Disorders Of Autonomic Nervous System Research Articles

Clinical autonomic nervous system laboratories in Europe: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies.

Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p= 0.021). This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.

Non-invasive diagnostic methods for fatal familial insomnia


 Fatal familial insomia (FFI) is a dominant autosomal genetic prion disease characterised by progressive sleep impairment, autonomic nervous system disorders and motor symptoms associated with significant loss of nerve cells in the medial thalamic nuclei.
 
 
 Making a diagnosis of FFI requires the presence of a certain or probable recognised first-degree relative of the patient, together with neuropsychiatric disorders present. In turn, the detection of the PrP mutation allows the diagnosis to be definitively established. In addition, three other tests - polysomnography, brain imaging and cerebrospinal fluid examination - can be helpful. 
 
 
 Fatal familial insomnia is not a fully understood disease. Diagnosis is based on the presence of symptoms of the disease. An important step in diagnosis will be the development of non-invasive diagnostic tests that are reliable in the early and presymptomatic stages of the disease. Polysomnography, imaging studies (PET, SPECT) and cerebrospinal fluid examination should be improved and widely accepted.

Preterm birth: the impact of risk factors on pregnancy outcomes

BACKGROUND: Despite the achievements of modern obstetrics and neonatology, the problem of preterm birth remains one of the most pressing.
 AIM: The aim of this study was to evaluate the influence of risk factors on the outcome of threatened preterm birth.
 MATERIALS AND METHODS: This prospective cohort study included the analysis of clinical and anamnestic data of 130 patients delivered at various gestational ages. The main group comprised 68 women with preterm delivery, with the control group consisting of 62 women with timely delivery.
 RESULTS: The outcome of preterm birth is adversely affected by overweight in the group of modifiable risk factors, by history of premature birth in the immediate family in the group of non-modifiable risk factors, and by a previous COVID-19, anemia and autonomic nervous system disorders in the group of potentially modifiable risk factors. The most reliable prognostic marker for the development of preterm labor was the shortening of the cervical length of less than 2.5 cm according to ultrasound.
 CONCLUSIONS: The formation of risk groups based on the analysis of clinical, anamnestic, medical, and social data, as well as somatic and gynecological diseases can help avoid the development of adverse outcomes of preterm birth.

Indicators of Immune and Neurohumoral Profile in Women of Fertile Age with Functional Disorders of the Autonomic Nervous System Associated with Polymorphic Variants of the HTR2A (rs7997012) and TP53 (rs1042522) Genes.

In women of fertile age with functional disorders of the autonomic nervous system (ANS), a complex of indicators of the immune and neurohumoral profile associated with polymorphic variants of the HTR2A (rs7997012) and TP53 (rs1042522) genes was revealed. In patients with the diagnosis "G90.8. Other disorders of the autonomic nervous system", the neurohumoral profile is characterized by excessive content of cortisol and serotonin (p<0.05), which indicates the development of the hypersympathicotonic variant of autonomic regulation disorders. The cellular immune profile in the examined individuals was characterized by a significant decrease in the content of CD3+CD4+ and CD3+CD8+ lymphocytes (p<0.05). At the same time hyperactivation of the humoral immune response was observed. In particular, we revealed enhanced production of IgG and IgM antibodies accompanied by increased count of CD19+ lymphocytes (p<0.05), which characterized clinical and laboratory manifestations of the asthenic syndrome. The women with ANS disorders had increased frequency of the G allele (OR=3.00; 95%CI 1.20-7.47) and GG genotype (OR=3.91; 95%CI 1.00-15.24) of the HTR2A (rs7997012) serotonin receptor gene, as well as the G allele (OR=1.93; 95%CI 1.04-3.57), CG genotype (OR=2.38; 95%CI 1.02-5.53) and the GG genotype (OR=1.48; 95%CI 0.42-5.24) of the TP53 (rs1042522) oncosuppressor protein gene (p<0.05). The polymorphic G allele and GG genotype variants of candidate genes (HTR2A (rs7997012) and TP53 (rs1042522) genes) in women with ANS pathology are associated with an imbalance of the neurohumoral (excess of cortisol and serotonin) and immune regulation (deficiency of the CD3+CD4+ and CD3+CD8+, excess of CD19+, IgG and IgM). These parameters form a complex of the immune, neurohumoral, and genetic profile indicators in women of fertile age that characterize functional disorders of ANS manifestations by hypersympathicotonic type with an asthenic component.

Effects of Inhalation of Essential Oil From Pelargonium graveolens on the Autonomic Nervous System of Awake Mice

Autonomic nervous system disorders have many causes, and thus, no effective remedy for these disorders has been established. In this study, we conducted animal experiments with essential oil from Pelargonium graveolens (EOPG, geranium essential oil), which may regulate the autonomic nervous system. EOPG was administered to awake mice by inhalation. Heart rate variability (HRV) was analyzed from the pulse wave of the mice on an elevated platform, and the ratio of sympathetic to parasympathetic nerve activity was determined. The results showed that inhalation of EOPG did not affect the heart rate but made activity of the parasympathetic nervous system dominant. This effect was thought to be due to linalool, a component of EOPG that was transferred into the brain and body.

Pattern Changes in the Heart Rate Variability of Patients Undergoing Coronary Artery Bypass Grafting Surgery.

Introduction Coronary artery bypass grafting (CABG) with extracorporeal circulation is a key therapy for coronary artery disease (CAD). However, cardiovascular events and cardiac arrhythmias may still occur in these patients following surgery. Many studies have demonstrated a correlation between cardiac arrhythmias and heart rate variability (HRV). This study aimed to establish the temporal change pattern of HRV observed following CABG. Methods A prospective method was used to study 119 consecutive patients with stable CAD who were assessed using 24-hour Holter recordings 2 days before CABG and 1 week, 3 months, and 6 months after the surgery at Hanoi Heart Hospital from June 2016 to August 2018. Main results: All the time-domain and frequency-domain parameters of HRV decreased precipitately after CABG and were mostly recovered 3 months postoperatively. The percentage of decreased HRV before surgery was 28.6% and 51.8% after 7 days, 19.6% after 3 months, and 12.7% after 6 months. ASDNN and SDNN before and after surgery had the highest rates of change. Conclusion The early decrease in HRV observed 7 days after CABG may be related to the acute effects of the surgery. The recovery of HRV at 3 months after surgery, regardless of the preoperative state of the patients, implies that the autonomic nervous system (ANS) disorder may be improved at this time. At 6 months after surgery, the autonomic nervous injury was recovered in combination with improvement of reperfusion, resulting in improvement in almost all HRV indices compared with those indices preoperatively.

Assessing the structural and functional changes in vagus nerve in multiple sclerosis

Multiple sclerosis (MS) is a progressive immune-mediated disease that leads to myelin loss, axonal damage as well as some autonomic nervous system (ANS) in the disease course. Sweat disorders, urinary disorders, orthostatic hypotension, gastrointestinal symptoms and sexual dysfunction are typical ANS disorders that reduce the quality of life of MS patients.The precise etiology of MS is due to the body response to multiple risks and cellular events. However immune dysregulation arising from multifactorial disease processes via an association between genetic predispositions and environmental factors is the possible cause.As we postulated that the vagus nerve (VN) has a vital role in the ANS, we hypothesize that MS can lead to changes in structure and function of VN, resulting in decreased parasympathetic output, causing imbalance between the sympathetic and parasympathetic nervous systems. Conclusion: the vagus nerve can be tested by ultrasonography if autonomic activity are impaired in MS patients. Future directions: further in vivo and experimental trials should be conducted at the future, which will help in non-invasive diagnostic procedure and will open new consideration in pharmaceutical treatments for multiple sclerosis.

SnapShot: Autonomic nervous system disorders

The peripheral autonomic nervous system (PANS) functions to maintain homeostasis of the internal body environment. Dysregulation of the PANS alters the functions of the cardiovascular, genito-urinary, skin, and gastrointestinal systems. Dysautonomia can occur independently or in coincidence with other diseases, such as synucleinopathies. Despite similar manifestations across many conditions, research points to a variety of pathophysiological mechanisms involving development, malfunction, and neurodegeneration.

Features Neurohumoral and Immune Profile in Children with Functional Disorders of the Autonomic Nervous System Associated with Sirtuin Gene SIRT1 (rs7069102) Polymorphism.

We revealed some features of the neurohumoral and immune profile in preschool children with functional disorders of the autonomic nervous system (ANS) associated with the polymorphism of the SIRT1 gene (rs7069102) responsible for stability of the cell cycle, energy and plastic metabolism of organic substances, and Ca2+ exchange. The neurohumoral profile of the surveyed children is characterized by excessive content of glutamic acid and serotonin, which leads to excessive synaptic activation and disorders of ANS inhibition (p<0.05). The cell immune profile is characterized by a reduced immunoregulatory index CD4+/CD8+ with a simultaneous deficiency of CD3+CD4+ and excess of CD3+CD8+ lymphocytes (p<0.05). These etiopathogenetic disorders of the neurohumoral and immune profile are associated with variant G-allele of the SIRT1 gene (rs7069102) and the corresponding homozygous GG-genotype (p<0.05), which leads to disturbances in the control of the cell cycle stability, including apoptosis, cytochrome deacetylation, inhibition of the glutamate dehydrogenase enzyme activity with excessive glutamate accumulation, energy metabolism in mitochondria, and Ca2+ exchange. The revealed features of neurotransmitters content (excess of serotonin and glutamic acid) and indicators of cell immunity (reduced proportion of CD4+/CD8+ cells) associated with the variant G allele and GG genotype of the SIRT1 gene (rs7069102) form a complex of neurohumoral, immune, and genetic markers in children with functional disorders of ANS (G90.8). This allows recommending them as indicators for early diagnosis and prevention of autonomic disorders in children.

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome.

Hydration with water and salt is the mainstay of treatment for autonomic nervous system disorders that impair orthostatic tolerance. The goal is to expand intravascular volume to compensate for the downward displacement of blood volume that occurs when standing and thereby sustain cerebral perfusion and restore quality of life. Despite strong consensus recommendations for salt supplementation as standard treatment of these disorders, published evidence of benefit is relatively weak, and no randomized clinical trials have occurred. This review summarizes the physiological rationale for hydration and evaluates the literature on oral and intravenous hydration in the treatment of neurogenic orthostatic hypotension, postural tachycardia syndrome, and recurrent vasovagal syncope. We conclude that oral salt replacement is indicated for treatment of neurogenic orthostatic hypotension because these patients have excessive renal sodium excretion, and for treatment of chronic orthostatic intolerance because these patients are often hypovolemic. As not all patients are able to tolerate sufficient oral hydration, there is also a role for intravenous volume-loading in severe cases of postural tachycardia syndrome. We offer guidance, based on review of the literature and the clinical judgment of a cardiologist and neurologist with experience treating autonomic disorders, regarding the option of ongoing intravenous hydration for treatment of severe, refractory cases of postural tachycardia syndrome.

Gender differences in the detection of carotid atherosclerosis: DUPLEX registry cross-sectional study results.

The aim of this study was to assess the features of detecting carotid atherosclerosis depending on gender, age, the presence of arterial hypertension, other major diseases and conditions according to The Duplex Registry Database. The registry sequentially included the results of duplex scanning of the carotid arteries (DSCA) of all patients who underwent it at the United Hospital with Outpatient Department in 2013 (n=2548). The incidence of carotid atherosclerosis (CAS) was higher in men than in women (58.6% (n=763) vs 45.5% (n=568), p<0.0000001). This was noted in all categories according to the gradation of stenosis, including in the category of the most severe lesion (>70%): 2.9% (n=32) vs 1.0% (n=13), p=0.003. The presence of CAD significantly increased the chances of detecting CAS in men (OR 4.47 vs 2.6, p<0.0000001). Signs more significant in their influence in women compared to men were the following: age (OR 5.3 [4.12; 6.71] p<0.0000001); arterial hypertension (OR 2.7 [2.12; 3.39] p<0.0000001) and cerebrovascular disease (OR 1.63 [1.13; 2.36] p=0.004). The OR of CAS detection for the "acute cerebrovascular accident" diagnosis in men and women differed 2 times (OR 1.2, p=0.4 vs 2.4, p=0.15). The "hypercholesterolemia" diagnosis when referred for DSCA did not show itself as a predictor of CAS detection in all study groups. Disorders of autonomic nervous system, hearing loss and screening examination showed a significant decrease in the probability of CAS detecting for the whole group (OR 0.14 [0.08;0.24] p<0.0000001; OR 0.16 [0.02;0.66] p=0.004 and OR 0.3 [0.25 0.37] p<0.0000001, respectively), so and separately for males and females. The present study revealed significant gender differences in the prevalence of carotid atherosclerosis and in the influence of various signs on an increase in the chances of its detection. The most significant signs were (OR men vs women): gender (1.3 vs 0.8), age (4.2 vs 5.3), arterial hypertension (1.8 vs 2.7), CAD (4.4 vs 2.6), cerebrovascular disease (1.26 vs 1.63).

Circular Radio-Frequency Electrode With MEMS Temperature Sensors for Laparoscopic Renal Sympathetic Denervation.

Laparoscopic renal denervation (LRDN) ablates sympathetic nerves on the outer wall of a renal artery to treat autonomic nervous system disorders such as hypertension and arrhythmia. Here, we developed a new circular radio frequency (RF) electrode for LRDN using micro-electro-mechanical systems (MEMS) technology. The electrode consists of a parallel bipolar MEMS electrode, two MEMS thermocouples, and a shape-memory alloy (SMA) substrate. The electrode is automatically wrapped and unwrapped under actuation controlled by the heat generated by RF energy on the electrode-tissue interface. The electrode was designed through a computational simulation analysis, and its actuation and temperature-sensing performance were tested in laboratory experiments and a porcine animal study. In an in-vivo study of porcine renal arteries, the electrode could automatically wrap and unwrap around an artery during LRDN. The bipolar MEMS electrode required 13 Vrms for heat generation up to 60°C, while the two MEMS thermocouples reliably measured the temperature without noise signals (a temperature coefficient of 38.3 or 38.5 µV/°C and an accuracy of ±0.44 or ±0.49°C). As revealed in a histological analysis using hematoxylin and eosin staining and Masson's trichrome staining, the renal artery was intact after LRDN. The circular RF electrode improves the safety of LRDN by reliably measuring the electrode temperature of the electrode during RDN and enhances the effectiveness of LRDN by reducing the complicated manipulations of the surgical instrument. The developed circular RF electrode will pave the way for LRDN treatment of autonomic nervous system disorders.

Association of sleep disorders with heart rate variability in children and adolescents with cystic fibrosis.

ABSTRACTObjective:To assess the association of sleep disorders with the findings of heart rate variability (HRV) in children and adolescents with cystic fibrosis (CF).Methods:Cross-sectional study including children and adolescents aged six to 18 years with a clinical diagnosis of CF. Sociodemographic and clinical data were collected. Sleep disorders were evaluated using baseline nocturnal polysomnography. The autonomic nervous system (ANS) was evaluated through resting HRV.Results:A total of 30 individuals (11.2 years) with a mean forced expiratory volume in the first second (FEV1) of 62.7% were included. The respiratory disturbance index presented a median of 2.6 and obstructive sleep apnea syndrome (OSAS) was identified in 30%. In the HRV analysis, a mean standard deviation of all inter-beat (RR) intervals (SDNN) of 60.8±45.9ms was found. There was a significant correlation between the HRV low-frequency/high-frequency (LF/HF) global modulation index and the minimum SpO2 during sleep in patients with FEV1<60% (r=0.71; p=0.02). The prevalence of sleep disorders and HRV abnormalities was higher in individuals with lesser pulmonary function (FEV1<60%).Conclusions:The results indicate a weak correlation of sleep disorders (minimum SpO2) with HRV parameters (LH/HF) in children and adolescents with CF. When pulmonary function was reduced, a stronger correlation was found, highlighting the influence of disease severity. A high prevalence of ANS disorders, nocturnal hypoxemia, and presence of OSAS was also found.

Correction of vegetative disorders in children with irritable bowel syndrome

Introduction. The article considers the formation of irritable bowel syndrome (IBS) in children. In recent years this pathology occurs more often among the adult and children population in many countries in the world. According to the modern view of the problem, this disease is considered a biopsychological disease, in the development of which an important role is played by the connection of psychological factors, dysfunctions of the autonomic nervous system, motor and secretory disorders of various parts of the intestine, which can cause the discomfort, changes of intestinal habits. All these factors lead to a decrease in the quality of life in children. Purpose of research. The main goal of this research is to study the peculiarities of the status of the autonomic nervous system in children with irritable bowel syndrome and to evaluate the effectiveness of the proposed therapy. Materials and methods One of the main methods for assessing the condition of the autonomic system in patients is cardiointervalography. During this examination, we calculated the index of tension, which is one of the main indicators of assessing the condition of this part of the nervous system. According to this index’s indicators, the vegetative system’s state can be divided into three main variants of functioning – vagotony, eutony, and sympathicotony. All patients were divided into groups according to the main complaints and course of IBS – IBS with constipation (IBS -C), IBS with diarrhea (IBS- D), a mixed form of IBS and an unclassified form of IBS. And also another two large groups were formed – main and control. Results. We analyzed the cardiointervalogram indicators in both groups of patients with different clinical variants of IBS. In the main group, we registered a statistically significant decrease in the index of tension and an improvement in autonomic nervous system dysfunction in patients with IBS with constipation and diarrhea. Indicators in these groups were changed from the state of vagotony and sympathicotonia to eutony. This indicates the restoration of the function of the normal function of the autonomic nervous system. Patients from the control group also showed changes in the index of tension, but the indicators stayed in the borders of vagotony and sympathicotony, and didn’t reach the level of eutony. Conclusions. Аfter the evaluation of the received data, it was proved that the use of hopanthenic acid in the complex therapy of irritable bowel syndrome effectively improve the status of the autonomic nervous system in children.

The gastrointestinal effects amongst Ehlers-Danlos syndrome, mast cell activation syndrome and postural orthostatic tachycardia syndrome

&lt;abstract&gt; &lt;p&gt;Ehlers-Danlos syndrome (EDS), mast cell activation syndrome, and postural orthostatic tachycardia syndrome are a triad of comorbid conditions that can occur simultaneously in many patients. Specifically, Ehlers-Danlos syndrome is a group of inherited connective tissue disorders that weakens the connective tissue and causes easy bruising. Mast cell activation syndrome (MCAS) is a condition in the connective tissue of vascularized organs that causes recurrent episodes of anaphylactic symptoms. The irregular activation of mast cells may contribute to immunological manifestations in EDS patients. Postural orthostatic tachycardia syndrome (POTS) is an autonomic nervous system disorder characterized by orthostatic intolerance. Review of the literature suggests an overlap of gastrointestinal (GI) symptoms such as nausea and abdominal pain, hernias, perforations, and more. Thus, this paper will delineate each condition's distinct gastrointestinal symptoms and explore similar gastrointestinal relationships among these conditions.&lt;/p&gt; &lt;/abstract&gt;

Autonomic Nervous System Function in Newly Diagnosed Multiple Sclerosis: Association With Lipid Levels and Insulin Resistance.

Autonomic nervous system (ANS) disorders are common in multiple sclerosis (MS). Previous studies showed differences in insulin resistance (IR) and lipoprotein levels in MS subjects compared to controls. Lipolysis caused by increased sympathetic activity could be one of the possible linking mechanisms leading to dyslipidemia in MS. Our study aimed to evaluate ANS activity in the context of glucose and lipid metabolism in people with MS. We prospectively measured short-term heart rate variability (HRV), fasting lipoprotein concentrations, and calculated IR indices based on plasma glucose and insulin levels during oral glucose tolerance test (oGTT) in 32 patients with MS and 29 healthy controls matched for age, sex and body mass index in our study. There was no significant difference in HRV parameters and lipoprotein levels between MS and controls. A significant positive correlation was found between low/high-frequency power ratio (LF/HF) and triglycerides (r=0.413, p=0.021) in MS subjects but not in controls. A significantly lower whole-body insulin sensitivity index (ISIMat) was found in patients with MS compared to the control group (7.3±3.7 vs. 9.8±5.6, p=0.041). No significant correlations were found between LF/HF and IR parameters. In MS subjects, the positive correlation of LF/HF with triglycerides could reflect the effects of sympathetic activity on lipolysis. Positive correlations of sympathetic activity with increased lipoprotein levels could rather reflect processes associated with immune system activation/inflammation, than processes involved in glucose homeostasis maintenance.

Hospital-based observational study of neurological disorders in patients recently vaccinated with COVID-19 mRNA vaccines

PurposeWe describe the spectrum of acute neurological disorders among hospitalized patients who recently had COVID-19 mRNA vaccination. MethodWe performed a prospective study at 7 acute hospitals in Singapore. Hospitalized patients who were referred for neurological complaints and had COVID-19 mRNA vaccines, BNT162b2 and mRNA-1273, in the last 6 weeks were classified into central nervous system (CNS) syndromes, cerebrovascular disorders, peripheral nervous system (PNS) disorders, autonomic nervous system (ANS) disorders and immunization stress-related responses (ISRR). ResultsFrom 30 December 2020 to 20 April 2021, 1,398,074 persons (median age 59 years, 54.5% males) received COVID-19 mRNA vaccine (86.7% BNT162b2, 13.3% mRNA-1273); 915,344(65.5%) completed 2 doses. Four hundred and fifty-seven(0.03%) patients were referred for neurological complaints [median age 67(20–97) years, 281(61.5%) males; 95.8% received BNT162b2 and 4.2% mRNA-1273], classified into 73(16.0%) CNS syndromes, 286(62.6%) cerebrovascular disorders, 59(12.9%) PNS disorders, 0 ANS disorders and 39(8.5%) ISRRs. Eleven of 27 patients with cranial mononeuropathy had Bell's palsy. Of 33 patients with seizures, only 4 were unprovoked and occurred within 2 weeks of vaccination. All strokes occurred among individuals with pre-existing cardiovascular risk factors. We recorded 2 cases of cerebral venous thrombosis; none were vaccine-induced thrombotic thrombocytopenia. Five had mild flares of immune-mediated diseases. ConclusionOur observational study does not establish causality of the described disorders to vaccines. Though limited by the lack of baseline incidence data of several conditions, we observed no obvious signal of serious neurological morbidity associated with mRNA vaccination. The benefits of COVID-19 vaccination outweigh concerns over neurological adverse events.

Has the time come for gastrointestinal functional testing to be included as part of autonomic nervous system testing?

Individuals with autonomic nervous system (ANS) disorders have a high burden of gastrointestinal symptoms. Unfortunately, many of these individuals are diagnosed with functional gastrointestinal disorders without a comprehensive clinical evaluation or an understanding of the underlying pathophysiological mechanism. The ANS regulates all body systems and is responsible for maintaining homeostasis by coordinating responses to physiological processes and perturbations and is integral in controlling functions of the gastrointestinal system.

PREGABALINS IN THE MANAGEMENT OF DIABETIC AND ALCOHOLIC POLYNEUROPATHY

Diseases of the peripheral nervous system are ranking a leading position among other neurological nosologies. And polyneuropathy is known as more prevalent and severe disease. Numerous scientific reports highlight issues on different pathological conditions in relation to polyneuropathy, and in particular intoxications, hypovitaminosis (isolated or as complications of certain pathological processes), infectious and hereditary diseases, paraneoplastic syndromes, metabolic disorders, allergic reactions. These diseases when uncontrolled or untreated may result in the development of complications, among which is polyneuropathy. The diagnosis of polyneuropathy is relatively not difficult, because the disease is manifested as distal symmetrical sensory and/or motor impairments with transient disorders of autonomic nervous system. Diabetic polyneuropathy, in particular, is a late complication of diabetes mellitus, which determines the prognosis of the disease. Alcoholic polyneuropathy in a form of acute, subacute or chronic current variants is caused by the combined effects of thiamine toxicity and vitamin deficiency. At the same time, dysmetabolic polyneuropathies differ by variability of clinical manifestations and the general developmental patterns of the nerve conduction block that is determined by the peculiarities of degenerative and regenerative processes under different pathogenetic factors. Differential diagnosis of polyneuropathies is mainly based on the detection of somatic pathology and the comparison of the dynamic changes in the course of the diseases and clinical manifestations. The study has demonstrated diabetic and alcoholic polyneuropathies have clear distinct clinical-neurophysiological patterns. The article also highlights the treatment outcomes of combination therapy with pregabalin for diabetic and alcoholic polyneuropathies.

Association Between Postoperative Long-Term Heart Rate Variability and Postoperative Delirium in Elderly Patients Undergoing Orthopedic Surgery: A Prospective Cohort Study.

BackgroundPostoperative delirium (POD) is a common complication after orthopedic surgery in elderly patients. The elderly may experience drastic changes in autonomic nervous system (ANS) activity and circadian rhythm disorders after surgery. Therefore, we intend to explore the relationship between postoperative long-term heart rate (HR) variability (HRV), as a measure of ANS activity and circadian rhythm, and occurrence of POD in elderly patients.MethodsThe study population of this cohort was elderly patients over 60 years of age who scheduled for orthopedic surgery under spinal anesthesia. Patients were screened for inclusion and exclusion criteria before surgery. Then, participants were invited to wear a Holter monitor on the first postoperative day to collect 24-h electrocardiographic (ECG) data. Parameters in the time domain [the standard deviation of the normal-to-normal (NN) intervals (SDNN), mean of the standard deviations of all the NN intervals for each 5-min segment of a 24-h HRV recording (SDNNI), and the root mean square of successive differences of the NN intervals (RMSSD)] and frequency domain [heart rate (HR), high frequency (HF), low frequency (LF), very low frequency (VLF), ultra low frequency (ULF), and total power (TP)] were calculated. Assessment of delirium was performed daily up to the seventh postoperative day using the Chinese version of the 3-Min Diagnostic Interview for CAM-defined Delirium (3D-CAM). The relationship between HRV and POD, as well as the association between HRV and duration of POD, was assessed.ResultsOf the 294 cases that finally completed the follow-up, 60 cases developed POD. Among the HRV parameters, SDNNI, VLF, and ULF were related to the occurrence of POD. After adjustment for potential confounders, the correlation between HRV indices and POD disappeared. Through stratified analysis, two significant negative correlations emerged: ULF in young-old participants and SDNNI, VLF, and ULF in male patients.ConclusionThe lower HRV parameters may be related to the occurrence of POD, and this correlation is more significant in young-old and male patients. ANS disorders and rhythm abnormalities reflected by HRV changes may represent a possible mechanism that promotes POD.