Severity Of Autonomic Dysfunction Research Articles

Altered connectivity of central autonomic network: effects of dysautonomia in hereditary transthyretin amyloidosis with polyneuropathy

Background Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN) is a progressive fatal disorder caused by deposition of mutant transthyretin (TTR) amyloids mainly in the nerves and heart. Autonomic dysfunction is a major disabling manifestation, affecting 90% of patients with late-onset ATTRv-PN. The current study aimed to investigate brain functional alterations associated with dysautonomia due to peripheral autonomic nerve degeneration in ATTRv-PN. Methods Resting-state functional MRI data were acquired from 43 ATTRv-PN patients predominantly of A97S (p.A117S) genotype, and the functional connectivity of central autonomic regions was assessed. Results Compared with age-matched healthy controls, the ATTRv-PN patients exhibited (1) reduced functional connectivity of the central autonomic regions such as hypothalamus, amygdala, anterior insula, and middle cingulate cortex with brain areas of the limbic, frontal, and somatosensory systems, and (2) correlations of reduced functional autonomic connectivity with the severity of autonomic dysfunction especially orthostatic intolerance, decreased heart rate variability, and greater clinical disability. Conclusions Our findings provide evidence linking peripheral autonomic dysfunction with altered connectivity in the central autonomic network in ATTRv-PN.

Unraveling Autonomic Dysfunction in GBA-Related Parkinson's Disease.

Patients with Parkinson's disease (PD) and GBA gene mutations (GBA-PD) develop nonmotor complications more frequently than noncarriers. However, an objective characterization of both cardiovascular and sudomotor autonomic dysfunction using extensive clinical and instrumental measures has never been provided so far. Survival is reduced in GBA-PD regardless of age and dementia, suggesting that other hitherto unrecognized factors are involved. To provide instrumental measures of pattern and severity of autonomic dysfunction in GBA-PD and explore their correlation with other non-motor symptoms and implications for clinical practice. In this cross-sectional study, 21 GBA-PD and 24 matched PD noncarriers underwent extensive assessment of motor and non-motor features, including neuropsychological testing. Cardiovascular autonomic function was explored through a comprehensive battery of indexes, including power spectral analysis of the R-R intervals and blood pressure short-term variability during resting state and active maneuvers. Dynamic Sweat Test was used to assess post-ganglionic sudomotor dysfunction. Despite minimal or absent clinical correlates, cardiovagal and sympathetic indexes, heart rate variability parameters and sudomotor postganglionic function were more severely impaired in GBA-PD than noncarriers (overcoming relatively preserved compensatory peripheral sympathetic function), suggesting more prominent cardiac sympatho-vagal demodulation, efferent baroreflex failure and peripheral sympathetic dysfunction in GBA-PD. Cardiovascular dysautonomia showed marginal correlations with cognitive impairment. Compared to PD noncarriers, GBA-PD display more severe instrumental autonomic abnormalities, which may be underestimated by purely clinical measures, despite their relevance on morbidity and mortality. This supports the necessity of implementing instrumental autonomic assessment in all GBA-PD, regardless of clinically overt symptoms.

Syncope with autonomic dysfunction assessed with the Thai-COMPASS 31 questionnaire

IntroductionAlteration of autonomic function is the main pathophysiology of most types of syncope, including syncope due to orthostatic hypotension and neurally mediated syncope or reflex syncope. The aim of this study was to investigate the difference in autonomic dysfunction assessed between each type of syncope and to evaluate the association between the severity of autonomic dysfunction and the recurrence of syncope. MethodologyThree hundred and six participants, including 195 syncope and 109 healthy control participants, were recruited to this retrospective cohort study. Autonomic function was initially assessed by the Thai version of the Composite Autonomic Symptom Score 31 (COMPASS 31), a self-administered questionnaire. ResultAccording to one hundred and ninety-five syncope participants, twenty-three participants had syncope due to orthostatic hypotension, 61 had reflex syncope, 79 had presyncope, and 32 had unclassified syncope. Participants in the syncope due to orthostatic hypotension and reflex syncope groups had significantly higher COMPASS 31 scores than the control and presyncope groups, of which the syncope due to orthostatic hypotension group had the highest score. The cutoff score of 32.9 for COMPASS 31 had a sensitivity of 50.0% and a specificity of 81.9% to predict the recurrence of syncope. ConclusionThe degree of autonomic dysfunction, which was assessed by COMPASS 31, could vary depending on the syncope type. The COMPASS 31, which is an easy-to-use self-administered questionnaire utilized for the assessment of autonomic symptoms and function, was a helpful tool for classifying some types of syncope and predicting the recurrence of syncope, which could lead to appropriate further management.

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

IntroductionAutonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care.Patients and methodIn a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up.ResultsThe cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time.ConclusionIn this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

Characterization of autonomic symptom burden in long COVID: A global survey of 2,314 adults.

Autonomic dysfunction is a known complication of post-acute sequelae of SARS-CoV-2 (PASC)/long COVID, however prevalence and severity are unknown. To assess the frequency, severity, and risk factors of autonomic dysfunction in PASC, and to determine whether severity of acute SARS-CoV-2 infection is associated with severity of autonomic dysfunction. Cross-sectional online survey of adults with PASC recruited through long COVID support groups between October 2020 and August 2021. 2,413 adults ages 18-64 years with PASC including patients who had a confirmed positive test for COVID-19 (test-confirmed) and participants who were diagnosed with COVID-19 based on clinical symptoms alone. The main outcome measure was the Composite Autonomic Symptom 31 (COMPASS-31) total score, used to assess global autonomic dysfunction. Test-confirmed hospitalized vs. test-confirmed non-hospitalized participants were compared to determine if the severity of acute SARS-CoV-2 infection was associated with the severity autonomic dysfunction. Sixty-six percent of PASC patients had a COMPASS-31 score >20, suggestive of moderate to severe autonomic dysfunction. COMPASS-31 scores did not differ between test-confirmed hospitalized and test-confirmed non-hospitalized participants [28.95 (15.62, 46.60) vs. 26.4 (13.75, 42.10); p = 0.06]. Evidence of moderate to severe autonomic dysfunction was seen in 66% of PASC patients in our study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the PASC population and independent of the severity of acute COVID-19 illness.

Changes of T lymphocyte subpopulations and their roles in predicting the risk of Parkinson’s disease

T lymphocytes are involved in the pathogenesis of Parkinson’s disease (PD), while the heterogeneity of T-cell subpopulations remains elusive. In this study, we analyzed up to 22 subpopulations of T lymphocytes in 115 PD patients and 60 matched healthy controls (HC) using flow cytometry. We found that PD patients exhibited decreased naïve CD8+ T cells (CD3+ CD8+ CD45RA+ CD45RO−) and increased late-differentiated CD4+ T cells (CD3+ CD4+ CD28− CD27−), compared to HC, which were not affected by anti-parkinsonism medication administration. The proportion of naïve CD8+ T cells in PD patients was positively correlated with their severity of autonomic dysfunction and psychiatric complications, but negatively associated with the severity of rapid eye movement and sleep behavior disorder. The proportion of late-differentiated CD4+ T cells was negatively correlated with the onset age of the disease. We further developed individualized PD risk prediction models with high reliability and accuracy on the base of the T lymphocyte subpopulations. These data suggest that peripheral cellular immunity is disturbed in PD patients, and changes in CD8+ T cells and late-differentiated CD4+ T cells are representative and significant. Therefore, we recommend naïve CD8 + and late-differentiated CD4+ T cells as candidates for multicentric clinical study and pathomechanism study of PD.

STUDY OF THE RELATIONSHIP BETWEEN MANIFESTATIONS OF AUTONOMIC DYSFUNCTION AND HYPERTENSION SEVERITY

Introduction. Hypertension is one of the most common diseases of the cardiovascular system, which is observed in the majority of the working population of Ukraine and around the world. Autonomic dysfunction syndrome is one of the first manifestations and precursors of hypertension. Materials and Methods. The study included 81 patients with hypertension and autonomic dysfunction. Patients were divided into 3 groups depending on blood pressure. To assess the pathology data, blood pressure was measured according to the 2018 recommendation and patients were surveyed according to a standard questionnaire to identify autonomic disorders by Vein. Results. When assessing the prevalence of symptoms of autonomic dysfunction in the study groups, there was a weak dependence of their occurrence with the severity of hypertension, even in patients with mild hypertension there was a significant frequency of symptoms, which cannot but adversely affect patients' quality of life. Assessing the severity of symptoms of autonomic dysfunction, the prevalence of symptoms such as palpitations, sweating, periodic discoloration of the extremities and paroxysmal headaches in the first group (the most favorable course of high blood pressure). For the second group, the most severe were symptoms such as intermittent numbness of the fingers and shortness of breath. The rank correlation between the degree of hypertension and the severity of autonomic dysfunction was 0.103 (p = 0.302), which indicates a positive correlation between these parameters, but the relationship was weak and did not acquire statistical significance. Conclusion. In patients with a combination of hypertension and autonomic dysfunction, the symptoms of the latter are common at any severity of hypertension. The relationship between the severity of hypertension and autonomic dysfunction could not be established, among hemodynamic indicators, pulse blood pressure was most correlated with the index of autonomic dysfunction.

The relationship between autonomic function tests and the degree of autonomic dysfunction in second year students

The aim of the work was to identify the relationship between autonomic function tests and the severity of autonomic dysfunction (AD), assessed by means of the Wein scale. The participants completed a number of questionnaires, including the Eysenck, Wein, Spielberger, and Beck questionnaires, the Toronto Alexithymic Scale (TAS), and the SF-36 Quality of Life questionnaire. The study involved 57 2nd-year students of the Pirogov Russian National Research University. A dynamometric test, a cold test, and an active orthostatic test were used. It was shown that junior medical students are characterized by high rates of anxiety, depression, and AD. The lack of correlations between AD severity and autonomic tests values along with significant correlations between AD severity and quality of life data, excepting physical functioning scale, allows us to assume that in the studied cohort AD is associated with substantial social, but not physical dysadaptation.

P542Cardiac autonomic dysfunction and inflammatory response in heart failure - markers for cardiac resynchronization therapy response?

Abstract Funding Acknowledgements FCP Introduction Cardiac sympathetic activation and inflammatory response are involved in chronic heart failure (HF) pathophysiology. The severity of autonomic dysfunction and inflammation might be responsible for different responses to HF treatment. Aim To evaluate the impact of cardiac autonomic dysfunction, and it´s association with systemic inflammation, on cardiac resynchronization therapy (CRT) response in severe HF patients. Methods Single centre, prospective, longitudinal study, including consecutive patients, referred to CRT. Demographic data, HF aetiology and NYHA class were evaluated. Left ventricular (LV) function data (LV ejection fraction - LVEF) by echocardiography, heart to mediastinum early ratio (HMRe) by 123I-MIBG cardiac scintigraphy, and plasmatic TNF-α levels (pg/mL) were determined, at baseline and 4 months after CRT implantation. CRT response was defined by an absolute increase of at least 5% in LVEF at 4 months evaluation after CRT. Patients were divided in 4 groups according to HMRe and TNF-α cut-points: Group I (TNF-α > 2.0 pg/ml + HMRe ≥ 1.6), Group II (TNF-α > 2.0 pg/ml + HMRe < 1.6), Group III (TNF-α ≤ 2.0 pg/ml + HMRe ≥ 1.6) and Group IV (TNF-α ≤ 2.0 pg/ml + HMRe < 1.6). Data was analyzed using descriptive statistics and groups were compared by Fisher"s exact test. Results A total of 95 patients were included (age 68.6 ± 10.2 years), 67.4% male and 32.6% female, 40% with diabetes mellitus, 30.5% with ischemic cardiomyopathy, 23.2% in NYHA III/IV, baseline LVEF - 26 ± 7%. At 4 months, LVEF was 40 ± 11%. In total, 73.7% were responders and 26.3% were non-responders to CRT. There were 28 patients (29.5%) with HMRe ≥ 1.6, with 25 responders (89.3%) and 48 patients (50.5%) with TNF-α ≤ 2.0 pg/ml, with 38 responders (79.2%). Group I had 16 patients (16.8%), with 81.2% responders; Group II had 31 patients (32.7%), with 61.3% responders; Group III had 12 patients (12.6%), with 100% responders, and Group IV had 36 patients (37.9%), with 72.2% responders. Conclusion: In patients with severe HF submitted to CRT, combining cardiac autonomic dysfunction and inflammation, associated to high rate of CRT non response. Contrarily, those with preserved cardiac autonomic function and no increased levels of inflammation identified most significantly CRT responders. CRT response according to HMRe and TNFα HMRe ≥ 1.6 (n = 28) HMRe < 1.6 (n = 67) Responders NO Respondersn (%) Responders NO Respondersn (%) TNF α > 2 pg/mL (n = 47) G I: 13 (81.2%) 3 (18.8%) GII: 19 (61.3%) 12 (38.7%) * TNF α ≤ 2 pg/mL (n = 48) G III: 12 (100%) 0 (0%)* G IV: 26 (72.2%) 10 (27.8%)

Relationship of the psychosomatic status of pediatric interns and the efficiency of their education

The results of a study of psychoemotional and psychosomatic status in a group of interns who are trained in an internship in the specialty "Pediatrics" are presented. It is established that changes in the psychosomatic status and personal characteristics of interns have a significant negative impact on the results of their training.In conducting the survey of interns-pediatricians found average levels of personal anxiety, extraversion and neuroticism. It should also be emphasized that signs of autonomic dysfunction were diagnosed in 65.0% of interns. The results of the final certification of interns were positively associated with their level of motivation (r = 0.40, p <0.05) and the severity of autonomic dysfunction (r = 0.58, p <0.05). It was established a feedback between the results of certification with complaints of pain syndrome of various localization (r = -0.37, p <0.05), complaints from the cardiovascular system (r = -0.42, p <0.05) and the level of personal anxiety (r = -0.36, p <0.05).

Ganglionic Acetylcholine Receptor Antibodies and Autonomic Dysfunction in Autoimmune Rheumatic Diseases.

Autonomic neuropathy has been reported in autoimmune rheumatic diseases (ARD) including Sjögren’s syndrome, systemic sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. However, the pathophysiological mechanism underlying autonomic dysfunction remains unknown to researchers. On the other hand, autoimmune autonomic ganglionopathy (AAG) is an acquired immune-mediated disorder, which causes dysautonomia that is mediated by autoantibodies against ganglionic acetylcholine receptors (gAChRs). The purpose of this review was to describe the characteristics of autonomic disturbance through previous case reports and the functional tests used in these studies and address the importance of anti-gAChR antibodies. We have established luciferase immunoprecipitation systems to detect antibodies against gAChR in the past and determined the prevalence of gAChR antibodies in various autoimmune diseases including AAG and rheumatic diseases. Autonomic dysfunction, which affects lower parasympathetic and higher sympathetic activity, is usually observed in ARD. The anti-gAChR antibodies may play a crucial role in autonomic dysfunction observed in ARD. Further studies are necessary to determine whether anti-gAChR antibody levels are correlated with the severity of autonomic dysfunction in ARD.

Progressive supranuclear palsy is not associated with neurogenic orthostatic hypotension.

To evaluate the pattern and severity of autonomic dysfunction in autopsy-confirmed progressive supranuclear palsy (PSP) compared to α-synuclein pathology. Autopsy-confirmed cases of 14 patients with PSP, 18 with multiple system atrophy (MSA), and 24 with Lewy body disease (LBD) with antemortem autonomic testing were reviewed retrospectively. All patients underwent comprehensive clinical evaluations by a movement disorder specialist, formal autonomic testing, and postmortem examinations at Mayo Clinic. The absence of orthostatic hypotension (OH) was the strongest autonomic parameter that distinguished PSP from α-synucleinopathies (0% vs 69%, p < 0.0001). Tests of adrenergic failure, which distinguish neurogenic OH, also differentiated PSP from other groups. These included the pressure recovery time (p = 0.0008), adrenergic impairment score (p = 0.001), and magnitude of change of systolic (p = 0.0002) and diastolic (p = 0.0001) blood pressures (BPs) during upright tilt. In addition, REM sleep behavior disorder was seen less frequently (p = 0.006) in PSP (33%) compared to MSA (87%) and LBD (90%). Antemortem clinical diagnostic accuracy for these phenotypically variable disorders was 57% for PSP and 83% for α-synucleinopathies. Our results suggest that the cardiovascular adrenergic system, which sustains BP during standing, is relatively unaffected, if not spared, in PSP. These findings increase our understanding of the clinical signature of PSP and have the potential to improve diagnostic accuracy in atypical parkinsonisms by distinguishing PSP from the α-synucleinopathies.

Postprandial Blood Pressure Decrease in Patients with Type 2 Diabetes and Mild or Severe Cardiac Autonomic Dysfunction.

Background Few reports have evaluated the relationship between changes in postprandial blood pressure and the severity of autonomic dysfunction in patients with type 2 diabetes. This was a cross-sectional study designed to investigate postprandial blood pressure changes in individuals without type 2 diabetes and patients with type 2 diabetes and mild or severe cardiac autonomic dysfunction. Methods Forty patients with type 2 diabetes mellitus and 20 individuals without type 2 diabetes participated in this study. Fifty-two participants underwent a meal tolerance test. Blood pressure (brachial systolic blood pressure (bSBP) and central systolic blood pressure (cSBP)), electrocardiogram recordings, and blood samples were assessed before and after meal ingestion. Patients with diabetes were divided into two groups based on their coefficient of variation of R–R intervals (CVRR): a normal or mildly dysfunctional group (mild group, CVRR ≥ 2%; n = 20) and a severely dysfunctional group (severe group, CVRR < 2%; n = 15). Results In the control group, bSBP and cSBP did not significantly change after meal ingestion, whereas both decreased significantly at 60 min after meal ingestion in the mild and severe groups. While blood pressure recovered at 120 min after meal ingestion in the mild group, a significant decrease in blood pressure persisted at 120 min after meal ingestion in the severe group. Conclusions Based on these results, adequate clinical attention should be paid to the risk of serious events related to postprandial decreases in blood pressure, particularly in patients with diabetes and severe cardiac autonomic dysfunction.

Clinical efficacy feasibility of osteopathic correction for patients with primary algomenorrhea

Introduction.From 30 to 92 % of reproductive age women suffer from menstrual pain (algomenorrhea). The effectiveness of drug treatment of this suffering does not exceed 50–70 %. Moreover, it is temporary and accompanied by a high incidence of side effects. Dysfunction of the autonomic nervous system is the basis of the algomenorrhea pathogenesis; it is resulting from chronic exposure to psychogenic factor and adaptive mechanisms decrease in thalamus and hypothalamus which is leading to the nociceptive system excitation. Currently, there are scientifi c studies showing the effectiveness of osteopathic correction of autonomic dysfunction that can eliminate menstrual pain.Goal of research— to justify the osteopathic treatment effectiveness for patients with primary algomenorrhea.Materials and methods.The study included 30 women aged from 15 to 29 years who applied to the gynecological offi ce, diagnosed with primary algomenorrhea and a disease period of 3 to 16 years. They were randomly divided into 2 groups: experimental and control, of 15 people each. The patients of experimental group received osteopathic treatment, the patients of control group received drug therapy only. Osteopathic status was determined in all patients before and after treatment. Pain intensity was assessed by using a visual analogue scale (VAS), the direction of autonomic dysfunction — by using the Kerdo index and the severity of autonomic dysfunction — according to the Wayne questionnaire.Results.Dura mater RBN S (93 % of patients) and RBN in the visceral chest region (70 %) were specifi c regional somatic dysfunctions. The remaining regional somatic dysfunctions were common less than in 50 % of patients. Specifi c local somatic dysfunctions (LD) in patients with algomenorrhea were uterus LD (73 %) and mediastinum LD (70 %). Due to osteopathic treatment, the number of regional and local somatic dysfunctions was decreased in the experimental group. Autonomic dysfunction severity and pain syndrome intensity were decreased as well.Conclusion.The results of the study allow us to recommend osteopathic treatment for patients with primary algomenorrhea.

Assessing severity of involvement of autonomic functions in iron-deficiency anemia patients

Background: Iron-deficiency anemia (IDA) is one of the most frequently found anemias in all countries. In India itself, 60–70% of population has IDA. Autonomic dysfunctions are common in anemias so also in IDAs. The present study was conducted to categorize these autonomic dysfunctions according to severity. Aims and Objective: The objective of the present study was to find if there are any autonomic dysfunctions in IDA patients and to assess the severity of autonomic dysfunction in IDA patients. Materials and Methods: A total of 60 patients of IDA were selected from hematology OPD and included in the study. The patients were subjected to autonomic function tests, and the results of the test were compared with age and socioeconomically matched healthy subjects. Results: Comparing the pattern of involvement of autonomic nervous system in IDA patients and the severity of autonomic dysfunction, it was seen that 13 (22%) had normal functions, early involvement was seen in 17 (28%) IDA patients, definite involvement is seen in 22 (37%) patients, and 5 (8%) had severe involvement, while remaining 3 (5%) had atypical involvement. Conclusion: Autonomic dysfunction manifests in IDA patients. This autonomic dysfunction may vary from early involvement to severe involvement. Severe autonomic dysfunction may even cause death in some cases.

Reduced brainstem functional connectivity in patients with peripheral autonomic failure

Autonomic homeostasis is dependent upon several brainstem nuclei, as well as several cortical and subcortical structures. Together, these sites make up, in part, the central autonomic network. Neurogenic orthostatic hypotension (NOH) is a cardinal feature of autonomic failure that occurs due to a failure to increase sympathetic efferent activity in response to postural changes. Therefore, the purpose of the current study was to investigate brainstem functional connectivity in NOH patients with peripheral autonomic lesions resulting in autonomic failure.Fifteen controls (63 ± 13 years) and fifteen Neurogenic Orthostatic Hypotension patients (67 ± 6 years; p = .2) with peripheral autonomic dysfunction completed 5-min of rest and three Valsalva maneuvers during a functional brain scan. Functional connectivity from the brainstem to cortical and subcortical structures were contrasted between patients and controls.At rest controls had significantly greater brainstem connectivity to the anterior cingulate cortex (T-value: 4.29), left anterior insula (T-value:3.31), left putamen (T-value:3.31) and bilateral thalamus (TRIGHT-value: 3.83; TLEFT-value:4.25) (p-FDR < 0.005). During Valsalva, controls showed significantly more connectivity between the brainstem and both the left anterior (cerebellum 4/5) and bilateral posterior cerebellum (cerebellar 9 and left cerebellar 6). Other cerebellar regions included brainstem-to-vermis. Other brainstem-to-cortical and subcortical regions included: bilateral putamen, posterior cingulate cortex (PCC), amygdala and medial prefrontal cortex. There was a significant negative correlation between the brainstem-cerebellar connectivity and severity of autonomic dysfunction (p < .01). During recovery phase of the Valsalva, controls had greater brainstem connectivity to the left thalamus (T-value:4.17); PCC (T-value:3.32); right putamen (T-value:3.28); right paracingulate gyrus (T-value:3.25) and left posterior cerebellum (C9) (T-value:3.21) (p-FDR < 0.05). The effect sizes for each brainstem connectivity during Valsalva and recovery ranged from moderate to strong.Patients with autonomic failure show reduced coupling between the brainstem and regions of the central autonomic network, including the cerebellum, insula, thalamus and cingulate cortices. Connectivity was associated with autonomic impairment. These findings may suggest impaired brainstem connectivity in patients with autonomic failure.

An updated normative data set from the autonomic reflex screen representative of Southwestern Ontario.

In evaluating autonomic dysfunction, the autonomic reflex screen (ARS) is an established set of standardized tests to evaluate the presence and severity of autonomic dysfunction. Our laboratory previously reported normative data on 121 healthy individuals; however, the sample size in older individuals was reduced compared with other age groups. Therefore, the objective of the current study was to provide updated normative values representative of young, middle-aged, and older individuals from Southwestern Ontario. Two hundred and fifty-two healthy individuals completed quantitative sudomotor axon reflex testing, heart rate responses to deep breathing (HRDB), and Valsalva maneuver using standard protocols of the ARS. All 4 sweat sites demonstrated a significant effect of sex (p < 0.001). In addition, the proximal leg, distal leg, and foot were all significantly affected by age (p < 0.001). Cardiovagal parameters, measured via HRDB and Valsalva ratio revealed a significant regression with age (p < 0.001). These results show similar trends with previously reported normative data sets. All normative data as a function of age and sex, where appropriate, are expressed as percentiles (2.5th, 5th, 95th, 97.5th). The current study provides updated normative data describing autonomic functioning in healthy individuals obtained from the sudomotor and cardiovagal components of the ARS.

Magnesium Deficiency Effect on the Severity of Autonomic Dysfunction in Mitral Valve Prolapse Patients with Emotional Tension

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis.Ekol Eye Hospital, Izmir, Turkey.Retrospective case series.Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy.Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669).Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Impaired Baroreflex Function during Orthostatic Challenge in Patients after Spinal Cord Injury.

The level of spinal cord injury (SCI) affects baroreflex regulation of blood pressure. While a parasympathetic cardiac chronotropic effect is preserved, baroreflex response could be impaired by sympathetic dysfunction under the SCI level. This study was aimed to evaluate the baroreflex function in SCI patients by the analysis of causal interaction between systolic blood pressure (SBP) and inter-beat intervals (IBI). Blood pressure was continuously recorded in 13 cervical SCI patients (CSCI), nine thoracic SCI (ThSCI) and 13 able-bodied controls (Con) during two phases: sitting (PS) and orthostatic challenge (PO). Beat-to-beat SBP and IBI sequences were obtained from continuous blood pressure recording. Closed loop of SBP-IBI interaction was mathematically opened by bivariate autoregressive model; causal coherence and baroreflex sensitivity (BRS) were calculated in baroreflex direction. Coherence quantifies causal synchronicity between SBP and IBI. The gain of transfer function from SBP to IBI represents BRS. PS (medians of CSCI/ThSCI/Con) coherence was 0.28/0.33/0.25 (no significant difference) and PS BRS was 6.98/7.54/6.66 (no difference). PO coherence was 0.18/0.58/0.45 (CSCI < ThCSI and Con; p < 0.01) and PO BRS was 2.38/5.87/6.22 (CSCI < ThCSI and Con; p < 0.01). For position change effect, there was no change in CSCI coherence; for ThSCI and Con, PS < PO (p < 0.05). For BRS in the CSCI group, PS < PO (p < 0.01); for ThSCI and Con, there was no change. BRS and coherence correlated negatively with SCI level (p < 0.01). In conclusion, baroreflex dysfunction in SCI patients was detected using causal analysis methods during orthostatic challenge only. Baroreflex dysfunction is probably an important mechanism of the more expressed blood pressure decrease associated with CSCI. The severity of autonomic dysfunction was related to SCI level.

Evaluation of autonomic neuropathy in alcoholic liver disease in Manipur

Context: The prevalence of autonomic neuropathy in alcoholic liver disease and its correlation with severity of liver disease is not known in Manipur population. Aims: The aim of this study was to study the prevalence of autonomic dysfunction in patients with chronic alcoholic liver disease and to determine the degree of severity of alcoholic liver disease by Child–Turcotte-Pugh scoring and its correlation with autonomic profile. Settings and Design: A cross-sectional study involving eighty adult patients with chronic alcoholic liver attending Medicine out patient's Department in a tertiary care teaching hospital in Imphal, from October 2011 to September 2013. Subjects and Methods: Autonomic profile included a preformed questionnaire and five autonomic function tests (3 parasympathetic and 2 sympathetic). Parasympathetic tests (heart rate variation to [1] deep and slow breathing, [2] Valsalva maneuver, and [3] standing) and sympathetic tests (blood pressure response to [1] postural change and [2] sustained isometric hand grip) were performed. Autonomic neuropathy detected was graded as normal, early, definite, severe, and atypical. Results: Autonomic dysfunction was observed in 58 (72.5%) patients (early 30 [37.5%], definite 10 [12.5%], severe 18 [22.5%], normal 22 [27.5%]). Heart rate response to standing (30:15 ratio) was the most altered parasympathetic test in 39 (67.2%). The parameters that correlated with the severity of autonomic dysfunction were Child–Pugh scoring (P = 0.000), platelet count (P = 0.000, cirrhosis (P = 0.001), varices (P = 0.02), and portal hypertension (P = 0.000). Conclusions: Screening of alcoholic liver disease patients with autonomic function tests directly correlated with the severity of alcoholic liver disease. Autonomic tests should be a part of patient work in alcoholic liver disease so that early intervention can be performed.