrast weighted images, and is readily identified. Calcified tissues, which have very little water and appear dark on all contrast weightings, are easily detected. Calcification on the plaque surface or cal-cific nodules extending into the lumen is difficult to detect due to low signal intensity, which is easily masked on black-blood sequence (SE or FSE T1, PD-and T2-weighted) 73 but they are easily detected on bright-blood sequence...

Lymphatic Circulation

A compression relaxation cycle causes the lymphatic vessels to suck up lymph. Lymph valves in lymphatic vessels make this possible. A volume of fluid equal to the total plasma volume in a single human is filtered from the blood to the tissues each day. It is critical that this fluid is returned to the venous system by lymph flow each day. The lymphatic vasculature collects approximately 3 L day of excess interstitial fluid and returns it to the blood. The lymph system is responsible for returning plasma proteins to the blood.

How to Perform Right Ventricular Angiography in ARVCD

The following recommendations have been proposed by Wichter et al. 12 for the core laboratory of RV angiography within the NIH-funded North American Multidisciplinary Study of ARVD 13 and the EU-funded European Registry of ARVC D 14 . The protocol was designed to perform RV an-giograms of best quality to assess structural and functional RV abnormalities in ARVC D and to allow quantitative measurements of RV volumes, ejection fraction, and regional contraction and relaxation.

Electromyographic Biofeedback

Frontalis is the forehead muscle that tenses when an individual is worried or under pressure. Some clinicians believe the tension in the frontalis area is one of the best indicators of overall body tension. The masseter muscle is connected to the jaw bone and contracts when an individual is tense or angry. The trapezius muscle contracts the shoulders when an individual is alarmed or chronically anxious. These muscles are often the focus in biofeedback training because they typically respond to stress and can be measured without much interference from other muscles. They can be a good starting point from which muscle relaxation training can be generalized.

General considerations

The study on water in skeletal muscle as an example, fast techniques (e.g. laser Raman spectroscopy, infrared spectroscopy and dielectric relaxation) could not find any intramolecular differences in hydrogen bond lengths, angles or strength between muscle water and pure water (Beall, 1981). However, slower techniques, such as nuclear magnetic resonance (NMR) (Fung and McGaughy, 1974), electron paramagnetic resonance (EPR) (Belagyi, 1975) (see Chapter 4), fluorescence polarization (Knight and Wiggins, 1979) and freezing behaviour (Rustgi et al., 1978), showed a restricted motion of at least a portion of cell water. This situation is identical to photographing moving objects with different shutter speeds. If the shutter speed is very high relative to the velocities of two moving objects (e.g. 1 800 s), the photo will probably not record any information as to whether one object is moving faster than the other. On the other hand, if the shutter speed is too slow (e.g. 1 2 s), the images...

Endothelial Regulation of the Coronary Microcirculation

In smaller vessels of both the coronary and peripheral circulations, factors other than NO can modulate endothelium-dependent vascular relaxation. One such factor is the endothelium-derived hyperpolarizing factor (EDHF). Even before the endothelium was found to be critical in modulating vascular tone, it was known that certain relaxing substances would hyperpolarize vascular smooth muscle. It was subsequently shown that this phenomenon was endothelium-dependent (83). This hyperpolarizing effect occurs via opening of vascular smooth muscle potassium channels, and the channel type involved has been the subject of substantial interest. These have largely been characterized using pharmacological means. In cerebral vessels, a voltage-regulated potassium channel has been implicated in endothelium-dependent hyperpolarization (84), whereas others have suggested that the EDHF acts on large conductance potassium channels. When the vascular smooth muscle is hyperpolar-ized, voltage-sensitive...

Emergy exergy and their joint use

According to Svirezhev (2000), this fact is normal, since this concept resembles that of a relaxation time, i.e., the time necessary to recover from disturbances, so that the exergy to empower ratio should be related with concepts like resilience and resistance of an ecosystem.

Chest Compressions

To give effective chest compressions, push hard and push fast. Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1V2 to 2 inches (approximately 4 to 5 cm). Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times.

Supramolecular Mechanical Properties of Protein Complexes

Most protein machines are made of complexes of noncovalently bound polypeptides. Characterization of the mechanical properties of these multimolecular structures is also an important challenge for single-molecule force spectroscopy. Supramolecular complexes with an integral structure and behavior, such as the long coiled-coil structure of the myosin II tail (Fig. 8.8b), have also been characterized using this technique (Table 8.1 Schwaiger et al. 2002). tte myosins are a large family of motor proteins that move along actin filaments as they hydrolyze ATP. Myosin II is a hexamer formed by four light chains and two heavy chains that have a globular N-terminal motor and a tail that dimerizes into a 150 nm long parallel coiled coil (Fig. 8.8). tte typical force-extension curve of a myosin tail presents a characteristic molecular fingerprint. Ms suggests a mechanism for myosin elasticity in which the folded coiled coil initially extends by entropic elasticity up to 20 pN, and then at 20-25...

Anatomy and Physiology of the Lower Urinary Tract

The storage and periodic elimination of urine are dependent on the reciprocal activity of two functional units in the lower urinary tract a reservoir, the bladder and an outlet represented by the bladder neck and the smooth and striated sphincter muscles of the urethra. During urine storage, the bladder outlet is closed and the bladder smooth muscle is quiescent, allowing intravesical pressure to remain low over a wide range of bladder volumes. During voluntary voiding, the initial event is a relaxation of the pelvic floor and striated urethral muscles, followed by a detrusor muscle contraction and opening of the bladder neck. This activity is mediated by three sets of peripheral nerves parasympathetic (pelvic), sympathetic (hypogastric) and somatic (pudendal) nerves (Fig. 1). These nerves also contain afferent axons terminating in the lower urinary tract which are involved in initiating micturition.

Preoperative abnormalities

Delay in the relaxation phase of reflexes, dry skin, a husky voice, loss of the outer part of the eyebrows, and weight gain. In severe disease there is lethargy, bradycardia, hypothermia, and respiratory depression. Deposition of a mucinous substance causes thickening of the subcutaneous tissues producing a nonpitting oedema. Myxoedematous infiltration of the vocal cords and tongue can occur. Cardiovascular complications include ischaemic heart disease, bradycardia, pericardial effusion, and cardiac failure (Gomberg-Maitland & Frishman 1998). Neurological complications may involve carpal tunnel syndrome, polyneuritis, myopathy, and cerebellar syndrome.About 70 of patients have paraesthesia or sensory neuropathy. Psychiatric disturbances may predominate.

Current Indications for Right Ventricular Angiography in ARVCD

As in every imaging technique, the diagnostic value of RV angiography depends on the experience of the investigator in the performance and interpretation of results of the study. In general, the angiographic diagnosis of ARVC D is based on segmental abnormalities rather than global RV enlargement or hypokinesia. Dedicated computer software is currently under development and will provide a new convenient and reproducible method for quantitative assessment of global and (probably more importantly) regional RV contraction and relaxation in comparison to a database of normal control subjects.

Management of Unexplained Chest Pain

Nonpharmacologic approaches can be useful in unexplained chest pain, just as in other functional gastrointestinal disorders. Cognitive behavioral psychotherapy, deep muscle relaxation, biofeedback, and other stress reduction techniques, are beneficial for some patients. Transcutaneous electrical nerve stimulation, acupuncture, and other alternative approaches, have had anecdotal success, but the best advice is to learn to maximize the use of antidepressants, particularly TCAs, in this patient group.

Behavioral and Psychological Approaches

Although pharmacologic therapy has a valuable role in these patients, it is also clear that a successful outcome requires taking into consideration several, equally important, factors. As explained previously, chronic pain cannot be viewed as a purely neurophysiologic phenomenon and has many other facets, the most important of which is the psychological dimension, consisting of cognitive, emotional and behavioral processes. The combination of these factors results in functional disability, a third dimension of chronic pain that is often ignored. Several psychological techniques have been used with good effect in the management of a variety of chronic pain syndromes, although specific evidence for their efficacy in chronic abdominal pain syndromes is generally lacking. Operant interventions focus on altering maladaptive pain behaviors, such as reduced activity levels, verbal pain behaviors and excessive use of medications. Cognitive behavioral therapy extends beyond this to also...

Other Objective Methods of Scoring

Electromanometry has been used to determine the degree of incontinence since the early 1960s 11-13 . Holschneider 8 electromanometrically defined four grades of continence. These grades were derived from numerous parameters, such as anorectal pressure profile, fluctuations, relaxation of the internal sphincter, external sphincter contractions, puborectalis sphinc-

Ontic Openness And Emergence

Both uncertainty equations are related to the complex relation between the observer and the experiment. The first one deals with position and momentum, the second one deals with energy and relaxation time. Both equations assume time reversibility and are valid in a given instant the momentum is related to the derivative of space with respect to time and the relaxation time is related to the lifetime of the elementary particle in the excited state. Both equations are valid in the quantum physics paradigm and deal with conservative quantities (mass, energy), but not with living systems or evolutionary quantities.

Neurophysiological Correlate Of Parkinsonism

Rigidity in patients with parkinsonism manifests as a difficulty of complete muscle relaxation, with often permanent tonic background EMG activity (11). Several neurophysiological tests have been used to assess rigidity, although direct clinico-neurophysiological correlations have proven more difficult than with bradykinesia. Rigidity has been considered to be the cause of some neurophysi- Like with bradykinesia, most tests directed to the evaluation of rigidity have been proven in patients with IPD, and more scarcely in patients with APDs. However, it is not unreasonable to admit that when and where rigidity is present, patients with APDs would present similar abnormalities as those described for IPD. Direct surface electrophysiological recording of a muscle in rigid patients in resting conditions may be enough to notice that there is increased muscle activity with respect to normal subjects. Electrophysiological evidence for that can be found when testing the relaxation time after a...

The mechanism of GK activation by aUostericsite binders

In hepatocytes, where the inhibitory regulatory protein GKRP is involved in the regulation of GK activity, the binding of a GKA prevents relaxation to the super-open form to which GKRP binds (vide supra). Since the binding of GKRP is necessary for the sequestration of GK into the nucleus, GKAs have the effect of restricting the localization of GK to the cytoplasm 4 .

SERCA2a Activity and Arrhythmogenesis

Even if not arrhythmogenic per se, increased SR Ca2+ might be predicted to potentiate the arrhythmic effects of catecholamines. This is of particular concern because the final target of the gene transfer is failing human heart, which is prone to arrhythmias because of both changes in the myocyte (e.g., prolonged duration of action potential) and in the myocardium (e.g., areas of necrosis) and is under constant sympathetic tone. Several distinct classes of catecholamine-dependent arrhythmias can be detected in the contracting isolated myocyte, and these are thought to have parallels in the myocardium in vivo. First, P-adrenoceptor agonists produce or accentuate early aftercontractions afterdepolarizations. These are observed at isoproterenol concentrations below maximum and do not necessarily disrupt stimulated contractions. The extra contraction is close to the main beat and can initially be observed as a second, long phase of relaxation the associated afterdepolar-ization occurs...

Support Groups for Cancer Patients

Reviews of the mental health effects of support groups for cancer patients have also yielded mixed results. In 1995, Fawzy, Fawzy, Arndt, and Pasnau identified 15 group interventions for cancer patients, the majority of whom were women who participated in heterogeneous groups composed of patients with mixed diagnoses and with both initial and recurrent metas-ticized disease. With one exception, the groups met from 4 to 11 times over a period of from 2 to 8 weeks, and typically included education, stress management (coping relaxation) training, and mutual aid. In 1996, Helgeson and Cohen identified seven evaluations of support groups that involved various degrees of peer discussion and education from expert leaders, as well as four studies that compared the effects of group discussion only to the effects of education only or combined education and group discussion. Both reviews underscore the fact that many of the studies did not meet the requirements of a formal randomized controlled...

The Prevention Of Depression

The program consisted of a cognitive component, a social problem-solving component, and a coping skills component. The cognitive component taught flexible thinking and how to evaluate the accuracy of beliefs. It also included explanatory style training to foster more accurate, less pessimistic attributions. For situations in which an accurate interpretation of events was negative, children were taught to focus on solutions or on ways to cope with emotions. Coping techniques included decatastrophizing about potential outcomes of the problem, distraction, steps to distance oneself from stressful situations, relaxation training, and ways to seek social support. In this way, investigators tried to address both cognitive distortions and cognitive deficiencies. The cognitive interventions addressed dysfunctional thinking, and the problem-solving and coping skills components prevented impulsive actions.

Post Operative Pain Management

- Relaxation training and withdrawal from interpersonal contact. Fear and anxiety are the major emotional concomitants of acute pain and are especially pronounced when associated with fear of death. Severe acute pain that remains unrelieved for days may lead to depression and helplessness as a result of patients experiencing a loss of control over their environment. It is now generally agreed that unrelieved severe acute pain exacerbates premorbid tendencies for anxiety, hostility, depression, or preoccupation with health. In a few cases, the inability to cope with pain may create an acute psychotic reaction. However, acute pain is one of the important factors contributing to the development of delirium in intensive care units. For all these reasons psychological approaches are an integral part of the medical care of the patient with pain (Box 5b). All patients can benefit from psychological assessment and support and some are good candidates for specific psychological therapy....

Management And Prognosis

Patients should be managed in an intensive care setting of a tertiary-care center whenever possible. Facilities and equipment that should be available include a quiet darkened room, suction equipment and oxygen, cardiac and respiratory monitors, a ventilator, and tracheostomy equipment. The patients must be managed by experienced caregivers skilled in ventilatory support and maintenance of cardiovascular stability. Minimizing external stimuli and maintaining intravenous hydration may be sufficient in the initial days of the illness. Sedation and muscle relaxation should be instituted, usually with diazepam (0.1-0.2 mg kg intravenously every four to six hours). Additional sedation with phenothiazines may be needed. If spasms are not adequately controlled, therapeutic paralysis may be necessary (4).

Personality and health

Although, as was seen in previous chapters, personality is reasonably settled, it is not set in stone. To some extent personality is modifiable and so it is with Type A behaviours. Generally, we can alter our perceptions and emotional reactions by working on our cognitions. So, someone who recognises Type A tendencies in himself or herself might set various life-style changes in place, ranging from taking more exercise and learning relaxation techniques to broadly changing typical reactions to stressful situations. An example might be learning to be relaxed when standing in a supermarket checkout queue behind someone who cannot find the correct money or who seems to have forgotten the pin number on their card. In this situation, the Type A person would be tense with frustration and impatience and even potentially hostile. The control of any such way of reacting can only be good for the immune system.

Glossary of Pharmacological Terms

Fade, the time-dependent decrease in response upon prolonged exposure of a biological system to an agonist. Originally, this was defined as the characteristic peak contraction followed by relaxation produced by guinea pig vas deferentia, but the term has also been generalized to

Gracilis Muscle Transplant

Pubis Malformation

By the palmaris longus muscle interrupting the evacuation of flatus. Note the spontaneous relaxation of the internal anal sphincter. AR Anorectum, ARP anorectal resting pressure profile (also ARRPP), R rectum, prop. preoperatively, postpone. postoperatively by the palmaris longus muscle interrupting the evacuation of flatus. Note the spontaneous relaxation of the internal anal sphincter. AR Anorectum, ARP anorectal resting pressure profile (also ARRPP), R rectum, prop. preoperatively, postpone. postoperatively

Modulation of Kinase Activity

DNA topoisomerase I is a nuclear target of a number of anticancer agents derived from the plant alkaloid camptothecin (Pommier et al. 1998) and for indolocarbazole derivatives (Bailly et al. 1999a 1999b) such as the antibiotic rebeccamycin and the antitumor agent NB-506, which is under-going phase II clinical trials (Meng et al. 2003). While NB-506 is structurally analogous to the specific protein kinase C (PKC) inhibitor staurosporine (Anizon et al. 1998), it has no significant effect on PKC (Anizon et al. 1998 Pommier et al. 1998 Bailly et al. 1999b Labourier et al. 1999) but inhibits both relaxation (Soret and Tazi 2003) and kinase activities of topoisomerase I (Pilch et al. 2001). Indeed, NB-506 has been shown in vitro to block spliceosome assembly and splicing through inhibition of SR protein phosphorylation. NB-506 also leads to specific inhibition of SR protein phosphorylation in cultured cells, suggesting that the drug could modulate gene expression by changing the splicing...

Of the Normal Rectum and Sphincters

Nervi Erigentes

Fig. 7.3 Defecography in a healthy child in sagittal position. A Normal anorectal angle formed by the puborectalis sling and the deep part of the external anal sphincter B internal sphincter relaxation starting with opening of the proximal one-third of the anal canal. The middle and superficial parts of the external anal sphincter are still closed C complete opening of the internal anal sphincter with simultaneous reflex inhibition of puborectalis levator ani and external sphincter muscles leading to defecation D almost complete emptying of the rectum after defecation and restoring of the anorectal angle (reproduced from Holschneider and Puri 23 ) Fig. 7.3 Defecography in a healthy child in sagittal position. A Normal anorectal angle formed by the puborectalis sling and the deep part of the external anal sphincter B internal sphincter relaxation starting with opening of the proximal one-third of the anal canal. The middle and superficial parts of the external anal sphincter are still...

Threshold Latent Period and Twitch

Myogram Image

A sufficiently weak electrical stimulus to a muscle causes no contraction. By gradually increasing the voltage and stimulating the muscle again, we can determine the threshold, or minimum voltage necessary to generate an action potential in the muscle fiber and produce a contraction. The action potential triggers the release of a pulse of Ca2+ into the cytoplasm and activates the sliding filament mechanism. At threshold or higher, a stimulus thus causes a quick cycle of contraction and relaxation called a twitch (fig. 11.13). Relaxation phase Relaxation phase What role does ATP play during the relaxation phase The contraction phase is short-lived, because the sacroplasmic reticulum quickly pumps Ca2+ back into itself before the muscle develops maximal force. As the Ca2+ level in the cytoplasm falls, myosin releases the thin filaments and muscle tension declines. This is seen in the myogram as the relaxation phase. The entire twitch lasts from about 7 to 100 msec.

Laurdan Probe the Tips

Guvs Bagatolli

LAURDAN belongs to the family of polarity-sensitive fluorescent probes, first designed and synthesized by Gregorio Weber for the study of the phenomenon of dipolar relaxation of fluorophores in solvents, bound to proteins and associated with lipids (Weber and Farris 1979 Mcgregor and Weber 1986 Parasassi et al. 1986 La-sagna et al. 1996). When inserted in lipid membranes, LAURDAN displays unique characteristics compared with other fluorescent probes, namely, (1) LAURDAN shows a phase-dependent emission spectral shift, i.e., bluish in the ordered lipid phase and greenish in the disordered lipid phase (this effect is attributed to the reorientation of water molecules present at the lipid interface near LAURDAN's fluorescent moiety), (2) LAURDAN distributes equally into the ordered and disordered lipid phases, (3) the electronic transition moment of LAURDAN is aligned parallel to the hydrophobic lipid chains, allowing use of the photoselection effect to qualitatively discriminate between...

Results of Anorectal Manometry


Fig. 26.3 Electromyographic recording of the external sphincter (EAS) during rectal distension. In response to each rectal distension, relaxation of the anal canal pressure and contraction of the external sphincter were observed (arrows) Fig. 26.3 Electromyographic recording of the external sphincter (EAS) during rectal distension. In response to each rectal distension, relaxation of the anal canal pressure and contraction of the external sphincter were observed (arrows)

The Effect ofa Mechanical Force on theThermodynamics and Kinetics ofthe Protein Unfolding Reaction

Manometry Thermodynamics

Classical thermodynamics (equilibrium thermodynamics or thermodynamics for short) deals with quasistatic processes, which are idealized, infinitely slow processes that can be approximated in practice by performing them very slowly. ttus, thermodynamics is not concerned with the rate at which a process takes place (i.e., kinetics). Time-dependent thermodynamic processes are studied by nonequilibrium thermodynamics. In quasistatic processes the system often goes through a sequence of states that are infinitesimally close to equilibrium, in which case the process is typically reversible, ttus, technically, quasistatic and reversible are different terms, not synonyms as they are sometimes treated in the literature. Whereas reversible processes are almost always quasistatic (only two exceptions are known at present superfluidity and superconductivity), the converse is not always true. Similarly, nonequilibrium processes are usually irreversible. In single-molecule mechanics, the...

Deposition of spermatozoa

Stallions Penis

Sight or smell of an oestrous mare or an area associated with sexual contact. The initial stage of erection is the relaxation of the penile muscles normally responsible for holding the penis retracted within its sheath. This is accomplished via parasympathetic stimulation of the splanchnic nerves to the penis, overriding the normal sympathetic stimulation and partly constricting the arterioles of the penis. This allows engorgement of the penile arterioles, increasing the volume of blood within the erectile tissue. The initial effect is evident in the corpus carvenosus penis, followed by the corpus carvenosus urethra. At the same time the sympathetic stimulation of the retractor muscle is overridden, allowing relaxation of this muscle and extrusion of the penis. The subsequent penile relaxation and engorgement of the erectile tissue result in the lengthening and gradual stiffening of the penis. Erection leads initially to a state of turgid pressure within the air spaces of the penis....

Wave On Left Ventricular Wave Form

Mitral Regurgitation Pressure Curve

A secondary goal of the project was to publish representative values of important input parameters including effective mitral valve area, transvalvular inertial length, blood viscosity, blood density, atrial compliance, ventricular compliance, left ventricular active-relaxation characteristics, and initial pressure and flow values in the porcine model, which might be of use to other scientists. Similarly, the third equation describing the system is the equation for change in ventricular pressure with time. The ventricular pressure is similarly related to the ventricular volume and the ventricular compliance, Cv. The change in pressure of the ventricle is also related to active relaxation. The active relaxation term, resulting from ventricular geometry, is described in more detail in Sec. 10.3.2. ---active relaxation term (10.13) 10.3.2 Active ventricular relaxation Another parameter affecting the final ventricular pressure during filling is active relaxation. To imagine active...

Internal Anal Sphincter

The questions as to whether these smooth muscle fibers should be preserved during the operation and whether they play an important role for postoperative continence remains open. In 1985, Iwai reported that internal sphincter relaxation correlated well to the Kelly score of continence 36 . However, in 1992 Pe a and Hedlund reported that the correlation between electromanometric findings and clinical results is incomplete 37 . In contrast, Rintala observed good continence in children with positive internal anal sphincter relaxation and a high anorectal pressure profile 8,9,38 . These findings are in contrast to follow-up studies of Chen-Lung in 1998 39 , who reported that internal sphincter relaxation was not correlated with the surgical procedure. However, if the internal sphincter relaxation was positive and a high anorectal pressure profile was established, the development of constipation was six times more likely to occur. By studying 24 infants less than 3 years who had ARM,...

The Superfamily Trichostrongyloidea

In addition to factors extrinsic to the host, factors within the host have been suggested as causes of arrest, the most important being immunity (Dunsmore, 1961 Ross, 1963 Donald et al., 1964 Dineen et al., 1965a,b). Larvae entering ahost with an established population of adult worms are most likely to arrest (Fox, 1976 Gibson and Everett, 1976 Michel, 1978 Behnke and Parish, 1979 Snider et al, 1981 Adams, 1983 Smith et al., 1984). The number of arresting worms in a host may be related to the number of adult worms present (Dineen, 1978) in that, as adults become senescent and die, there is a relaxation of immunity and some arrested larvae then leave the gut wall to replace the lost adults. Thus, the host immune system might regulate the number of adult worms.

Phospholamban Downregulation and Heart Failure

Fig. 3. (A) Effects of p-adrenoceptor stimulation on cultured rabbit myocytes (left) sample trace for isoproterenol (iso, 10 nmol L) on contraction of a 48-h cultured adult rabbit myocyte as (1) shortening or (2) normalized to show speed of contraction and relaxation (right) averaged R50 (early) and time-to-90 (R90) (late) relaxation (n 17 preparations). (B) Effects of SERCA2a overexpression on cultured rabbit myocytes (left) sample contractions of uninfected myocytes (CON) and an Adv.SERCA2a-GFP-overexpressing myocyte (SERCA-GFP) at 48 h (right) averaged R50 and R90. ( ) untreated myocytes (n 105 cells seven preparations) ( ) Ad.SERCA2a.GFP-treated myocytes (n 99 cells seven preparations). (Adapted from ref. 21.) Fig. 3. (A) Effects of p-adrenoceptor stimulation on cultured rabbit myocytes (left) sample trace for isoproterenol (iso, 10 nmol L) on contraction of a 48-h cultured adult rabbit myocyte as (1) shortening or (2) normalized to show speed of contraction and relaxation (right)...

Udenafil Erectile Dysfunction [111115

Udenafil is the fourth in a class of drugs targeting the inhibition of the enzyme phosphodiesterase 5 (PDE5) for the treatment of erectile dysfunction. Inhibition of PDE5 results in the increase in endogenous cyclic guanosine monophosphate (cGMP) concentrations in the penile corpus cavernosum. cGMP induces smooth muscle cell relaxation and subsequent increased blood flow leading to a sustainable erection. Udenafil is a potent antagonist of human PDE5 with an IC50 of 8.25 nM and a comparable selectivity profile as sildenafil for the other PDEs. Unlike ta-dalafil, it does not inhibit PDE11, which has been implicated in myalgia and testicular toxicity. The key steps in the synthesis of udenafil involve the coupling of

TROSY for Studies of Intermolecular Interactions and Drug Design

Study of intermolecular interactions, including protein-protein, protein-nucleic acid, and protein-ligand interactions, can provide valuable information related to the physiological roles of a newly discovered protein. Moreover, these studies are of primary interest for drug discovery aiming at the design of high-affinity ligands for relevant biological molecules (Hajduk et al. 1999 Pellecchia et al. 2002 Meyer and Peters 2003). Several standard NMR experiments used to study intermolecular interaction can take advantage of TROSY, which substantially extends the molecular mass range of the targets that are amenable to NMR studies, tte TROSY-type triple-resonance experiments open up the possibility to perform resonance assignments on larger protein targets, and 2D 15N,1H -TROSY experiments can then be used for screening. Further, TROSY can be introduced into pulse sequences used for intermolecular magnetization transfer experiments, spin-relaxation studies, or hydrogen-deuterium...

Continence and the Mechanism of Defecation in Normal Individuals

Caused by filling of the stomach or ileum, respectively) as well as voluntary contraction of the abdominal musculature, may initiate defecation by filling the rectum with colonic contents. The increasing intrarec-tal pressure stimulates the distension receptors in the puborectalis muscle and the parapuborectal tissues, and desire to pass stool is consciously felt. At the same time, a reflex relaxation of the internal anal sphincter occurs. This allows even the smallest amounts of stool to reach the anal canal. The hypersensitive mucosa of the anal canal is able to distinguish the difference between flatus and liquid or solid stool. The reflex contraction of the external anal sphincter and the puborectalis will prevent expulsion of stool from the anal canal and thus inhibit fecal soiling. This effect is increased by the compression of the lower anal canal by the engorged hemorrhoidal vessels of the rectum and the corrugator muscle of the anus. This allows the rectum time to adapt...

Antitopoisomerase I Antibodies

The so-called anti-topoisomerase I (anti-scl-70) antibodies target DNA topoisome-rase I, which is found in the nucleoplasm and nucleolus and catalyzes the cleavage and rebinding of single-stranded DNA during the relaxation phase of supercoiled DNA. Although the name Scl-70 antibody is still used, the scientifically more correct name is anti-topoisomerase I antibody (ATA). IIF using HEp-2 cells usually reveals fine granular to homogeneous staining of the nucleoplasm with or without (depending on the substance used for fixation) staining of the nucleoli and chromatin of mitotic cells. Immunodiffusion, enzyme immunoassay, and Western blot are used in routine diagnostic testing. ATAs are marker antibodies with a diagnostic specificity of > 99 . The sensitivity for diagnosis of SSc is 1543 (reviewed in 42 ). ATAs are associated with diffuse skin involvement and internal manifestations (lung, heart, kidney). ATA-positive scleroderma patients generally have a more severe clinical course...

Types of Esophageal Motor Dysfunction

The terminology used in describing esophageal motility disorders is not fully standardized. At Washington University we classify dysmotility using a simple scheme representing the two principal types of motor dysfunction (Figure 18-1). The first leads to impaired contraction in the esophageal body and or lower esophageal sphincter (LES). Resultant hypomotility predisposes the patient to gastroesophageal reflux disease (GERD), either by increasing reflux events or delaying clearance of refluxate. The second type of motor dysfunction reflects inadequate or failed inhibition of contraction in these same regions or an imbalance between contraction and inhibition. Neural inhibitory effects are required for the correct timing of contraction in the esophageal body and for appropriate relaxation of the LES. The resultant Complete peristaltic failure (without evidence of poor LES relaxation) hypermotility manifests as rapid propagation or nonperi-staltic contraction in the esophageal body,...

Biophysical techniques

Kinetic properties and functions of water have been studied, using calorimetry (Ruegg et al., 1975 Bakradze and Balla, 1983 Vertucci, 1990 Sun, 1999), infrared (IR) and Raman spectroscopy (Careri et al. , 1979 Cameron et al., 1988), NMR spectroscopy (Fung and McGaughy, 1974 Mathur-de Vre, 1979 Seewaldt et al., 1981 Rorschach and Hazlewood, 1986 Ratkovic, 1987), quasi-elastic neutron-scattering spectroscopy (Lehmann, 1984 Trantham et al., 1984) and dielectric relaxation techniques (Harvey and Hoekstra, 1972 Kamiyoshi and Kudo, 1978 Clegg et al., 1982 Pissis et al., 1987, 1996 Bruni and Leopold, 1992). These techniques differ greatly in how and what they measure with respect to the dynamic properties and structures of water and other biomolecules. A great deal of confusion over the physical state of water in biological systems has resulted from the separation of information obtained with diverse techniques applied to similar systems. The nature of different Different dielectric...

Prokinetic Therapy Dopamine Antagonists

Ges Disease

Metoclopramide (Reglan) is the most commonly used prokinetic drug and the agent that we employ as first line therapy. It is a central and peripheral dopamine receptor (D2) antagonist and a powerful antiemetic at the chemorecep-tor trigger zone level while also being effective in improving gastric emptying by increasing antral contractions and decreasing receptive relaxation of the proximal stomach. However, as many as 40 of patients cannot tolerate metoclopramide because of central nervous system (CNS) side effects. If tolerated orally, the usual dose is 10 to 20 mg 30 minutes before meals and bedtime. One strategy for patients who do tolerate this agent orally is to also use it subcutaneously (sc) during periods of worse nausea or vomiting. Metoclopramide sc can be given by the patient (2 mL 10 mg 2 or 3 times daily) with oral medication during and after hospitalizations while stepping down to

Cortical Spreading Depression

Evidence favouring CSD as the basis of the migraine aura has gradually accumulated since Leao and Morison first suggested this 87 , and is reviewed in Migraine page 29. We can learn something of the mechanisms of CSD induction from descriptions from migraineurs (with aura) of the precipitating factors they implicate. Sometimes onset follows relaxation after a period of intense concentration or physical exercise. The onset is attributed to hunger by some migraineurs with aura, and we may speculate in the light of discussion below (page 25 Relationship of Cortical Glucose Availability with PID Frequency) that hypoglycaemia is responsible in these individuals. The various other precipitating factors do not at present appear relevant in this context.

A specific health problem smoking

1 to gain positive feelings such as relaxation The major techniques that can be used to help the cessation of smoking are hypnosis, relaxation, self-talk, nicotine patches and rapid smoking. The latter is an interesting technique based on making smoking become aversive by having the person smoke a large number of cigarettes in a very short time, in order to make them feel sick. This is straightforward classical conditioning, putting together the behaviour of smoking with an unconditioned, aversive response -being sick. Self-talk is like the converse of rapid smoking, helping the person stick to the decision to stop smoking by reinforcing for themselves the positive benefits of so doing.

Interaction Between Venous Sinus Hypertension and CSF Pressure

On a 0.15 Tesla magnet reported no signal change in 7 children with PTS. The same finding was reported by Silbergleit et al. 154 in 6 patients with PTS using a 0.35 Tesla magnet. Benefiting from improved technology, Moser et al. 120 used a heavily-weighted T2 MR technique (1.5 Tesla) to investigate the brain water content in 10 patients with PTS. They found an increase in the signal white matter free water content as reflected in prolongation of the T2 relaxation time. The authors concluded that this represents a diffuse low level of oedema. In addition, a triple-echo sodium MR technique was used to study 5 patients. Three demonstrated no change in their sodium signal. However, two patients who were clinically the most severely affected demonstrated increases in their sodium signal. As most sodium is extracellular, the authors concluded that the increase in brain water was likely to represent a vasogenic oedema. Sorenson et al. 161, 162 using diffusion sensitive sequences at 1.5 Tesla...

Medicine In The Roman World

The Methodists believed that the body was composed of atoms and pores. Disease was the result of abnormal states of the pores due to excess tension or relaxation. Thus, knowledge of the three common conditions of the human body the constricted, the lax, and the mixed provided all the guidance the physician needed to treat his patients. Appropriate remedies relaxed or tightened the pores as needed. The Methodists claimed that, because their system was so complete, no further research into the causes of disease and therapeutics was necessary. But Juvenal, a Roman satirist, said that Methodist practitioners had killed more patients than they could count.

Antisense Strategies in Animal Myocytes SERCA2a Overexpression Compared to Phospholamban Downregulation in Rat and

Adenoviral gene transfer into isolated myocytes has allowed the investigation of changes in phospholamban in species other than mouse, as well as direct comparison of phospholamban depletion with SERCA2a overexpression in the same preparation. Rat is similar to mouse in the predominance of SERCA2a (92 ) compared to other mechanisms of calcium removal, while in rabbit heart (like human) SERCA2a controls approx 70 , and there is a much larger role for the Na+ Ca2+ exchanger to remove excess calcium from the cell (15). Initial results with an antisense strategy for phospholamban in adult myocytes were disappointing (14), but later work showed that even partial (approx 50 ) reduction of phospholamban could have effects almost equivalent to SERCA2a overexpression (approx fivefold) on contraction amplitude (Fig. 1) and only slightly less on relaxation (16,17). This correlates well with results from transgenic animals, in which phospholamban knockout can be even more effective than SERCA2a....

Atherosclerosis Arterial Stiffness and Antihypertensive Therapy

As shown earlier in this book, the links between atherosclerosis, arterial stiffness, age and high BP are often difficult to establish, particularly according to age. Many atherosclerotic alterations (AA) are subclinical and difficult to define in routine clinical investigations. On the other hand, many markers have been proposed, such as defects in vascular relaxation, alterations in endotheli-um-dependent flow dilatation and or presence of atherosclerotic plaques (see chapter by Baldewsing et al., pp 35-61, and chapter by Hayoz and Mazzolai, pp 62-75). Within the framework of antihypertensive drug therapy, it seems likely that the links between atherosclerosis and arterial stiffness should primarily be explored through a simple clinical description of CV events clearly related to AA. The principal AA are those responsible for peripheral arterial disease (see chapter by Safar, pp 199-211), coronary ischemic disease (see chapter by Kingwell and Ahimastos, pp 125-138) and carotid...

Rationales For The Implementation Of Support Groups

Another rationale for introducing support groups has more to do with the transmission of information, education, and skills to the participants than with the emotional support provided by the group. There are several reasons why a support group is a desirable context for learning new information and skills. First, there may be a significant amount of technical information that all participants want and need to know to improve their comprehension and handling of their situations. The sheer volume of information may require it to be divided into consumable chunks that can be disseminated more efficiently en masse than individually. For example, support groups for cancer patients typically cover the following topics the causes of cancer explanation of the diagnoses, tests, and prognoses of the various subtypes of the disease explanation of the various components of the treatment plan, such as surgery and chemotherapy, and their side effects discussion of the personal and social impacts...

ADVAntAgES of ArthroSCoPiC AnD EnDoSCoPiC DiSC Surg Ery

In an animal model, Hampton et al. (9) reported on the healing potential of a surgically induced defect in the annular fibers of 10 dogs. The dogs were sacrificed within 3-12 wk postoperatively. Dissection of the surgical site demonstrated that the defect was filled with a solid plug of fibrous structures. Postoperative imaging studies by my colleagues and I on patients who had undergone percutaneous posterolateral discectomy confirmed these findings. Markolf and Morris (10) reported a decrease in compressive stiffness and an increase in creep and the relaxation rate of the intervertebral disc in cadaveric specimens that were exposed to annular fenestration and then followed by exposure of the spinal unit to compressive forces. In younger specimens, extrusion of nuclear tissue had a tendency to seal off the annular defect and to restore normal function of the spinal unit.

Magnetic Resonance Imaging

Magnetic resonance (MR) imaging (MRI) is a noninvasive technique that uses the interaction between the magnetic properties of nuclei and radio waves to portray the structure of biological tissues (Damadian, 1971 Lauterbur, 1973). When placed in an external magnetic field and exposed to radio waves of proper frequency, the hydrogen nuclei within body tissues resonate i.e., can absorb energy from a tuned radio wave and then, after a delay (relaxation time) emit the energy back at the same frequency . The energy radiated back by the resonating nuclei, typically hydrogen nuclei (protons) for imaging, is the signal that is used for generating the MR image. The intrinsic differences in hydrogen density between the various components of body tissues (e.g., fat, blood, glandular tissue, muscle, etc.), as well as differences in magnetic relaxation times from voxel to voxel, determine the contrast of the MR image. Since these differences in MR characteristics are greater than differences in...

Individual Differences

The Abbe Faria, another follower of Mesmer, recognized individual differences in response to animal magnetism as early as 1819, and there are large individual differences in response to hypnosis as well. Hypnosis has little to do with the hypnotist's technique and very much to do with the subject's capacity, or talent, for experiencing hypnosis. Hypnotizability is measured by standardized psychological tests such as the Stanford Hypnotic Susceptibility Scale or the Harvard Group Scale of Hypnotic Susceptibility. These instruments are work samples, analogous to other performance tests. They begin with a hypnotic induction in which the subjects are asked to focus their eyes on a fixation point, relax, and concentrate on the voice of the hypnotist (although suggestions for relaxation are generally part of the hypnotic induction procedure, people can respond positively to hypnotic suggestions while engaged in vigorous physical activity). The hypnotist then gives suggestions for further...

How and Why Biofeedback Is Used in Clinical Settings

A major use of biofeedback is to teach relaxation skills. A second use of biofeedback is to alter pathophysiological processes such as blood flow or SNS arousal for migraine headache patients, to decrease the flow of gastric juices for ulcer patients, to decrease muscle tension and increase proper posture for the chronic back-pain patient. Biofeedback should be considered as a therapeutic tool that can help introduce the client to therapy in a concrete and nonthreaten-ing manner. It can be especially useful for the patient who focuses on physical problems or insists his problems are not physiological. Biofeedback can also be used to increase feelings of self-efficacy and self-control. The client learns quickly the connection between emotions, thoughts, and physiological responses.