24-h Recordings Research Articles

Screening for Life-Threatening Arrhythmia in Asymptomatic Patients After Paediatric Cardiac Surgery: A Single-Centre Retrospective Analysis of 790 Pre-hospital-discharge 24-h Holter Electocardiogram Recordings.

Severe arrhythmias may occur early after open heart surgery. Because younger patients do not usually show any specific symptoms, presently Holter monitoring is routinely performed for 24h predischarge at our centre to prevent adverse outcomes. It is unknown whether this test is truly justified in this patient population. Retrospective single-centre analysis of all consecutive patients younger than 19years old after open heart surgery 2013-2019 who underwent routine Holter monitoring before hospital discharge. Patients with permanent pacemakers and patients who died during this hospital stay were excluded. The cohort was divided into two groups depending on whether severe arrhythmia occurred or not. The study includes 790 Holter recordings from 666 patients with a median age of 0.5years (IQR 0.23-3.08), performed at a median time of 8days (IQR 6-15) postoperatively. Postoperative arrhythmia was detected in 554 of 790 24-h Holter recordings (70%); in 47 of 790 (6%), this arrhythmia was classified as severe. The most common severe arrhythmias were premature ventricular contractions (n = 26/47) and long pauses (n = 14/47). A longer aortic cross-clamp time (mean 94.5 (SD ± 53.0) versus 68.1 (SD ± 51.9) min, p = 0.001) was associated with the occurrence of severe postoperative arrhythmia. Severe arrhythmias are rare in predischarge assessments after open heart surgery in children. In current postoperative monitoring at our centre, the diagnostic yield of ECG Holter monitoring for 24h is too low to justify routine screening in all paediatric patients after open heart surgery.

Association between ablation-induced baroreceptor reflex modification and procedure efficacy in patients with atrial fibrillation.

The autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF). Catheter ablation (CA) is a well-established treatment method for AF and significantly affects the ANS, including baroreceptor (BR) function. However, little is known about the changes in BR function caused by radiofrequency (RF) or cryoballoon energy (CB) and its impact on future AF recurrences. To assess 1-year efficacy of CA of AF in relation to BR function modification and type of ablation energy used. The study group consisted of 78 patients (25 females, mean age 58 ± 9 years) with paroxysmal AF and first CA (39 patients in the RF group and 39 in the CB group). The BR function was assessed non-invasively, using tilt testing before and after CA, and three BR parameters were calculated: event count (BREC) depicting overall BR activity, slope mean depicting BR sensitivity (BRS), and BR effectiveness index (BEI). The efficacy of CA was assessed during 1-year follow-up, which consisted of ambulatory visits and 24-h Holter ECG recordings at 3, 6, and 12 months after CA. The quality of life was assessed by using a dedicated scale [University of Toronto Atrial Fibrillation Severity Scale (AFSS)]. The two groups did not show differences in terms of clinical or demographic data. One-year follow-up was completed for 35 (89.7%) patients from the CB group and for 34 (87.2%) from the RF group. The rates of efficacy of CB and RF were similar [31/35 (88.6%) vs. 26/34 (76.5%), respectively]. After CA, the BR function decreased in both groups, with a significantly greater decrease in the CB group. The changes in BR parameters were similar in both responders and non-responders after CA in the whole group [BREC 10.0 (2.0-24.0) vs. 12.0 (4.0-21.5), p = 0.939; BRS 5.4 (3.7-6.5) vs. 4.8 (3.6-7.2), p = 0.809; BEI 24.8 (15.9-27.4) vs. 17.5 (8.9-27.5), p = 0.508, respectively]. According to the AFSS, the AF symptoms were significantly reduced in both groups to a similar extent. CA for AF significantly decreased the BR function, especially in patients undergoing CB. There was no correlation between CA-induced changes in BR parameters and ablation outcome.

Effects of long-term transcutaneous auricular vagus nerve stimulation on circadian vagal activity in people with Prader-Willi Syndrome: A case-series

BackgroundPrader-Willi Syndrome (PWS) is a genetic neurodevelopmental disorder marked by disruptions in circadian rhythms and autonomic nervous system (ANS) activity, hyperphagia, and episodes of emotional outbursts. Previous trials suggest that both invasive and non-invasive vagus nerve stimulation (VNS) can reduce emotional outbursts in PWS, potentially through its effects on vagal activity. AimThis case series investigated the effects of transcutaneous auricular VNS (taVNS) on cardiac markers of circadian vagal activity, specifically heart rate variability (HRV) and heart rate (HR), and their potential links to improvements in emotional outbursts. MethodsFive individuals with PWS (mean age: 26.9 years; 3 males, 2 females) received four hours of daily taVNS for 12 months, followed by one month of two-hour daily sessions. Outcome measures included daily recording of emotional outbursts and every three months 24-h HRV and HR recordings. Mixed cosinor models were applied to analyze changes in circadian rhythms of HRV and HR. A linear mixed model was used to assess the predictive value of cardiac vagal activity on emotional outbursts. ResultsCircadian amplitudes of HRV and HR were significantly higher at the end of the treatment compared to baseline (all p’s < .01). There was a significant increase in the rhythm-adjusted mean of HRV (p < .01), while the rhythm-adjusted HR mean significantly decreased, both indicating increased cardiac vagal activity. Higher rhythm-adjusted mean HRV predicted a lower number of emotional outbursts. ConclusionThe results suggest that taVNS may be effective by targeting ANS activity in individuals with PWS, contributing to improvements in behavioral regulation.

Electrophysiological detection of exam stress inhealth schools' students.

Anxiety is a common issue among university students, many of them experience anxiety, depression, and stress during their school life. This study aimed to compare the acute physiological stress responses of students divided into two groups according to their perceived anxiety levels (positive test anxiety, PTA+, and negative test anxiety, PTA-). Heart rate variability (HRV) and electrodermal activity (EDA) were used to assess stress.Thirty-one healthy volunteers participated in the study. Participants completed anxiety assessments, including the Westside Test Anxiety Scale (WTAS), the State-Trait Anxiety Inventory (STAI), and the Test State Anxiety Inventory (TSAI). Based on their scores, participants were categorized into PTA+ and PTA- groups. All participants underwent 24-h continuous recordings of pulse and electrodermal activity (EDA) on two separate occasions: one day prior to a written exam and during a designated exam-free day serving as a baseline control.We compared the HRV and EDA data obtained on a regular day and on an exam day between the two groups. Results showed that the PTA+ group had significantly higher heart rate, stress index, low frequency, and short-term detrended fluctuation analysis (DFAα1) on the exam day. The tonic EDA component was also higher in the PTA+ group. Stress-related HRV and EDA parameters were negatively correlated with exam scores.In conclusion, the study found that physiological stress indicators obtained from HRV and EDA are associated with perceived exam anxiety in students.

P004 BODY MASS INDEX IS RELATED TO SUBTYPES OF ARTERIAL HYPERTENSION IN CHILDREN

Background and Objective: Arterial hypertension (AH) subtypes in the pediatric population may represent distinct pathophysiological subsets, potentially allowing for more targeted interventions and improved blood pressure (BP) management. Emerging evidence suggests that various hemodynamic mechanisms may underlie hypertension development across different age groups. Moreover, overweight and obesity, are closely linked to hypertension and other risk factors. Therefore, this study aims to investigate the relationship between body mass index (BMI) and (AH) subtypes in the pediatric population. Methods: A cross-sectional study was conducted, involving 195 records from 189 children referred to an outpatient cardiology center due to suspected BP abnormalities. Each participant underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM) using a device validated. Demographic, clinical, and anthropometric data were collected. The American Heart Association (2022) criteria were utilized to ensure accurate 24-h ABPM recordings and to classify AH subtypes based on average BP, including: i) isolated diastolic hypertension (IDH); ii) non-divergent systolic-diastolic hypertension (ND-SDH) (pulse pressure [PP]&lt;50 mmHg); iii) divergent systolic-diastolic hypertension (D-SDH) (PP&gt;50 mmHg); and iv) isolated systolic hypertension (ISH). BMI Z-Score was calculated using Colombian reference tables, and nutritional status was determined based on World Health Organization recommendations. Results: Among the participants, 46.0% were male, with a distribution of nutritional status showing 3% underweight, 37% normal weight, 30% overweight, and 30% obese. The average age was 12.3±3.0 years (range: 5-17 years). 24-h ABPM records revealed that 34.0% had normotension, 33.0% had IDH, 16.0% had ND-SDH, 13.0% had D-SDH, and 3% had ISH. The ANOVA test indicated significant differences in BMI Z-Score values among AH subtypes (P value &lt;0.001) (Figure). Conclusions: BMI is related with AH subtypes in children. Specifically, BMI tends to be higher in D-SDH and ISH, which could be characterized by a hyperdynamic state marked by increased activity of the sympathetic nervous system. This finding may help to elucidate the pathophysiology of hypertension in obese children.

Electroclinical characteristics and therapies of tonic spasms

BackgroudEpileptic spasms followed by a tonic component have been frequently observed in patients with late-onset spasms (LOS). However, there is a lack of comprehensive analysis and summary of clinical data related to tonic spasms (TS), including seizures, video-electroencephalogram (V-EEG), synchronous electromyography (EMG) and follow-up data.MethodsTo investigate the characteristics of TS, we prospectively collected the clinical data, including 24-h V-EEG and synchronous EMG data of 32 enrolled patients who suffered from epileptic spasms followed by a TS onset at least once during the 24-h V-EEG in the epilepsy center of Xijing Hospital between June 2015 and July 2020. The patients were prescribed anti-seizure medications (ASMs) and followed up for 2–7 years.ResultsThe average age of epilepsy onset was 48.06 ± 16.07 months (range: 25 to 88 months). Among the enrolled patients, 22 patients presented with mild intellectual deficits. During the 24-h video-EEG monitoring, an average of 6.94 TS events (range: 3 to 21) were recorded, and these TS seizures often occurred in clusters. In addition to TS, 26 patients experienced generalized tonic-clonic seizures (GTCS), atypical absence seizures, myoclonic seizure, and epileptic spasms. None of the 32 patients with TS displayed hypsarrhythmia during the 24-h video-EEG recording. A total of 28 patients showed normal EEG backgrounds. Interictal epileptic discharges, including slow waves (SW), spike/sharp slow waves (SSW), and spikes, often displayed multifocally. Notably, two patients achieved seizure freedom for more than 2 years through monotherapy with oxcarbazepine (OXC), which was associated with normalization of the EEG.ConclusionsIt is difficult to classify the patients with TS as any existing epileptic syndromes, which were distinct from West syndrome or Lennox-Gastaut syndrome. TS might be an underreported seizure type and further studies are needed to gain a more comprehensive understanding of the electro-clinical features and appropriate choice of ASMs for treating tonic spasms.

Time budgets and weight shifting as indicators of pain in hospitalized horses.

Pain assessment in horses presents a significant challenge due to their nonverbal nature and their tendency to conceal signs of discomfort in the presence of potential threats, including humans. Therefore, this study aimed to identify pain-associated behaviors amenable to automated AI-based detection in video recordings. Additionally, it sought to determine correlations between pain intensity and behavioral and postural parameters by analyzing factors such as time budgets, weight shifting, and unstable resting. The ultimate goal is to facilitate the development of AI-based quantitative tools for pain assessment in horses. A cohort of 20 horses (mean age 15 ± 8) admitted to a university equine hospital underwent 24-h video recording. Behaviors were manually scored and retrospectively analyzed using Loopy® software. Three pain groups were established based on the Pain Score Vetmeduni Vienna : pain-free (P0), mild to moderate pain (P1), and severe pain (P2). Weight shifting emerged as a reliable indicator for discriminating between painful and pain-free horses, with significant differences observed between pain groups (p < 0.001) and before and after administration of analgesia. Additionally, severely painful horses (P2 group) exhibited lower frequencies of feeding and resting standing per hour compared to pain-free horses, while displaying a higher frequency of unstable resting per hour. The significant differences observed in these parameters between pain groups offer promising prospects for AI-based analysis and automated pain assessment in equine medicine. Further investigation is imperative to establish precise thresholds. Leveraging such technology has the potential to enable more effective pain detection and management in horses, ultimately enhancing welfare and informing clinical decision-making in equine medicine.

Astrocyte switch to the hyperactive mode.

Increasing pieces of evidence have suggested that astrocyte function has a strong influence on neuronal activity and plasticity, both in physiological and pathophysiological situations. In epilepsy, astrocytes have been shown to respond to epileptic neuronal seizures; however, whether they can act as a trigger for seizures has not been determined. Here, using the copper implantation method, spontaneous neuronal hyperactivity episodes were reliably induced during the week following implantation. With near 24-h continuous recording for over 1 week of the local field potential with in vivo electrophysiology and astrocyte cytosolic Ca2+ with the fiber photometry method, spontaneous occurrences of seizure episodes were captured. Approximately 1 day after the implantation, isolated aberrant astrocyte Ca2+ events were often observed before they were accompanied by neuronal hyperactivity, suggesting the role of astrocytes in epileptogenesis. Within a single developed episode, astrocyte Ca2+ increase preceded the neuronal hyperactivity by ~20 s, suggesting that actions originating from astrocytes could be the trigger for the occurrence of epileptic seizures. Astrocyte-specific stimulation by channelrhodopsin-2 or deep-brain direct current stimulation was capable of inducing neuronal hyperactivity. Injection of an astrocyte-specific metabolic inhibitor, fluorocitrate, was able to significantly reduce the magnitude of spontaneously occurring neuronal hyperactivity. These results suggest that astrocytes have a role in triggering individual seizures and the reciprocal astrocyte-neuron interactions likely amplify and exacerbate seizures. Therefore, future epilepsy treatment could be targeted at astrocytes to achieve epilepsy control.

Sleep-phasic heart rate variability predicts stress severity: Building a machine learning-based stress prediction model.

We propose a novel approach for predicting stress severity by measuring sleep phasic heart rate variability (HRV) using a smart device. This device can potentially be applied for stress self-screening in large populations. Using a Holter electrocardiogram (ECG) and a Huawei smart device, we conducted 24-h dual recordings of 159 medical workers working regular shifts. Based on photoplethysmography (PPG) and accelerometer signals acquired by the Huawei smart device, we sorted episodes of cyclic alternating pattern (CAP; unstable sleep), non-cyclic alternating pattern (NCAP; stable sleep), wakefulness, and rapid eye movement (REM) sleep based on cardiopulmonary coupling (CPC) algorithms. We further calculated the HRV indices during NCAP, CAP and REM sleep episodes using both the Holter ECG and smart-device PPG signals. We later developed a machine learning model to predict stress severity based only on the smart device data obtained from the participants along with a clinical evaluation of emotion and stress conditions. Sleep phasic HRV indices predict individual stress severity with better performance in CAP or REM sleep than in NCAP. Using the smart device data only, the optimal machine learning-based stress prediction model exhibited accuracy of 80.3 %, sensitivity 87.2 %, and 63.9 % for specificity. Sleep phasic heart rate variability can be accurately evaluated using a smart device and subsequently can be used for stress predication.

Ambulatory Arterial Stiffness Index is Associated with the Presence and Severity of Coronary Artery Disease

ObjectiveTo evaluate the relationship between the ambulatory arterial stiffness index (AASI) and the degree of coronary stenosis, and assess its predictive value for the presence and severity of coronary artery disease (CAD).Materials and methodsIn total, 619 consecutive patients who presented with exertional anginal symptoms and/or acute coronary syndrome between January 2021 and December 2022 underwent elective non-urgent CAG with no emergency conditions and performed 24-h ambulatory blood pressure monitoring (ABPM) were included in this study and were divided into the control group (n = 68) and CAD group (n = 551) according to the angiography results. Ambulatory Arterial Stiffness Index (AASI) is obtained from the 24-h ABPM recordings, defined as 1 minus the regression slope of diastolic blood pressure on systolic blood pressure values. CAD complexity was determined by the Gensini score (GS). The patients with CAD were stratified according to the tertiles of the Gensini score (GS < 24 versus GS > 48), and GS > 48 is considered severe coronary artery disease. To explore the relationship between AASI and the severity of CAD, Spearman correlation analysis was conducted. Logistic regression analysis was then performed to determine the influence of AASI on CAD as well as severe CAD. Moreover, a Receiver Operating Characteristic (ROC) curve was constructed to assess the predictive value of AASI for CAD and severe CAD.ResultsThe CAD group had a substantially higher median AASI than the control group [0.47 (0.4, 0.58) vs.0.32 (0.24, 0.41), P < 0.001]. There was a positive correlation between AASI and Gensini score. Compared to controls, patients in low-, medium-, and high-GS had significantly higher levels of AASI in a rising trend (P < 0.001). Logistic regression demonstrated that AASI was an independent contributor to CAD and severe CAD. The area under the curve (AUC) for AASI in predicting CAD was 0.806 (P < 0.001), and for predicting high-GS CAD was 0.663 (P < 0.001).ConclusionAASI was associated with CAD and the severity of coronary stenosis and demonstrated predictive potential for both CAD and severe CAD.

Feasibility of in-home electroencephalographic and actigraphy recordings in dogs.

Idiopathic epilepsy is a prevalent neurological disease in dogs. Dogs with epilepsy often present with behavioral comorbidities such as aggression, anxiety, and fear. These behaviors are consistent with pre, post, or interictal behaviors, prodromal changes, seizure-precipitating factors, or absence and focal seizures. The overlap in behavior presentations and lack of objective research methods for quantifying and classifying canine behavior makes determining the cause difficult. Behavioral comorbidities in addition to the task of caring for an epileptic animal have a significant negative impact on dog and caregiver quality of life. This pilot study aimed to assess the feasibility of a novel technology combination for behavior classification and epileptic seizure detection for a minimum 24-h recording in the dog's home environment. It was expected that combining electroencephalography (EEG), actigraphy, and questionnaires would be feasible in the majority of trials. A convenience sample of 10 community-owned dogs was instrumented with wireless video-EEG and actigraphy for up to 48 h of recording at their caregiver's home. Three questionnaires (maximum 137 questions) were completed over the recording period by caregivers to describe their dog's everyday behavior and habits. Six of the 10 included dogs had combined EEG and actigraphy recordings for a minimum of 24 h. This shows that in-home EEG and actigraphy recordings are possible in community-owned dogs and provides a basis for a prospective study examining the same technology combination in a larger sample size.

Application of short-term analysis of skin temperature variability in prediction of survival in patients with cirrhosis.

Background: Liver cirrhosis is a complex disorder, involving several different organ systems and physiological network disruption. Various physiological markers have been developed for survival modelling in patients with cirrhosis. Reduction in heart rate variability and skin temperature variability have been shown to predict mortality in cirrhosis, with the potential to aid clinical prognostication. We have recently reported that short-term skin temperature variability analysis can predict survival independently of the severity of liver failure in cirrhosis. However, in previous reports, 24-h skin temperature recordings were used, which are often not feasible in the context of routine clinical practice. The purpose of this study was to determine the shortest length of time from 24-h proximal temperature recordings that can accurately and independently predict 12-month survival post-recording in patients with cirrhosis. Methods: Forty individuals diagnosed with cirrhosis participated in this study and wireless temperature sensors (iButtons) were used to record patients' proximal skin temperature. From 24-h temperature recordings, different length of recordings (30 min, 1, 2, 3 and 6h) were extracted sequentially for temperature variability analysis using the Extended Poincaré plot to quantify both short-term (SD1) and long-term (SD2) variability. These patients were then subsequently followed for a period of 12 months, during which data was gathered concerning any cases of mortality. Results: Cirrhosis was associated with significantly decreased proximal skin temperature fluctuations among individuals who did not survive, across all durations of daytime temperature recordings lasting 1hour or more. Survival analysis showcased 1-h daytime proximal skin temperature time-series to be significant predictors of survival in cirrhosis, whereby SD2, was found to be independent to the Model for End-Stage Liver Disease (MELD) score and thus, the extent of disease severity. As expected, longer durations of time-series were also predictors of mortality for the majority of the temperature variability indices. Conclusion: Crucially, this study suggests that 1-h proximal skin temperature recordings are sufficient in length to accurately predict 12-month survival in patients with cirrhosis, independent from current prognostic indicators used in the clinic such as MELD.

Twenty-four hour Holter ECG in normocalcemic and hypercalcemic patients with hyperparathyroidism.

To investigate the occurrence of arrhythmias in patients with normocalcemic (NC) primary hyperparathyroidism (PHPT) compared to both hypercalcemic PHPT patients and control subjects by means of 24-h Holter ECG. Thirteen NCPHPT postmenopausal patients were enrolled and age-matched with 13 hypercalcemic PHPT patients and 13 controls. Every subject underwent basal ECG, 24-h Holter ECG and mineral metabolism biochemical evaluation. PHPT patients had higher mean serum calcium levels compared to both NCPHPT and controls; there was no difference in mean serum calcium levels between NCPHPT and controls. Both NCPHPT and PHPT patients had significantly higher mean PTH levels compared with controls. There were no differences in ECG parameters between the three groups, except for QTc interval. PHPT patients had normal QTc interval values, but significantly shorter mean values compared with those of controls and NCPHPT patients. During 24-h Holter ECG recording, 100% of PHPT patients had supraventricular premature beats (SVPBs), compared to 46% of NCPHPT (p = 0.005) and to 53% of controls (p = 0.01). PHPT patients experienced ventricular premature beats (VPBs) (69.2%) vs 15% of NCPHPT patients (p = 0.01) and 23% of controls (p = 0.04). There was no difference between NCPHPT and controls subjects concerning occurrence of both VPBs and SVPBs. NCPHPT patients did not experience an increased occurrence of arrhythmias compared to controls, while PHPT patients showed an increased occurrence compared to both controls and NCPHPT. Our findings are most probably related to the short QTc interval caused by hypercalcemia observed in PHPT patients, but not in NCPHPT.

Status epilepticus in patients with genetic generalized epilepsy: a case series study

BackgroundGenetic generalized epilepsy (GGE) accounts for nearly one-third of all epilepsies. The feature of status epilepticus (SE) in patients with GGE has been rarely studied. We aimed to determine the electroclinical characteristics of SE in patients with GGE.MethodsIn this retrospective study, nine patients with GGE were enrolled at Xijing Hospital, Xi’an, China from May 2014 to May 2020. SE was confirmed by 24-h video-EEG recording. The demography, clinical manifestation, brain MRI and SE pattern were analyzed.ResultsOf the nine patients in the study, seven were female. The mean age of the patients at the time of inclusion was 16.8 years (range 7–31 years), and the mean age at the onset of epilepsy was 10.9 years (range 6–17 years). The follow-up time ranged from 3 months to 6 years. Myoclonic absence status was identified in four patients showing eyelid myoclonia with absence and one patient showing perioral myoclonia with absences. Myoclonic SE was identified in three patients showing juvenile myoclonic epilepsy. Autonomic SE was found in one patient with eyelid myoclonia with absence. SE was terminated by oral midazolam in four patients. In the other five patients, SE terminated spontaneously.ConclusionsThe seizure type of SE in patients with GGE is often consistent with their major symptoms. Oral midazolam may be an option to terminate SE in patients with GGE.

Predictive Model of All-Cause Death in Patients with Heart Failure using Heart Rate Variability.

Central Illustration : Predictive Model of All-Cause Death in Patients with Heart Failure using Heart Rate Variability. Short and long-duration heart rate variability (HRV) data from Holter monitoring could identify predictors of all-cause death in heart failure (HF) patients. To build a predictive model of all-cause death in patients with HF using HRV. Retrospective study including patients with suspected or confirmed HF who were admitted for decompensated HF or syncope that underwent Holter monitoring. In analysis of augmented sympathetic tonus, we evaluated the lowest HRV in nonoverlapping 10-minutes periods throughout 24h continuous electrocardiographic signal recording (short HRV variables). Variables with p<0.01 were included in a multivariate Cox regression model to determine the occurrence of the all-cause death. Variables with statistical significance in Cox regression were chosen to build the predictive model. P<0.05 was considered significant. A total of 116 patients were included, mean age of 71.9±16.3 years, 45.7% men, mean follow-up of 2.83±1.27 years. Thirty-nine deaths occurred (33.6%). By comparing survivors vs. non-survivors, the variables that showed statistical significance were lowest SDNN, lowest rMSSD, age and left ventricular ejection fraction (LVEF). In Cox regression, independent predictors of all-cause death were: age>69 years (HR 3.95, 95%CI 1.64-9.52); LVEF≤57% (HR 4.70, 95%CI 2.38-9.28) and lowest rMSSD≤12ms (HR 5.54, 95%CI 2.04-15.08). An integer value was assigned to each variable. Score<3 showed AUC=0.802 (95%CI 0.72-0.87). In HF patients hospitalized for decompensated HF or syncope, independent long-term predictors of all-cause death were age, LVEF, and 10-minutes rMSSD. These findings indicate that even brief moments of high sympathetic tone can impact survival, specifically in the elderly and patients with HF with reduced ejection fraction.

Effects of sling belt provision on behaviour, skin lesions, and salivary cortisol level in growing pigs after transport and regrouping

The provision of enrichment material has been widely recommended to mitigate stress and minimise aggressive behaviour as well as enhance the welfare of pigs after transport and regrouping. In this study, we assessed the effects of providing a polyester sling belt (SB) on behaviour, number of skin lesions, and salivary cortisol levels in growing pigs shortly after transport and regrouping. A total of 571 pigs (29.6 ± 2.4 kg) were allocated to one of the following three treatment groups: 1) C: control group, 2) SB5: provision of 5–6 SB per pen, and 3) SB10: provision of 10–12 SB per pen. After being transported for 2 h, the pigs were housed in pens having fully slatted floors and regrouped with unfamiliar pigs. Their behaviours after regrouping were observed via 24-h video recording. Body weight and number of skin lesions were assessed on days 0 (the day of transport and regrouping) and day 6. Saliva samples were collected from nine pigs per treatment on days 1 and 2. The SB10 group exhibited significantly lower levels of injurious interaction than did the C group (P < 0.05). This injurious interaction tended to have positive correlations with the salivary cortisol levels on day 2 (r = 0.64, P = 0.06) and the changes in the proportion of pigs with skin lesion score (1+2) from day 0–6 (r = 0.66, P = 0.05). Furthermore, it was positively correlated with the proportion of pigs with skin lesion score (1+2) on day 6 (r = 0.80, P = 0.01). Additionally, manipulation behaviour towards the SB showed a negative correlation with skin lesions on day 6 (r = −0.70, P < 0.05) and also displayed a negative tendency to be correlated with salivary cortisol levels on day 2 (r = −0.64, P = 0.06). During the study period, the SB10 group exhibited the greatest reduction in the proportion of pigs with skin lesions than did the other groups (P < 0.05). Salivary cortisol levels did not differ significantly among the treatment groups on day 1; nevertheless, the lowest level was observed in the SB10 group on day 2 (P < 0.05). In conclusion, providing SB to growing pigs housed in pens with slatted flooring shortly after transportation and regrouping can improve their health and welfare by reducing injurious behaviour, skin lesions and activity in the HPA-axis suggesting stress.

Accurate Monitoring of 24-h Real-World Movement Behavior in People with Cerebral Palsy Is Possible Using Multiple Wearable Sensors and Deep Learning.

Monitoring and quantifying movement behavior is crucial for improving the health of individuals with cerebral palsy (CP). We have modeled and trained an image-based Convolutional Neural Network (CNN) to recognize specific movement classifiers relevant to individuals with CP. This study evaluates CNN's performance and determines the feasibility of 24-h recordings. Seven sensors provided accelerometer and gyroscope data from 14 typically developed adults during videotaped physical activity. The performance of the CNN was assessed against test data and human video annotation. For feasibility testing, one typically developed adult and one adult with CP wore sensors for 24 h. The CNN demonstrated exceptional performance against test data, with a mean accuracy of 99.7%. Its general true positives (TP) and true negatives (TN) were 1.00. Against human annotators, performance was high, with mean accuracy at 83.4%, TP 0.84, and TN 0.83. Twenty-four-hour recordings were successful without data loss or adverse events. Participants wore sensors for the full wear time, and the data output were credible. We conclude that monitoring real-world movement behavior in individuals with CP is possible with multiple wearable sensors and CNN. This is of great value for identifying functional decline and informing new interventions, leading to improved outcomes.

Test-retest reliability of short- and long-term heart rate variability in individuals with spinal cord injury

Study designCross-sectional.ObjectivesTo investigate test-retest reliability of heart rate variability (HRV) metrics in SCI without restriction of activity over long (24-h) and shorter durations (5-min, 10-min, 1-h, 3-h and 6-h).SettingsUniversity hospital in Khon Kaen, Thailand.MethodsForty-five participants (11 with tetraplegia and 34 with paraplegia) underwent two 24-h recordings of RR-intervals to derive time and frequency HRV metrics. Relative reliability was assessed by intraclass correlation coefficient (ICC) and absolute reliability by coefficient of variation (CV) and Bland–Altman limits of agreement (LoA).ResultsFor 5- and 10-min durations, eight of eleven HRV metrics had moderate to excellent reliability (ICC 0.40–0.76); the remaining three were poor (ICC < 0.4). HRV values from 1-h and 3-h durations showed moderate to excellent reliability (ICC of 0.46–0.81), except for 1-h reliability of ULF and TP (ICC of 0.06 and 0.30, respectively). Relative reliability was excellent (ICC of 0.77–0.92) for 6-h and 24-h durations in all HRV metrics. Absolute reliability improved as recording duration increased (lower CVs and narrower LoAs). Participants with high AD risk (SCI level at or above T6) showed lower test-retest reliability of HF and LF values than participants with low AD risk.ConclusionRelative reliability of HRV was excellent for 6-h and 24-h. The best absolute reliability values were for 24-h duration. Time-domain outcomes were more reliable than frequency domain outcomes. Participants with high risk of AD, particularly those with tetraplegia, showed lower reliability, especially for HF and LF.

Day-to-day deviations in sleep parameters and biological aging: Findings from the NHANES 2011-2014

ObjectivesThe majority of the previous research has focused on the impact of average sleep parameters on longevity. In this study, we aimed to investigate the associations of day-to-day deviations in sleep parameters with biological ages among 6052 adults participating in the 2011-2014 waves of the US National Health and Nutrition Examination Survey. MethodsSleep parameters, including sleep duration, efficiency, midpoint, and day-to-day deviations in sleep parameters, including standard deviation of sleep duration (sleep variability), standard deviation of sleep midpoint (sleep irregularity), catch-up sleep, and social jetlag, were obtained from 4 to 7 days of 24-h accelerometer recording. We used physiological data to compute measurements of biological aging according to 3 published algorithms: PhenoAge, Klemera-Doubal method Biological Age, and homeostatic dysregulation. ResultsAfter adjustment of multiple covariates, we observed that all parameters of day-to-day deviations in sleep were significantly associated with biological aging with larger sleep variability, larger sleep irregularity, more catch-up sleep, and more social jetlag linked with more advanced biological aging. The significant associations of sleep irregularity, catch-up sleep, and social jetlag with biological aging indices remained even after adjustment for sleep duration, efficiency, and midpoint. ConclusionIn this study, we found that day-to-day deviations in sleep parameters are independently associated with biological aging in US general population. Since day-to-day deviation in sleep is a modifiable behavioral factor, our finding suggests that intervention aiming at increasing regularity in sleep patterns may be a novel approach for extending a healthy life span.

Cardiovascular variability, sociodemographics, and biomarkers of disease: the MIDUS study.

Introduction: Like heart rate, blood pressure (BP) is not steady but varies over intervals as long as months to as short as consecutive cardiac cycles. This blood pressure variability (BPV) consists of regularly occurring oscillations as well as less well-organized changes and typically is computed as the standard deviation of multiple clinic visit-to-visit (VVV-BP) measures or from 24-h ambulatory BP recordings (ABPV). BP also varies on a beat-to-beat basis, quantified by methods that parse variation into discrete bins, e.g., low frequency (0.04-0.15Hz, LF). However, beat-to-beat BPV requires continuous recordings that are not easily acquired. As a result, we know little about the relationship between LF-BPV and basic sociodemographic characteristics such as age, sex, and race and clinical conditions. Methods: We computed LF-BPV during an 11-min resting period in 2,118 participants in the Midlife in the US (MIDUS) study. Results: LF-BPV was negatively associated with age, greater in men than women, and unrelated to race or socioeconomic status. It was greater in participants with hypertension but unrelated to hyperlipidemia, hypertriglyceridemia, diabetes, elevated CRP, or obesity. LF-diastolic BPV (DBPV), but not-systolic BPV (SBPV), was negatively correlated with IL-6 and s-ICAM and positively correlated with urinary epinephrine and cortisol. Finally, LF-DBPV was negatively associated with mortality, an effect was rendered nonsignificant by adjustment by age but not other sociodemographic characteristics. Discussion: These findings, the first from a large, national sample, suggest that LF-BPV differs significantly from VVV-BP and ABPV. Confirming its relationship to sociodemographic risk factors and clinical outcomes requires further study with large and representative samples.