Changes In HR Research Articles

Stress Watch: The Use of Heart Rate and Heart Rate Variability to Detect Stress: A Pilot Study Using Smart Watch Wearables.

Stress is an inherent part of the normal human experience. Although, for the most part, this stress response is advantageous, chronic, heightened, or inappropriate stress responses can have deleterious effects on the human body. It has been suggested that individuals who experience repeated or prolonged stress exhibit blunted biological stress responses when compared to the general population. Thus, when assessing whether a ubiquitous stress response exists, it is important to stratify based on resting levels in the absence of stress. Research has shown that stress that causes symptomatic responses requires early intervention in order to mitigate possible associated mental health decline and personal risks. Given this, real-time monitoring of stress may provide immediate biofeedback to the individual and allow for early self-intervention. This study aimed to determine if the change in heart rate variability could predict, in two different cohorts, the quality of response to acute stress when exposed to an acute stressor and, in turn, contribute to the development of a physiological algorithm for stress which could be utilized in future smartwatch technologies. This study also aimed to assess whether baseline stress levels may affect the changes seen in heart rate variability at baseline and following stress tasks. A total of 30 student doctor participants and 30 participants from the general population were recruited for the study. The Trier Stress Test was utilized to induce stress, with resting and stress phase ECGs recorded, as well as inter-second heart rate (recorded using a FitBit). Although the present study failed to identify ubiquitous patterns of HRV and HR changes during stress, it did identify novel changes in these parameters between resting and stress states. This study has shown that the utilization of HRV as a measure of stress should be calculated with consideration of resting (baseline) anxiety and stress states in order to ensure an accurate measure of the effects of additive acute stress.

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

Objective To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018–January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 μg/kg, 0.5 μg/kg, and 0.8 μg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results No notable differences in general data were observed among the groups (P > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B (P < 0.05), and the scores were higher in group D than those in group C (P < 0.05). The HR changes at each period were close between groups A and B (P > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D (P > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 (P < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B (P < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 (P < 0.05). With no statistical difference in the MAP levels at T0 among the four groups (P > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D (P < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D (P < 0.05), with longer extubation time in group B than that in groups C and D (P < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C (P < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B (P < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C (P < 0.05). Conclusion Dexmedetomidine at doses of 0.5 μg/kg and 0.8 μg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 μg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 μg/kg.

Does the type of seizure influence heart rate variability changes?

ObjectiveHeart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure – FBTCS – versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. MethodsWe performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally. ResultsWe included 14 patients, with a median age of 36 (min–max, 16–55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease.In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS.From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). Significance/conclusionThis work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.

Task switching challenge to reveal abnormal brain‐heart signatures in cognitively healthy individuals with abnormal CSF amyloid/tau

AbstractBackgroundAlpha oscillations during task switching reveals general attention (low alpha) and higher executive attentional control (high alpha). Alpha oscillations have been related to heart rate variability (HRV), both change in Alzheimer’s disease (AD). We aim to explore if task switching challenge with quantitative electroencephalography (qEEG) can reveal abnormal alpha power and HRV in individuals with high risk of AD, and we predict HRV improves qEEG’s detection of high AD risk.MethodWe compared alpha power during task switching testing between two groups of cognitively healthy participants (52‐91 years) based on different cerebrospinal fluid (CSF) amyloid/tau ratio: normal (CH‐NAT, n=19) or pathological amyloid/tau ratio (CH‐PAT, n=27). Participants were required to name the color or word of a colored word for each stimulus, with two sequential stimuli per trial. Alpha event‐related desynchronization (ERD) was analyzed during low load, repeat trials (color‐color or word‐word) and high load, switch trials (color‐word or word‐color). HRV was assessed from 5‐minute ECG recording during rest or task, including: standard deviation of RR‐intervals (SDNN), root mean squared of successive differences (RMSSD) in the time domain, as well as high (HF) and low frequency (LF) in the frequency domain. We trained a binary classifier to predict the CH‐PATs using a 30 random split of training (80%) and testing (20%) data and two‐layer, fully connected neural network after identifying significant qEEG and HRV features.ResultWe found that low alpha power was less negative in CH‐PATs than CH‐NATs (Central: ‐0.18±0.66 vs. ‐0.72±0.72, p=0.011, Cohen’s d=0.79; Parietal: ‐0.25±0.75 vs. ‐0.83±0.92, p=0.024, Cohen’s d=0.70) (Fig. 1). Furthermore, we observed significant HR and LF changes from resting to task state only in CH‐PATs, but not in CH‐NATs (Fig. 2). After identifying brain features and heart features, we explored the HRV effect on brain features’ test accuracy.ConclusionThese results suggest: 1) low alpha power during task switching challenge differs between CH‐PATs and CH‐NATs; 2) HRV suggests hyperactive autonomic regulations from resting to task in CH‐PATs, but not CH‐NATs. qEEG reveals interaction of brain and heart features in early AD pathology that may help early diagnosis and monitoring of novel therapies.

Abstract 14141: Role of Pak1 in Sinus Node Function

Introduction: Sinus node (SN) dysfunction (SND) and atrial arrhythmia frequently occur simultaneously with a hazard ratio of 4.2 for new onset atrial fibrillation (AF) in SND patients. We demonstrated previously that loss of p21-activated kinase 1 (Pak1), a serine/threonine kinase increases the propensity for AF by increasing cellular production of reactive oxygen species (ROS). Since pacemaker current (HCN4) is negatively regulated by cellular ROS we hypothesized that loss of Pak1 leads to attenuated SN function. Methods: Heart rate regulation was quantified in wild type (WT) and Pak1 deficient mice (Pak1 -/- ) in vivo and the isolated Langendorff perfused heart using ECGs, bipolar and multi-electrode array derived atrial electrograms. Unpaired t-test was used to compare means between groups. Results: In vivo WT and Pak1 -/- animals exhibited no difference in basal heart rate (WT: 450 ± 26 bpm, n=16; Pak1 -/- : 440 ± 24 bpm, n=13), but intrinsic HR after autonomic blockage, was reduced in Pak1 -/- (WT: 399 ± 32 bpm, n=16; Pak1 -/- : 365 ± 34 bpm, n=13, p&lt;0.05). The result was confirmed in the Langendorff configuration (WT: 359 ± 47 bpm, n=12; Pak1 -/- : 293 ± 47 bpm, n=21, p&lt;0.01) suggesting attenuated SN impulse generation. To determine the contribution of the Ca clock, hearts were perfused with cyclopiazonic acid (5 μM) a blocker of the sarcoplasmic reticulum Ca ATPase. CPA attenuated the HR in WT and Pak1 -/- (WT: -19.6 ± 6.6 % n=2 ; Pak1 -/- : -15.8 ± 7.5 %, n=5) but did not eliminate the difference in HR (WT: 320 ± 37 bpm, n=2; Pak1 -/- : 255 ± 26 bpm, n=5, p&lt;0.05). Block of HCN4 by ivabradine (3 μM), reduced the HR in WT and Pak1 -/- (WT: -45.1 ± 6.3 %, n=6; Pak1 -/- : -22.2 ± 8.6 %, n=7, p&lt;0.001) and eliminated differences in spontaneous activity (WT: 186 ± 43 bpm, n=6; Pak1 -/- : 234 ± 41 bpm, n=7). In vivo the change in HR in response to ß-blocker propranolol (WT: -13.5 ± 2.5 %, n=6; Pak1 -/- : -18.4 ± 1.5 %; n=4, p&lt;0.01) and muscarinic receptor blocker atropine (WT: 9.7 ± 5.0%, n=10; Pak1 -/- : 4.6 ± 4.4 %; n=9, p&lt;0.05) revealed that the attenuated SN impulse generation in Pak1 -/- mice was compensated by an increased sympathetic and attenuated parasympathetic tone. Conclusion: Attenuated Pak1 expression results in suppressed SN impulse generation likely by ROS dependent attenuation of HCN4 expression.

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Introduction: The intraoperative anesthetic and postoperative analgesic requirements are of great importance especially in neurosurgical anesthesia. This requires balancing a deep and effective anesthesia and postoperative analgesia versus the risks of delayed recovery and postoperative respiratory depression from excessive analgesics. Magnesium sulfate is an antagonist of the N-Methyl-D-Aspartate (NMDA) receptors in a voltage-dependent fashion. Propofol also inhibits the NMDA subtype of the glutamate receptor. Therefore, magnesium sulfate when coadministered with propofol potentiates anesthetic effect and NMDA antagonism of propofol. Majority of the studies that evaluated the anesthetic and analgesic requirement in patients receiving magnesium sulfate depended on the clinical parameters, for example, hemodynamic parameters and measurement of pain scores. In this study, we added bispectral index (BIS) and neuromuscular monitoring using train-of-four (TOF) to adjust intraoperative anesthetic requirements in addition to the clinical parameters.&#x0D; Methodology: This randomized controlled double-blind study included 50 adult ASA I and II male and female patients undergoing neurosurgical maneuvers. Patients were randomly divided into two equal groups. Routine intraoperative monitoring including invasive BP and in addition TOF and BIS were applied. In a blind fashion, patient in group I (Magnesium group) received magnesium sulfate 20 mg/kg as bolus dose over 5 min followed by 0.1 ml/kg/hr of 10% solution as infusion, while patient in group II (Control group) received saline with the same bolus and infusion rates after the induction of anesthesia. Anesthesia was induced in both groups by fentanyl 2 µg/kg, propofol 1.5–2 mg/kg, and rocuronium in a dose of 0.6 mg/kg to facilitate ETT insertion. This is followed by continuous infusion of propofol 6–10 mg/kg/hr and fentanyl 1–2 mic/kg/hr. The parameters which were assessed included hemodynamic parameters (HR and BP), TOF, and BIS. Total consumptions of propofol, fentanyl, rocuronium, and postoperative analgesic requirements (PCA morphine) were recorded. In addition, recovery time and postoperative pain score by visual analog scale (VAS) were recorded.&#x0D; Result: There was no significant difference in patient characteristics between the two groups. As regard the hemodynamic changes and BIS, no significant difference was seen between the two groups except the HR change which was significantly reduced (p = 0.005) with surgical stimulation in group I compared to the other group. Results also showed that the mean fentanyl, propofol, and rocuronium consumption, recovery time, degree of postoperative pain, and postoperative analgesic requirements were significantly less in patients that received magnesium sulfate infusion compared to those in the control group.&#x0D; Conclusion: Magnesium sulfate is most likely a safe and cost-effective supplement to the general anesthesia in neurosurgery as it reduces the total anesthetic and analgesic requirements and postoperative pain.

Outcomes of Single Versus Tandem Hematopoietic Stem Cell Autologous Transplant in High-Risk Myeloma Patients: A Single-Center Experience

Introduction: Over the past decade, significant advances in the treatment strategy of newly diagnosed multiple myeloma patients (NDMM) have challenged the initial management strategy in transplant-eligible (TE) patients. The value of a single autologous stem cell transplant (ASCT) is established in standard-risk myeloma; however, the role for tandem ASCT reveals conflicting results, especially in patients with high-risk cytogenetic (HR) features. HR changes include at least one of the cytogenetic lesions: t(4;14), t(14;16), t(14;20), del17p, 1q amp +, 1q amp + del 1p. Subgroup analyses of HR patients in the EMN02 study suggest benefits with tandem ASCT.Methods: We retrospectively reviewed our single centre ASCT experience in TE NDMM patients with HR from London, Canada, from January 1, 2007, to April 30, 2021 with the primary objective to compare single versus tandem ASCT for patients with high-risk MM. Secondary objectives include progression-free survival (PFS), overall survival (OS) and the effect of maintenance therapy on survival. OS and PFS were estimated using the Kaplan-Meier method. We also applied univariate and multivariate cox regression to assess the effects of age, hemoglobin, and creatinine on survival.Results: 155 NDMM received at least one ASCT between January 1, 2007 to April 30, 2021. 61/155 (39.3%) patients had HR disease. T(4:14) was seen in 19/61 (31.1%) patients; t(14:16) in 9/61 (9.8%) patients; del 17p in 20/61 (32.7%) patients, 1q amp in 36/61 (59.0%) patients and 1p del + 1q amp in 8/61 (13.1%). Patients with more than one abnormality was seen in 22/61 (36.0%) patients. In this high-risk group, the most common induction regimen consisted of cyclophosphamide, bortezomib, and dexamethasone (CyBorD) in 58/61 patients (95.0%). 34 (55.7%) patients received single ASCT and 27 (44.2%) patients received tandem ASCT. 18/34 (52.9%) single ASCT patients and 15/27 (55.5%) tandem ASCT patients received maintenance therapy. Maintenance therapy included single-agent lenalidomide (imid) in 14/61 (22.9%); single-agent bortezomib or ixazomib (proteasome inhibitor (PI)) in 8/61 (13.1%), and; imid + PI combination in 11/61(18.0%). Baseline characteristics are summarized in Table 1.Single versus tandem ASCT in HR patients revealed no statistically significant PFS difference at 60 months (p=0.3). Maintenance therapy demonstrated a substantial improvement in PFS regardless of the number of ASCT (single ASCT HR=0.1687, 95% CI range 0.05-0.52, p<0.001) tandem ASCT (HR=0.1319, 95% CI range 0.01-0.96, p=0.019). PFS was similar in patients who did not receive maintenance in tandem ASCT (20 months) or single ASCT (19 months) (p=0.57).At the 60-month follow-up, the median PFS for high-risk patients without maintenance was 18.8 months. In contrast, the PFS for patients on maintenance was not reached (HR=0.1446, 95% CI range 0.05-0.38, p<0.001). There was no difference in OS (p=0.38) with or without maintenance therapy. When comparing single-agent vs. combination strategy with maintenance, there was no PFS (p=0.47) or OS (p=0.68) difference between strategies. All patients were progression-free in those who received any maintenance at 60 months.Conclusion: In our single centre experience, single vs. tandem ASCT in TE NDMM with HR disease did not contribute to long-term survival outcomes, but the presence of any maintenance therapy had a more considerable impact on PFS. Our data does show a longer progression-free survival compared to previous published data, which is likely due to our sample size. [Display omitted] DisclosuresLam: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; SeaGen: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffmann-La Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees. Phua: Amgen: Honoraria; NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria. Louzada: Amgen: Honoraria; Pfizer: Honoraria; Celgene: Honoraria; Janssen: Honoraria.

Prevention of Oculocardiac Reflex by Premedication With Low Dose I/V Ketamine during Strabismus Surgery

Background: OCR commonly occurs during strabismus surgery, producing bradycardia, arrhythmias and even cardiac arrest after manipulation of orbital structures. Ketamine is NMDA receptor antagonist and acts as an analgesic. Aim: To determine the effect of ketamine premedication on prevention of OCR during strabismus surgery. Study design: Randomized control trial Methodology: 60 patients were randomly divided into two groups i.e., Ketamine 0.75mg/kg (Group K) and control (Group C). Group K patients were premedicated with 0.75mg/kg ketamine while Group C patients did not receive any premedication. Heart rate and ECG were observed 30 sec before and continuously after traction on extraocular muscles was applied upto end of surgery for bradycardia and arrhythmias. Percentage change in HR and presence of arrhythmias was documented. All the data was collected using case report form and analyzed using SPSS version 15. Results: In Group C, 15(50%) cases had arrhythmias while in Group K, only 4(13.33%) cases had arrhythmias. Mean HR in Group C was 118.77±6.92/min and in Group K was 101.57±15.65/min. In Group C, oculocardiac reflex was present in 23(76.7%) cases and in Group K, OCR was present in 6 (20%) cases and prevented in 24 (80%) cases. Conclusion: Premedication with 0.75mg/kg IV ketamine significantly reduces the occurrence of oculocardiac reflex during strabismus surgery. Keywords: Ketamine, Oculocardiac Reflex, Premedication, Prevention, Strabismus

Monitoring Effects of Sleep Extension and Restriction on Endurance Performance Using Heart Rate Indices.

Roberts, SSH, Aisbett, B, Teo, W-P, and Warmington, S. Monitoring effects of sleep extension and restriction on endurance performance using heart rate indices. J Strength Cond Res 36(12): 3381-3389, 2022-Heart rate (HR) indices are useful for monitoring athlete fatigue or "readiness to perform." This study examined whether HR indices are sensitive to changes in readiness following sleep restriction (SR) and sleep extension (SE). Nine athletes completed a crossover study with 3 conditions: SR, normal sleep (NS), and SE. Each condition required completion of an endurance time trial (TT) on 4 consecutive days (D1-D4). Athletes slept habitually before D1; however, time in bed was reduced by 30% (SR), remained normal (NS), or extended by 30% (SE), on subsequent nights (D1-D3). Daily resting HR and HR variability were recorded. The maximal rate of HR increase and HR recovery was determined from a constant-load test before TTs. Exercise intensity ratios incorporating mean HR, mean power (W), and perceived exertion (RPE) were recorded at steady state during constant-load tests (W:HR SS ) and during TTs (W:HR TT , RPE:HR TT ). Compared with D4 of NS, RPE:HR TT was lower on D4 of SE ( p = 0.008)-when TT performances were faster. Compared with D1 of SR, RPE:HR TT was higher on D3 and D4 of SR ( p < 0.02). Moderate correlations were found between percentage changes in W:HR TT and changes in TT finishing time in SR ( r = -0.67, p = 0.049) and SE ( r = -0.69, p = 0.038) conditions. Intensity ratios incorporating mean HR seem sensitive to effects of sleep duration on athlete readiness to perform. When interpreting intensity ratios, practitioners should consider potential effects of prior sleep duration to determine whether sleep-promoting interventions are required (e.g., SE).

Singing and music making: physiological responses across early to later stages of dementia.

Background: Music based interventions have been found to improve the wellbeing of people living with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate dementia during a singing group, and six people in the later stages of dementia during an interactive music group. The interactive music group was also video recorded to provide information about engagement. Data were analysed using simulation modelling analysis. Results: The singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster paced songs. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during an interactive music group compared to a control session (music listening). EDA (p < 0.0001 for 14/18 participants) and ST (p < 0.001 for 10/18 participants) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 participants). EDA was higher during slower music (p < 0.0001 for 13/18 participants), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different styles of music. Conclusions: Physiological measures may provide valuable information about the experiences of people with dementia participating in arts and other activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures with video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.

Acoustic signal dominance in the multimodal communication of a nocturnal mammal

Multimodal communication in animals is common, and is particularly well studied in signals that include both visual and auditory components. Multimodal signals that combine acoustic and olfactory components are less well known. Multimodal communication plays a crucial role in agonistic interactions in many mammals, but relatively little is known about this type of communication in nocturnal mammals. Here, we used male Great Himalayan leaf-nosed bats Hipposideros armiger to investigate multimodal signal function in acoustic and olfactory aggressive displays. We monitored the physiological responses (heart rate [HR]) when H. armiger was presented with 1 of 3 stimuli: territorial calls, forehead gland odors, and bimodal signals (calls + odors). Results showed that H. armiger rapidly increased their HR when exposed to any of the 3 stimuli. However, the duration of elevated HR and magnitude of change in HR increased significantly more when acoustic stimuli were presented alone compared with the presentation of olfactory stimuli alone. In contrast, the duration of elevated HR and magnitude of change in HR were significantly higher with bimodal stimuli than with olfactory stimuli alone, but no significant differences were found between the HR response to acoustic and bimodal stimuli. Our previous work showed that acoustic and chemical signals provided different types of information; here we describe experiments investigating the responses to those signals. These results suggest that olfactory and acoustic signals are non-redundant signal components, and that the acoustic component is the dominant modality in male H. armiger, at least as it related to HR. This study provides the first evidence that acoustic signals dominate over olfactory signals during agonistic interactions in a nocturnal mammal.

Virtual Reality Effects on Acute Pain during Office Hysteroscopy: A Randomized Control Trial

<h3>Study Objective</h3> To evaluate the use of virtual reality (VR) as a noninvasive and nonpharmacologic analgesic during office hysteroscopy procedures. <h3>Design</h3> Single site, parallel group, unblinded randomized controlled trial. <h3>Setting</h3> Single academic outpatient minimally invasive gynecology surgery clinic. <h3>Patients or Participants</h3> Women over 18 years of age scheduled to undergo in office hysteroscopy were invited to participate in the study. 85 participants were approached, 50 consented to participate and were randomized using a computerized random number generator (n=25 in VR group and n=25 in standard group). <h3>Interventions</h3> Patients were randomized to VR intervention or standard of care from May to November 2020. The VR intervention consisted of listening to a 10-minute guided Zen meditation using The Guided Meditation VR App through an Oculus Go headset. <h3>Measurements and Main Results</h3> Primary outcome was peak pain score during the procedure based on a 100 mm visual analogue scale (VAS) score. The secondary outcomes were change in pain score (peak pain score minus baseline pain score) and change in participant's HR (average BPM before procedure – average BPM during procedure). Data was also collected to assess patient and surgeon satisfaction. The peak pain score during the procedure for the VR group was 35 [15, 60] vs 30 [9, 54] for the standard hysteroscopy group (P=0.317). Compared with the standard of care, VR had no significant effect on median heart rate change during the procedure (-4.6 [-0.5,11.1] vs +2.8 [0.1,7.7] P=0.327). Participants in the VR group had a positive experience with VR and 88% reported the music was very or slightly calming and 84% reported meditation was very or slightly helpful. No serious adverse events occurred. <h3>Conclusion</h3> This study found no statistically significant difference in pain scores or change in heart rate prior to, during, or after hysteroscopic procedures with VR compared to standard of care. Participants were satisfied with the VR intervention.

Singing and music making: physiological responses across early to later stages of dementia

Background: Music based interventions have been found to improve the wellbeing of people living with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate dementia during a singing group, and six people in the later stages of dementia during an interactive music group. The interactive music group was also video recorded to provide information about engagement. Data were analysed using simulation modelling analysis. Results: The singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster paced songs. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during an interactive music group compared to a control session (music listening). EDA (p < 0.0001 for 14/18 participants) and ST (p < 0.001 for 10/18 participants) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 participants). EDA was higher during slower music (p < 0.0001 for 13/18 participants), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different styles of music. Conclusions: Physiological measures may provide valuable information about the experiences of people with dementia participating in arts and other activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures with video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.

HR Activities Amidst the COVID-19 Pandemic across Levels of Analysis

Theoretical background: The arrival of the COVID-19 pandemic heralded significant changes to existing HR activities followed by organizations and companies, trying to respond to government restrictions and new employment conditions. During these challenging times, employees are in the need of robust support by HR professionals in order to keep on performing, being motivated and thriving within their organizations and companies. Nonetheless, these modified HR activities are going through the stages of conception, actual implementation and, finally, they are experienced by employees. The intended, actual and experienced HR activities may evolve over time due to external and internal factors that are connected to pandemic. Understanding these changes is necessary for achieving effective HR management and optimal levels of organizational performance. Purpose of the article: The aim of this article is to discuss the factors that affect HR activities through the framework of their internalization process. The factors that may be catalysts for changes of the HR activities on different levels: intended, actual and experienced activities over time are discussed and guidelines for future research are suggested. Research methods: The article applies literature review of possible factors that may induce changes in intended, actual and experienced HR practices in the context of the COVID-19 pandemic. Main findings: Absence of appropriate HR activities may increase anxiety and stress levels of employees. This negative impact can be potentially augmented by the perceived gap between employee expectations and the actual experience of these HR activities. In an effort to better understand these gaps occurring during the internalization process, we suggest that HR activities at the intended level may change due to business transformation, workplace transformation and employee well-being, while line manager’s characteristics and interactions with HRM departments may be catalysts for change in the actual HR. Finally, the assessment of the outcome of HR activities, the way in which they are delivered, and their continuity could be considered as important factors at the experienced level of the internalization process.

Dapagliflozin Mediates Plin5/PPARα Signaling Axis to Attenuate Cardiac Hypertrophy.

Objective: The purpose of this study was to investigate the effect of dapagliflozin (DAPA), a sodium-glucose cotransporter 2 inhibitor, on relieving cardiac hypertrophy and its potential molecular mechanism. Methods: Cardiac hypertrophy induced by abdominal aortic constriction (AAC) in mice, dapagliflozin were administered in the drinking water at a dose of 25 mg/kg/d for 12 weeks was observed. Echocardiography was used to detect the changes of cardiac function, including LVEF, LVFS, LVEDd, LVEDs, HR and LV mass. Histological morphological changes were evaluated by Masson trichrome staining and wheat germ agglutinin (WGA) staining. The enrichment of differential genes and signal pathways after treatment was analyzed by gene microarray cardiomyocyte hypertrophy was induced by AngII (2 μM) and the protective effect of dapagliflozin (1 μM) was observed in vitro. The morphological changes of myocardial cells were detected by cTnI immunofluorescence staining. ELISA and qRT-PCR assays were performed to detect the expressions levels of cardiac hypertrophy related molecules. Results: After 12 weeks of treatment, DAPA significantly ameliorated cardiac function and inhibited cardiac hypertrophy in AAC-induced mice. In vitro, DAPA significantly inhibited abnormal hypertrophy in AngII-induced cardiacmyocytes. Both in vivo and in vitro experiments have confirmed that DAPA could mediate the Plin5/PPARα signaling axis to play a protective role in inhibiting cardiac hypertrophy. Conclusion: Dapagliflozin activated the Plin5/PPARα signaling axis and exerts a protective effect against cardiac hypertrophy.

Anesthetic Effect of Sufentanil Combined with Remifentanil in Patients Undergoing Radical Gastrectomy

Objective: To explore and analyze the anesthetic effect of sufentanil combined with remifentanil in patients undergoing radical gastrectomy for gastric cancer. Methods: In this study, 100 patients receiving radical gastrectomy for gastric cancer in our hospital were selected as the research subjects, and the period from June 2019 to February 2021 was divided into different anesthesia regimens. Fifty patients receiving remifentanil anesthesia were used as the control group, and 50 patients receiving remifentanil combined with sufentanil anesthesia were used as the research group. The anesthetic effect of the two groups of patients was analyzed and compared. Results: The HR and MAP of the study group at different time after intubation were lower than those of the control group (P&lt;0.05). The changes of HR and MAP before and after intubation in two groups were significant compared with those before intubation (P&lt;0.05). The postoperative VAS score of the study group was significantly better than that of the control group (P&lt;0.05). Conclusions: In radical gastrectomy for gastric cancer, the choice of sufentanil and remifentanil as the anesthesia scheme can effectively stabilize the hemodynamics of patients, relieve the degree of postoperative pain, with obvious clinical value.

Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes

ObjectivesAdenosine hyperemia is an integral component of the physiological assessment of obstructive coronary artery disease in patients with chronic coronary syndrome (CCS). The aim of this study was to compare systemic, coronary and microcirculatory hemodynamics between intravenous (IV) adenosine hyperemia versus physical exercise stress in patients with CCS and coronary stenosis. MethodsTwenty-three patients (mean age, 60.6 ± 8.1 years) with CCS and single-vessel coronary stenosis underwent cardiac catheterization. Continuous trans-stenotic coronary pressure-flow measurements were performed during: i) IV adenosine hyperemia, and ii) physical exercise using a catheter-table-mounted supine ergometer. Systemic, coronary and microcirculatory hemodynamic responses were compared between IV adenosine and exercise stimuli. ResultsMean stenosis diameter was 74.6% ± 10.4. Median (interquartile range) FFR was 0.54 (0.44–0.72). At adenosine hyperemia versus exercise stress, mean aortic pressure (Pa, 91 ± 16 mmHg vs 99 ± 15 mmHg, p < 0.0001), distal coronary pressure (Pd, 58 ± 21 mmHg vs 69 ± 24 mmHg, p < 0.0001), trans-stenotic pressure ratio (Pd/Pa, 0.63 ± 0.18 vs 0.69 ± 0.19, p < 0.0001), microvascular resistance (MR, 2.9 ± 2.2 mmHg.cm−1.sec−1 vs 4.2 ± 1.7 mmHg.cm−1.sec−1, p = 0.001), heart rate (HR, 80 ± 15 bpm vs 85 ± 21 bpm, p = 0.02) and rate-pressure product (RPP, 7522 ± 2335 vs 9077 ± 3200, p = 0.0001) were all lower. Conversely, coronary flow velocity (APV, 23.7 ± 9.5 cm/s vs 18.5 ± 6.8 cm/s, p = 0.02) was higher. Additionally, temporal changes in Pa, Pd, Pd/Pa, MR, HR, RPP and APV during IV adenosine hyperemia versus exercise were all significantly different (p < 0.05 for all). ConclusionsIn patients with CCS and coronary stenosis, invasive hemodynamic responses differed markedly between IV adenosine hyperemia versus physical exercise stress. These differences were observed across systemic, coronary and microcirculatory hemodynamics.

A Hemodynamic Study to assess response, tolerance and dose optimization of Carvedilol in Child Class A patients with Portal Hypertension

Background: Carvedilol has an established role in Chronic Liver disease (CLD) associated Portal Hypertension, however its role in specific subclasses of CLD has not been studied, neither the factors leading to non-response thereby predisposing such patients to variceal bleed with empiric therapy.&#x0D; Aims and Objectives: The purpose of this study was. 1. To evaluate the hemodynamic response to Carvedilol and optimum dosage in patients of CTP Class A Cirrhosis. 2. To determine any clinical variables that would help in differentiating responders from non-responders.&#x0D; Materials and Methods: In forty-three consecutive patients of chronic liver disease Child Turcotte Pugh (CTP) Class A with esophageal varices, Hepatic Venous Pressure Gradient (HVPG) was measured at baseline, 90 minutes after initial administration of 12.5 mg of Carvedilol and after 3 months of dose optimization.&#x0D; Results: Twenty-one (48.8%) patients demonstrated Acute Response and after dose optimization Chronic Response was seen in 29 (67.4%) patients with additional 8 (18.6%) patients responding to dose optimization. Fourteen (32.55%) patients failed to show any response. Low pre-drug Cardiac Output (CO), High pre-drug mean arterial pressure (MAP), more than 2.5mmHg drop in HVPG acutely, higher dose toleration of more than 18.5mg and lower change in HR predicted response.&#x0D; Conclusion: Patients with CTP Class A Cirrhosis with Portal Hypertension and Esophageal Varices tolerate Carvedilol well and nearly two-thirds show hemodynamic response when dose is optimized over a period of time, including patients who initially show no acute response. Nearly one-third of patients show no response even after dose optimization.

Abiraterone In Vitro Is Superior to Enzalutamide in Response to Ionizing Radiation.

Abiraterone acetate and Enzalutamide are novel anti-androgens that are key treatments to improve both progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer. In this study, we aimed to determine whether combinations of AR inhibitors with radiation are additive or synergistic, and investigated the underlying mechanisms governing this. This study also aimed to compare and investigate a biological rationale for the selection of Abiraterone versus Enzalutamide in combination with radiotherapy as currently selection is based on consideration of side effect profiles and clinical experience. We report that AR suppression with Enzalutamide produces a synergistic effect only in AR-sensitive prostate models. In contrast, Abiraterone displays synergistic effects in combination with radiation regardless of AR status, alluding to potential alternative mechanisms of action. The underlying mechanisms governing this AR-based synergy are based on the reduction of key AR linked DNA repair pathways such as NHEJ and HR, with changes in HR potentially the result of changes in cell cycle distribution, with these reductions ultimately resulting in increased cell death. These changes were also shown to be conserved in combination with radiation, with AR suppression 24 hours before radiation leading to the most significant differences. Comparison between Abiraterone and Enzalutamide highlighted Abiraterone from a mechanistic standpoint as being superior to Abiraterone for all endpoints measured. Therefore, this provides a potential rationale for the selection of Abiraterone over Enzalutamide.

Effect of leg lift on stroke volume index in children 11-17 years old before and after induction of general anesthesia.

Fluid administration in ERAS is one component which anesthesiologists have control. Change in stroke volume index (SVI) is used to assess fluid responsiveness. This study sought the effect of perioperative fluid responsiveness in pediatric patients. The Cheetah NICOM™ (noninvasive CO monitor) was employed because of correlation with other CO monitors. The Cheetah NICOM™ is an FDA-approved device in adults. Its indications in children are unknown. 24 enrolled patients (age 11-17) were ASA 1 or 2 without cardiopulmonary disease. The study examined changes in SVI, HR, SBP, and DBP between the semi-recumbent and legs lifted positions, both awake and after anesthesia. Each patient had baseline vital signs measured and fluid responsiveness determined with the Cheetah NICOM™ monitor. Stroke volume index (SVI) was measured in both the semi-recumbent position and after passive leg lift. Measurements were repeated immediately after induction of general anesthesia. Twenty-one of 24 patients received inhalation induction with sevoflurane and three patients received intravenous propofol followed by sevoflurane. Airway management included intubation in 19 of 24 and a laryngeal mask airway (LMA) in five of 24 patients. There was a 25% increase in SVI after leg lift from 54.8ml/m2 to 68.0ml/m2 in awake patients (p &lt; 0.001). Diastolic pressure decreased by 15.4% from 67.9mmHg to 58.2mmHg from semi-recumbent position and leg lift, respectively (p=.004). No significant change in heart rate or SBP was found. Following induction, patient SVI increased with leg lift by 25.6% from 42.6ml/m2 to 53.5ml/m2 after leg lift (p=.003). Heart rate decreased by 9.3% and SBP increased 2.8% with leg lift. 96% of normal 11-17-year-old children were fluid responsive while awake and 79% after induction of general anesthesia.