Changes In HR Research Articles

Consistency of emotional reactivity assessment results obtained in different behavioural tests

Emotional reactivity may be a very broad concept comprising many components of temperament traits. The aim of the study was to verify the consistency of assessment of the horse’s reactivity level evaluated with different behavioural tests and to answer the question whether emotional reactivity is indeed such a broad concept that assessment thereof with only one specific test is not possible. The research material included 31 different-aged małopolski horses (3–17 years) from equestrian recreational centres. All horses were subjected to a series of behavioural tests divided into 3 groups: group I – handling tests, group II – human-horse interaction tests, and group III – novelty tests. The analysis of the horses’ behaviour was based on assessment of the emotional arousal degree reflected by changes in the heart rate HR, scores (1–5), and measured time (s). Additionally, rank correlations between the tests were estimated. The research results suggest that emotional reactivity is a trait consisting of many variables rather than a single indicator of the horse’s temperament. Reactivity should therefore be analysed at various levels, which classify the animal in different ways, as shown in the present study. Only handling tests are sufficiently consistent in the assessment of horses’ reactivity; hence, the bridling test can reflect the degree of animal’s arousal in other situations related to daily handling activities. The other groups of tests, or even the individual tests in these groups, define other elements of the animal’s temperament, only apparently evaluating one trait, i.e. the emotional reactivity of horses. It is therefore a mistake to classify an individual unambiguously as an animal with low or high emotional reactivity, as this trait depends on the type of the test applied.

The Influence of Pilates Exercise on Women`s Anthrophometry Indices, Core Muscle Performance and Heart Rate Changes during the Session

Research background and hypothesis. Pilates exercises are used in fitness and in some forms of rehabilitation programs (Di Lorenzo, 2011). Pilates focuses on core body exercise and activation of transversus abdominis muscle (TrA), multifidus and pelvic floor muscles can also be used as an exercise programme controlling body mass and blood pressure. Little is known about the Pilates exercise intensity and heart rate changes during the practice session.The aim of the current research was to study the impact of Pilates exercise on women’s body weight, core muscle performance and to evaluate heart rate changes during the practice session.Research methods included anthropometry measurements, heart rate and core muscle performance measures.Research results. In the period of 8-week Pilates training we found that it had a significant impact on women’s fat body mass and static core muscle endurance. Slightly decreasing tendency was found in BMI, but there were no statistically different changes between the results at the beginning and after 8-week training period. Measuring HR changes during the Pilates session we found that moderate HR was 98.2 (4.7) beats/min and maximum HR was 131.4 (7.2) beats/min. Maximum HR took approximately 10% and moderate HR – 90% of training period time. Discussion and conclusions. We found that 8-week Pilates training period had a positive influence on the participants’ core muscle performance, fat body mass and minor BMI reduction. As a result, Pilates exercises could be used for the prevention of low back pain and to reduce obesity. Slight HR changes during the session indicate that Pilates exercises may have implications for the rehabilitation of individuals who have high blood pressure and cannot go in for high intensity physical activity.Keywords: BMI, heart rate, Pilates training, static endurance of core muscles

Effects of neoadjuvant chemotherapy on minimum alveolar concentration values of sevoflurane and desflurane in patients with hepatocellular carcinoma complicated with jaundice.

The effects of neoadjuvant chemotherapy on the minimum alveolar concentration (MAC) values of sevoflurane and desflurane in patients with hepatocellular carcinoma (HCC) complicated with jaundice were investigated. Eighty patients with HCC complicated with jaundice were selected. Forty patients underwent the neoadjuvant chemotherapy and were grouped into the desflurane group (Group D) and the sevoflurane group (Group S). Patients in all chemotherapy groups received 2 cycles of chemotherapy prior to surgery and underwent surgical treatment 3 weeks after chemotherapy. The remaining 40 patients in the control group were divided into the desflurane group (Group C1) and the sevoflurane group (Group C2). Changes in MAP, HR and BIS at different time points before and after anesthesia induction and skin incision were compared among the groups. Results showed that there were no significant differences in MAP, HR and BIS before anesthesia induction (T0) (P>0.05); at each time point from T1 to T6, MAP, HR and BIS of Group D were significantly lower than those of Group C1 (P>0.05). Furthermore, MAP, HR and BIS of Group S were significantly lower than those of Group C2 (P>0.05). The MACMean of sevoflurane and desflurane were compared among all patient groups using the mean method. MACMean values of Group D were significantly lower than those of Group C1 (P<0.05). Notably, MACDixon values of sevoflurane and desflurane were compared among all patient groups using the Dixon method and the differences were statistically significant (P<0.05). Logistic regression analyses were conducted, respectively, which revealed that the MAC of sevoflurane and desflurane were associated with whether patients received the neoadjuvant chemotherapy. MACLog of sevoflurane and desflurane were decreased in patients receiving the neoadjuvant chemotherapy. The results suggested that neoadjuvant chemotherapy can reduce MAC values of sevoflurane and desflurane in HCC patients complicated with jaundice and may improve these patients' sensitivity to sevoflurane and desflurane.

The Phenomenon of Climate Change in Organization and HR- Related Literature: A Conceptual Brief Analysis

Abstract Climate change has become one of the main challenges facing humanity. Over the past decade, this phenomenon, which may have been caused by natural variability and/or human activity, has attracted many scholars from different scientific disciplines to warn of its potential consequences. The author of this paper has decided to address the existence of this important phenomenon in organizational literature. However, upon exploring different academic databases, the rarity of research focusing on climate change and its relationship and/or effect on HR or organizational aspects became obvious. Accordingly, the author recommends other HR and organizational scholars devote considerable space to this phenomenon in their field.

Hypertensive Young Adult Female Obese Zucker Rats (OZR) do not have the Blunted Baroreflexes and Poor Glycemic control observed in age‐matched Hypertensive Male OZR

Obese Zucker rats (OZR) have hyperphagia owing to dysfunctional leptin receptors and gain excess weight compared to lean Zucker rats (LZR) with functional leptin receptors. Young adult male OZR (12–14 wks) develop hypertension and impaired baroreflexes coincident with blunted activation of the nucleus tractus solitarius (NTS), the brain stem site that receives baroreceptor afferent inputs. Male OZR at this age have hyperinsulinemia and chronically elevated fed glucose levels (despite normal fasting glucose) with significant glucose intolerance as measured by telemetry (DSI). Treatment with metformin (300mg/day, 4 wks) restores glycemic control in OZR without eliminating hypertension or hyperinsulinemia, with no effect on these measures in LZR. After treatment with metformin male OZR have improved baroreflexes and activation of the NTS, suggesting hyperglycemia contributes to these deficits in adult male OZR. In contrast to males, at this age female OZR are hypertensive but do not develop impaired baroreflex‐mediated changes in heart rate (HR; Tenorio et al., 2013). The present study examined whether preserved baroreflex‐mediated changes in HR in female OZR extend to sympathetic baroreflexes and diminished activation of the NTS, and whether female OZR maintain glycemic control at this age (13–14 wks). Female OZR had excess weight gain (215±8 g vs. 483±14 g in 9 LZR and 10 OZR, P&lt;0.05), similar to male OZR. Female rats were instrumented with indwelling femoral catheters run through a tether to record MAP and HR and infuse drugs while rats were conscious and undisturbed. As expected, female OZR had higher MAP (135±2 vs. 121±2 mmHg in 10 OZR and 7 LZR, P&lt;0.05). However, infusion of phenylephrine (PE) to raise MAP by 40 mmHg evoked a comparable bradycardia in female OZR and LZR (−111±13 vs. −129±20 bpm in 9 OZR and 7 LZR) and c‐Fos expression in NTS (311±38 and 390±32 counts). A different set of rats was anesthetized with isoflurane for surgical preparation to measure MAP (femoral artery) and splanchnic sympathetic nerve activity (SNA) and to infuse drugs (femoral vein). Then, the rat was anesthetized with urethane (1.5g/kg iv LZR body weight), ventilated, and paralyzed. As seen with PE‐induced bradycardia, iv infusions of PE and nitroprusside to evoke wide range of MAP elicited comparable changes in SNA of female 5 OZR and 5 LZR (range, 90±16% in OZR vs. 94±3% in LZR and slope, −1.96±0.4 in OZR vs. −2.86±0.4 in LZR). As seen in males, adult female OZR were hyperinsulinemic compared to LZR (7.5±2.0 vs. 1.0±0.1 ng/dl, p&lt;0.05). In contrast to hyperglycemia seen in male OZR, 24hr fed glucose measured by telemetry was equivalent in female OZR and LZR (95±3 vs. 89 ±1 mg/dl in 7 LZR and 6 OZR), and when challenged with glucose (1g/kg, ip) the AUC in female OZR and LZR were comparable (275±38 vs. 195±12 in 6 OZR and 6 LZR). These data suggest better maintenance of glycemic control in hypertensive, hyperinsulinemic young adult female OZR may preserve activation of the NTS and baroreflexes. In addition, these data highlight differing mechanisms for the development of hypertension and impaired control of SNA and HR by baroreflexes in the setting of metabolic syndrome.Support or Funding InformationNIHR01HL138109 to AMS AHA GRNT18880005 to AMS PRE27260088 to PCThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Time Course of Blueberry Ingestion on Measures of Arterial Stiffness and Blood Pressure

IntroductionAn individual's risk of cardiovascular disease is affected by numerous factors, with hypertension among the most significant. Specifically, hypertension causes increased pressure within the blood vessels which can compromise the integrity of the vasculature. Blueberries possess compounds known as anthocyanins which exert anti‐hypertensive properties and may reduce blood pressure. The objective of the present study was to examine the effect of daily blueberry ingestion on blood pressure, augmentation index (AIx), and central pulse wave velocity (cPWV) over a three week period, as well as to assess acute effects, one hour and two hours post‐consumption.MethodsParticipants (n=22) were composed of men and women between the ages of 40 to 70 years who met pre‐determined inclusion criteria. Participants were randomized into group A (n=10) or B (n=12) and received 38 g/d of freeze‐dried blueberry powder or placebo, respectively. Participants had baseline values obtained and then consumed A or B every evening with dinner for three weeks. Blood pressure, AIx, and cPWV were measured at the end of each week. At the end of the third week, participants had the weekly measures taken and then ingested 38g of A or B and had acute measures taken at one hour and two hours post ingestion.ResultsParticipants did not differ based on age, height, weight, body mass index, or percent body fat. Chronic blueberry ingestion resulted in significant treatment time interaction effects for systolic blood pressure (p=0.036). No chronic treatment time interactions were observed for diastolic blood pressure, AIx, or cPWV. With respect to one hour and two hours post‐consumption, significant treatment time interaction effects were found for systolic blood pressure (p=0.015). No acute treatment time interactions were found for diastolic blood pressure, AIx, or cPWV. Furthermore, no significant treatment time interactions were observed for energy, macronutrient, or micronutrient intake including nutrients known to affect blood pressure.ConclusionOf interest was the change in systolic blood pressure following both acute and chronic dosing. It was not supported to be mediated by a change in vessel distensibility since PWV was not altered. Therefore, the change in blood pressure was most likely due to a change in HR both following acute supplement ingestion and as a chronic effect over time. This finding is of interest due to the relatively short time course and requires further investigation.Support or Funding InformationU.S. Highbush Blueberry CouncilThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Internal jugular vein distensibility in assessment of fluid responsiveness in donors of living donor liver transplantation

BackgroundThe concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities.PurposeThe purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness.MethodsA prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5 ml/kg. ultrasonic and hemodynamic measurements were reassessed 10 min (T 10) after the fluid resuscitation.ResultsHighly significant changes in MABP, HR, and CVP (p < 0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P = 0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P ≥ 0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P = 0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r = −0.390, P = 0.013) and (r = −0.332∗, p = 0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r = −0.359, P = 0.023) also with CVP (r = −0.464, P = 0.017). No difference was found regarding the HR (P = 0.336).ConclusionOrgan transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor.

Effect of sensory adaptations for routine dental care in individuals with intellectual and developmental disabilities: A preliminary study

ABSTRACTBackground: This study examined whether a sensory adapted dental environment (SADE) diminished anxiety and agitation in adults with intellectual and developmental disability (IDD) when compared to a routine dental environment (RDE).Method: Agitated behaviours (frequency and duration) were video-taped and anxiety-related physiological measures recorded (heart rate [HR] and blood pressure [BP]) during dental treatment in RDE and 6 months later in SADE. An ICC2,k assessed the reliability of subject behaviours. The impact of treatment condition was compared with paired t-tests and ANCOVAs.Results: 41 participants, 22 males, aged 47.9 (14.2), were examined; 61% were diagnosed with profound IDD. SADE reduced frequency and duration of agitated behaviours and reduced physiological evidence of agitation (HR and BP) over RDE with p < .004.Conclusion: This research demonstrated a decrease in frequency and duration of agitated behaviours and smaller changes in HR and BP when dental care is provided in a SADE.

The short-term effects of indoor size-fractioned particulate matter and black carbon on cardiac autonomic function in COPD patients

BackgroundPrevious studies have reported adverse health effects of indoor air pollutants especially particulate matter (PM) and black carbon (BC). Patients with chronic obstructive pulmonary disease (COPD) have been shown to be more likely with cardiovascular comorbidities in which cardiac autonomic dysfunction plays an important role. However, there is little evidence for the effect of indoor PM and BC exposures on cardiac autonomic function in COPD patients. ObjectivesTo evaluate the association between exposure to indoor size-fractioned PM and BC and changes in HRV and HR in COPD patients. MethodsForty-three doctor diagnosed, stable COPD patients were recruited and measured for 24-h HRV and HR. Real-time indoor size-fractioned PM and BC were monitored on the day before and the day of performing health measurements. Mixed-effects models were used to estimate the associations between indoor PM and BC and HRV indices and HR after controlling for potential confounders. ResultsIncreasing levels of size-fractioned PM and BC were associated with decreased HRV indices and increased HR. An IQR (3.14μg/m3) increase in 8-h BC moving average and an IQR (20.72μg/m3) increase in 5-min PM0.5 moving average concentrations were associated with declines of 7.45% (95% CI: −10.89%, −3.88%) and 16.40% (95% CI: −21.06%, −11.41%) in LF, respectively. The smaller the particles size, the greater effects on HRV indices and HR. Patients' BMI modified the associations between size-fractioned PM and BC and their HRV and HR. For an IQR increase in PM0.5, there was decline in HF of 34.85% (95% CI: −39.08%, −30.33%) in overweight patients, compared to a 2.01% (95% CI: −6.44%, 11.19%) increase in normal-weight patients. ConclusionsExposures to indoor PM and BC were associated with altered cardiac autonomic function in COPD patients, and the associations for HRV measures of parasympathetic activity (e.g., HF) were more apparent in overweight patients.

LOCAL AND SYSTEMIC EFFECTS OF REPETITIVE SEIZURES

LOCAL AND SYSTEMIC EFFECTS OF REPETITIVE SEIZURES

Effects of Hyperbaric Exposure on the Cardiovascular System. Role of the Autonomous Nervous System

Abstract Introduction Among experienced divers, dive adaptation is seen as a modified pattern of physiological changes. This is reflected, inter alia, in the change in cardiovascular responses, therefore there is need to examine the role of the autonomic nervous system in cardiovascular response modulation after hyperbaric exposure. Material and methods Ten experienced divers took part in the study. The effects of hyperbaric exposure at 30 and 60 meters and interaction (depth x time) were measured. Changes in HR, RRI, CI and HRV values have been taken into analysis. Results Hyperbaric exposure at 30 meters significantly affected HFnu-RRI elevation and decrease of LFnu-RRI (F = 42.92, p &lt;0.00001), without significant affecting the HR, RRI and CI. Exposure to hyperbaric 60 m increased HR and CI (F = 7.64, p = 0.01 and F = 4.89, p = 0.04 respectively) and RRI (F = 7.69, p = 0.01), without significant impact on other variables. The influence of interaction (depth x time) was significant in all measured variables. Conclusions The results indicate that hyperbaric exposure at 60 meters affected HR, RRI, CI parameters, that were not significantly affected by hyperbaric exposure at 30 meters. On the other hand, the exposure at 30 meters showed a significant effect on the LFnu and HFnu HRV, which were not significantly affected by the exposure at 60 meters. Significant effect of time and depth interaction in each of the analyzed variables was observed.

Effects of body mass index on subarachnoid anesthesia

Objective To explore the effect of non-standardized BMI on subarachnoid anesthesia. Methods A total of 100 inpatients with either low or high BMI subjected to lower extremity surgery were enrolled, and were assigned into group A(BMI 24, n=50). The patients received subarachnoid injection of 2 ml 0.75% L-bupivacaine through the space between vertebra L3 and L4. The spinal levels of subarachnoid anesthesia were measured by acupuncture and alcohol swab. We analyzed the efficiency of subarachnoid anesthesia in two groups of patients by recording the speed and spinal levels of anesthesia, scores for neuromuscular blocking, HR, BP, time spent for recovery from anesthesia, and adverse reactions to anesthetics. Results Although subarachnoid anesthesia in group A developed as fast as that in group B, the vertebra levels of anesthesia in group B(T6, T7) were lower than those in group A(T9, T10). During anesthesia, patients in group A and B did not differ in the scores for neuromuscular blocking, but patients in group A showed less changes in blood pressure and HR. However, patients in group B recovered faster from anesthesia than those in group A, but had higher incidence of adverse reactions to anesthesia. Conclusions BMI may affect the spinal levels, recovery, and adverse reactions of subarachnoid anesthesia, and should be taken into consideration in the performance of subarachnoid anesthesia. Key words: Body mass index; Subarachnoid block; Anesthetic effects

Prognostic value of vasodilator response using rubidium-82 positron emission tomography myocardial perfusion imaging in patients with coronary artery disease.

Prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) is well established. There is paucity of data on how the prognostic value of PET relates to the hemodynamic response to vasodilator stress. We hypothesize that inadequate hemodynamic response will affect the prognostic value of PET MPI. Using a multicenter rubidium (Rb)-82 PET registry, 3406 patients who underwent a clinically indicated rest/stress PET MPI with a vasodilator agent were analyzed. Patients were categorized as, "responders" [increase in heart rate ≥ 10 beats per minute (bpm) and decrease in systolic blood pressure (SBP) ≥10mmHg], "partial responders" (either a change in HR or SBP), and "non-responders" (no change in HR or SBP). Primary outcome was all-cause death (ACD), and secondary outcome was cardiac death (CD). Ischemic burden was measured using summed stress score (SSS) and % left ventricular (LV) ischemia. After a median follow-up of 1.68years (interquartile range = 1.17- 2.55), there were 7.9% (n = 270) ACD and 2.6% (n = 54) CD. Responders with a normal PET MPI had an annualized event rate (AER) of 1.22% (SSS of 0-3) and 1.58% (% LV ischemia = 0). Partial and non-responders had higher AER with worsening levels of ischemic burden. In the presence of severe SSS ≥12 and LV ischemia of ≥10%, partial responders had an AER of 10.79% and 10.36%, compared to non-responders with an AER of 19.4% and 12.43%, respectively. Patient classification was improved when SSS was added to a model containing clinical variables (NRI: 42%, p < 0.001) and responder category was added (NRI: 61%, p < 0.001). The model including clinical variables, SSS and hemodynamic response has good discrimination ability (Harrell C statistics: 0.77 [0.74-0.80]). Hemodynamic response during a vasodilator Rb-82 PET MPI is predictive of ACD. Partial and non-responders may require additional risk stratification leading to altered patient management.

Altered Behavioral and Autonomic Pain Responses in Alzheimer's Disease Are Associated with Dysfunctional Affective, Self-Reflective and Salience Network Resting-State Connectivity.

While pain behaviors are increased in Alzheimer’s disease (AD) patients compared to healthy seniors (HS) across multiple disease stages, autonomic responses are reduced with advancing AD. To better understand the neural mechanisms underlying these phenomena, we undertook a controlled cross-sectional study examining behavioral (Pain Assessment in Advanced Dementia, PAINAD scores) and autonomic (heart rate, HR) pain responses in 24 HS and 20 AD subjects using acute pressure stimuli. Resting-state fMRI was utilized to investigate how group connectivity differences were related to altered pain responses. Pain behaviors (slope of PAINAD score change and mean PAINAD score) were increased in patients vs. controls. Autonomic measures (HR change intercept and mean HR change) were reduced in severe vs. mildly affected AD patients. Group functional connectivity differences associated with greater pain behavior reactivity in patients included: connectivity within a temporal limbic network (TLN) and between the TLN and ventromedial prefrontal cortex (vmPFC); between default mode network (DMN) subcomponents; between the DMN and ventral salience network (vSN). Reduced HR responses within the AD group were associated with connectivity changes within the DMN and vSN—specifically the precuneus and vmPFC. Discriminant classification indicated HR-related connectivity within the vSN to the vmPFC best distinguished AD severity. Thus, altered behavioral and autonomic pain responses in AD reflects dysfunction of networks and structures subserving affective, self-reflective, salience and autonomic regulation.

Abstract P367: Masked Hypertension is Not Associated With Orthostatic Hypertension

The aim of this study was to see if there is any association between masked hypertension (MHTN) and orthostatic HTN (OHTN). In addition, we evaluated if MHTN was associated with diabetes (DM). Lastly we compared BP and HR changes between DM and non-diabetics (NDM)pts. We performed ambulatory BP monitoring (ABPM) in 70 consecutive pts referred to us for evaluation of hypertension. From this number of pts there were 20 pts with OHTN for an incidence of 28%. There were 8 pts with MHTN for an incidence of 11.4%. There were 26 pts with DM and 44 pts were NDM The studies were performed after 5 minutes of rest. We obtained BP’s in the dominant arm. We subsequently performed the 24hs ABPM using Space Lab On Trak 90227 monitors. Out of 8pts with MHTN, none had OHTN and only 2 were pts with DM. In addition, we compared age, weight, BP sitting and standing as well as HR sitting and standing in our 70 patients that were divided in 2 groups, DM v/s NDM. The following table depicted our results: In summary, we found a higher sitting diastolic BP in nondiabetic pts. There was no significant difference between both groups in the remaining parameters. In conclusion, in our small population of pts there was no association between MHTN and OHTN. The association between MHTN and DM was very low. When comparing 8 different parameters depicted in the table the only significant difference between DM and NDM was on the sitting diastolic BP.

Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine

BackgroundHeart rate (HR) reduction is of benefit in chronic heart failure (HF). The effect of heart rate reduction using Ivabradine on various echocardiographic parameters in dilated cardiomyopathy has been less investigated. MethodsOf 187 patients with HF (DCM, NYHA II–IV, baseline HR>70/min), 125 patients were randomized to standard therapy (beta blockers, ACEI, diuretics, n=62) or add-on Ivabradine (titrated to maximum 7.5mg BD, n=63). Beta-blockers were titrated in both the groups. ResultsAt 3 months both groups had improvement in NYHA class, 6min walk test, Minnesota Living With Heart Failure (MLWHF) scores and fall in BNP, however the magnitude of change was greater in Ivabradine group. Those on Ivabradine also had lower LV volumes, higher LVEF (28.8±3.6 vs 27.2±0.5, p=0.01) and more favorable LV global strain (11±1.7vs 12.2±1.1, p=<0.001), MPI (0.72±0.1 vs 0.6±0.1, p=<0.001), LV mass (115.2±30 vs 131.4±35, p=0.007), LV wall stress (219.8±46 vs 238±54) and calculated LV work (366±101 vs 401±102, p=0.05). The benefit of Ivabradine was sustained at 6 months follow up. The % change in HR was significantly higher in Ivabradine group (−32.2% vs −19.3%, p=0.001) with no difference in blood pressure. Resting HR<70/min was achieved in 96.8% vs 27.9%, respectively in the two groups. ConclusionAddition of Ivabradine to standard therapy in patients with DCM and symptomatic HF and targeting a heart rate<70/min improves symptoms, quality of life and various echocardiographic parameters.

Angiotensin II system in the nucleus tractus solitarii contributes to autonomic dysreflexia in rats with spinal cord injury.

BackgroundAutonomic dysreflexia (AD) is a potentially life-threating complication after spinal cord injury (SCI), characterized by episodic hypertension induced by colon or bladder distension. The objective of this study was to determine the role of impaired baroreflex regulation by the nucleus tractus solitarii(NTS) in the occurrence of AD in a rat model.MethodsT4 spinal cord transection animal model was used in this study, which included 40 Male rats Colorectal distension (CD) was performed to assess AD and compare the changes of BP, HR, and BRS, six weeks after operation. After that, SCI rats with successfully induced AD were selected. Losartan was microinjected into NTS in SCI rats, then 10, 30, 60 minutes later, CD was performed to calculate the changes of BP, HR, and BRS in order to explicit whether Ang II system was involved in the AD occurrence. Ang II was then Intra-cerebroventricular infused in sham operation rats with CD to mimic the activation of Ang II system in AD. Finally, the level of Ang II in NTS and colocalization of AT1R and NMDA receptor within the NTS neurons were also detected in SCI rats.ResultsCompared with sham operation, SCI significantly aggravated the elevation of blood pressure (BP) and impaired baroreflex sensitivity (BRS) induced by colorectal distension; both of which were significantly improved by microinjection of the angiotensin receptor type I (AT1R) antagonist losartan into the NTS. Level of angiotensin II (Ang II) in the NTS was significantly increased in the SCI rats than sham. Intracerebroventricular infusion of Ang II also mimicked changes in BP and BRS induced by colorectal distension. Blockade of baroreflex by sinoaortic denervation prevented beneficial effect of losartan on AD.ConclusionWe concluded that the activation of Ang II system in NTS may impair blood pressure baroreflex, and contribute to AD after SCI.

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.

Effectiveness of Tai Chi on Cardiac Autonomic Function and Symptomatology in Women With Fibromyalgia: A Randomized Controlled Trial.

The present study examined the effects of a 12-week Tai Chi (TC) training regimen on heart rate variability (HRV), symptomatology, muscle fitness and body composition in women with fibromyalgia. Participants were randomly assigned to either a TC training group (n = 18) or a control group (n = 19). HRV, symptomatology, muscle fitness and body composition were measured before and after 12 weeks. There were significant decreases (p < 0.05) in sympathovagal balance (LnLF/LnHF), sympathetic tone (LnLF, nLF), pain, and fatigue, and significant increases (p < 0.05) in parasympathetic tone (LnHF, nHF), strength and flexibility following TC compared with no changes after control. The changes in LnLF and LnLF/LnHF were correlated with changes in pain. There were no significant changes in HR, sleep quality and body composition after TC or control. TC may be an effective therapeutic intervention for improving sympathovagal balance, pain, fatigue, strength and flexibility in women with fibromyalgia.

Association between cytochrome P450 family 2 subfamily E member 1 levels and minimum alveolar concentrations of sevoflurane that block adrenergic responses to pneumoperitoneum stimulation in smokers receiving laparoscopic cholecystectomy

Objective To determine whether smoking affects minimum alveolar concentrations of sevoflurane that block adrenergic responses(MACBAR) in patients receiving laparoscopic cholecystectomy. Methods A total of 90 ASA grade Ⅰ or Ⅱ patients(30-50 years old) receiving laparoscopic cholecystectomy were enrolled in this study, and the patients had 49 smokers and 41 non-smokers. The levels of cytochrome P450 family 2 subfamily E member 1(CYP2E1, a principal enzyme metabolizes sevoflurane) and cotinine (a metabolite of nicotine, a bioactive component in cigarettes) in serum were measured one day before the operation. The patients received similar procedures for the induction of general anesthesia, thereafter, the anesthesia was maintained with sevoflurane. Pneumoperitoneum stimulation was applied to trigger adrenergic responses that were assessed by changes in MAP and HR. Meanwhile, MACBAR was recorded. Results HR and MAP were at the same levels between smokers and non-smokers(P>0.05). As expected, the levels of CYP2E1 and cotinine in serum were significantly higher in smokers than non-smokers(P<0.05). After general anesthesia was induced, HR and MAP were significantly decreased in both smokers and non-smokers(P<0.05). Pneumoperitoneum stimulation elevated these parameters more robustly in smokers than non-smokers(P<0.05). Moreover, MACBAR of sevoflurane and levels of CYP2E1 showed a significant correlation (r=0.51, P<0.05) , and both were higher in smokers than non-smokers(P<0.05). Conclusions Smoking patients had higher levels of CYP2E1, which may accelerate the metabolism of sevoflurance and increase MACBAR. Key words: Smoking; Sevoflurane; Minimum alveolar concentration to block the adrenergic response; Cotinine; Cytochrome P450 family 2 subfamily E member 1