Nervous System Disturbances Research Articles

Prion diseases: fatal familial insomnia

Introduction. Fatal familial insomnia (FFI) is one of the transmissible spongiform encephathalopathies characterized by neuronal loss, sleep impairment, subsequent non-specific disturbances of autonomic nervous system (e.g. tachycardia) and endocrine dysfunctions. It is fatal autosomal dominant prion disease, which is extremaly rare- FFI affects only about one person per milion annually. The aim of this study is to review the literature and systematize knowledge about fatal familial insomnia.Brief description of the state of knowledge. The causative agent of this disease is a misfolded version of the physiological prion protein called PrP(Sc) in the brain. Major vulnerable regions in FFI are mediodorsal and anterior ventral nuclei of the thalamus. Average survival time after the onset of symptoms is 18 months. Hence molecular mechanisms involved in pathogenesis are poorly understood, the disease is incureable yet. However, there are a number of therapeutic options currently under investigation, e.g. immunotherapy or doxycycline usage.Conclusions. Subsequent researches are essential to improve understending of fatal familial insomnia. The prime issue is to develop functioning therapeutic or preventive treatment. While some of presented terapeutic approches appers promising, all of them require profoud research.

Development and validation of the mirror image comfort and avoidance scale (MICAS)

Purpose The purpose of this study was to develop an instrument to measure the experience of viewing one's reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies designed to improve the mirror-viewing experience for those who have suffered psychological or bodily trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument. Methods The developed items went through content expert validation, exploratory and confirmatory factor analyses, and internal consistency reliability testing. Results Using an exploratory factor analysis (n = 137) and a confirmatory factor analysis (n = 142), we validated a 17-item instrument for two distinct populations: veterans (n = 108) and individuals with upper and lower limb loss (n = 210). The mirror viewing comfort subscale (9 items; α = 0.90) and the mirror avoidance subscale (8 items, α = 0.94) were deemed reliable. Strong, significant correlations between pre-and post-comfort scores (r = 0.81, p < 0.001), as well as pre-and post-avoidance scores (r = 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. Conclusions This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure. Implications for rehabilitation Individuals who suffer actual or perceived body disfigurement due to surgery or trauma may suffer mirror discomfort or mirror trauma when viewing their bodies in a mirror. This reaction is due to a pre-frontal cortex neurological disruption and autonomic nervous system fright/flight or faint. Psychological disorders (e.g., devastation, shame, self-revulsion, decreased body image) may ensue. Falls have occurred due to mirror trauma due to an autonomic nervous system disturbance (faint) and may result in ongoing mirror avoidance. When mirrors are needed for incision visualization, mirror avoidance has led to severe surgical site infections. Although there were many scales available in the literature to measure several aspects of the effects of actual or perceived body disfigurement, there were no scales that measured the mirror-viewing experience. Clinicians and researchers can use the Mirror Comfort and Avoidance Scale (MICAS) to assess mirror comfort and avoidance.

Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Behcet's Disease.

BackgroundBehçet’s disease (BD) is a multisystemic vasculiti where cardiac involvement is not common. Previous studies have shown that the incidence of ventricular arrhythmia and sudden cardiac death (SCD) is higher in patients with BD than in the healthy population. Among various possible explanations, autonomic nervous system (ANS) dysfunction has been suggested. Few studies have evaluated ANS function in patients with BD, and the results obtained are controversial.ObjectiveWe aimed to assess cardiac autonomic function by heart rate variability (HRV) in patients with BD; to evaluate circadian changes in HRV; and to study the relationship between HRV parameters and disease parameters.MethodsThirty-six patients with Behçet’s disease (median age 42 years, 28 men) and 36 age- and sex-matched healthy volunteers were included. HRV analyses were performed in the time and frequency domains for the entire 24-hour period and for the daytime and nighttime periods. BD activity was studied with Behcet’s disease current activity form (BDCAF).ResultsPatients with BD had significantly lower values of SDNN compared to controls. PNN50, RMSSD, and HF components mean values were significantly reduced in patients than in controls implying parasympathetic impairment. LF was comparable between the two groups, whereas LF/HF ratio was significantly higher in BD group. The circadian rhythm of HRV was preserved in patient group. There was no significant correlation of CRP or disease duration with HRV indices in Behçet’s subjects. BDCAF score was found to be negatively correlated with LF/HF.ConclusionPatients with BD, despite no cardiovascular involvement, have reduced parasympathetic activity compared with controls. However, circadian rhythms of autonomic function were preserved. As known, there is strong evidence for the role of the ANS in the pathogenesis of ventricular arrhythmias. Thus, being a practical tool, HRV can be an interesting approach for the rhythmic follow-up of BD patients.

Brainwave assistive system for paralyzed individuals

The Brain-Computer Interface (BCI) is a system based on brainwaves that can be used to translate and comprehend the innumerable activities of the brain. Brainwave refers to the bioelectric impulses invariably produced in the human brain during neurotransmission, often measured as the action potential. Moreover, BCI essentially uses the widely studied Electroencephalography (EEG) technique to capture brainwave data. Paralysis generally occurs when there is a disturbance in the central nervous system prompted by a neurodegenerative or unforeseen event. To overcome the obstacles associated with paralysis, this paper on the brainwave-assistive system is based on the BCI incorporated with Internet-of-things. BCI can be implemented to achieve control over external devices and applications. For instance, the process of cursor control, motor control, neuroprosthetics and wheelchair control, etc. In this paper, the OpenBCI Cyton-biosensing board has been used for the collection of the EEG data. The accumulated EEG data is executed subsequently to obtain control over the respective systems in real-time. Hence, it can be concluded that the experiments of the paper support the idea of controlling an interfaced system through the real-time application of EEG data.

P-PN027. Sympathetic skin response in diabetic neuropathy with and without peripheral arterial disease

Introduction . Diabetic neuropathy (DN) is a common complication of diabetes. Symptoms can be tingling, pain or numbness in the lower limb. Peripheral arterial disease (PAD) is also a complication of diabetes which can cause pain in the lower limb. The presence of DN and PAD affect each other, resulting in worsening of patient condition. Autonomic nervous system disturbance, shown by sympathetic skin response (SSR) abnormalities, is an independent finding that appear early in patient with PAD. Methods . A cross sectional study with 46 DN patients based on clinical and nerve conduction study (NCS) examination. Patient were evaluated with toe-brachial index (TBI) and SSR then were categorized to PAD and non-PAD group. Results . In our study, the mean age of the study population was 63,09 years (±9,98). The mean duration of diabetes in the study population was 13,57 years (±10,43). Most of the patients had poorly controlled diabetes with a median HbA1C of 7,35 (min-max: 5,6 – 12,2). Twenty two patients (47,8%) have PAD. Ten patients (45,45%) in PAD group and 8 patients (33,33%) in non-PAD group had absent SSR in the lower limb. There was no statistically significant association between SSR abnormalities and the presence of PAD (p = 0,40). Conclusion . SSR abnormalities are more common in DN with PAD group.

Clinical evolution of perinatal pathology. Dialogues with the Teacher

Here are reported the data of investigating clinical evolution of perinatal brain pathology performed under the auspices of Professor V.A. Karlov. Analysis of the data obtained revealed an importance for detecting ante- and intranatal predictors for most relevant neurological disorders in childhood: neonatal seizures, some epilepsy forms, headache and attention deficit / hyperactivity disorders. The speaker argues for the necessity to conduct topical diagnostics of the nervous system disturbances in neonates and justifies a relationship between early and delayed neurological disorders in diverse pediatric periods.

Kainate receptors: from synaptic activity to disease.

Kainate receptors (KARs) are glutamate receptors that participate in the postsynaptic transmission of information and in the control of neuronal excitability, as well as presynaptically modulating the release of the neurotransmitters GABA and glutamate. These modulatory effects, general follow a biphasic pattern, with low KA concentrations provoking an increase in GABA and glutamate release, and higher concentrations mediating a decrease in the release of these neurotransmitters. In addition, KARs are involved in different forms of long- and short-term plasticity. Importantly, altered activity of these receptors has been implicated in different central nervous system diseases and disturbances. Here, we describe the pre- and postsynaptic actions of KARs, and the possible role of these receptors in disease, a field that has seen significant progress in recent years.

Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus

BackgroundTetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit.MethodsClinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge.ResultsAge, temperature, heart rate, lower peripheral oxygen saturation (SpO2) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively).Heart rate, SpO2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively).Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95–41.57, 53.0 [41.6–56.3] and 54.8 [51.6–57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO2, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge.ConclusionsMV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome.

Comparative Study between Two Doses of Intravenous Ondansetron on Maternal Haemodynamics during Elective Caesarean Delivery under Spinal Anaesthesia

Abstract Background: Hypotension is one of the most common intra-operative complications associated with spinal anaesthe-sia. Its incidence in caesarean section has been estimated to be as high as 50-60%. Despite fluid preloading, lateral uterine displacement and the use of vasopressor agents. It occurs due to sympathetic block which leads to autonomic nervous system disturbances and a decrease in systemic vascular resistance. This can occur because the level of block must be at least at T4 to ensure adequate analgesia severe hypotension following spinal anaesthesia in caesarean section is a dangerous com-plication. If it is unnoticed or inadequately treated, it can lead to serious maternal or fetal compromise. Aim of Study: To evaluate the effect of two doses of prophylactic ondansetron on spinal anesthesia-induced hypo-tension and bradycardia among patients undergoing elective cesarean deliveries. Patients and Methods: This study was carried out in Ain Shams Hospital Obstetric Theatres from March 2020 to September 2020. Written informed consent was obtained from every parturient included in the study. Ethical approval for this study was provided by the Ethics Committee of Faculty of Medicine, Ain Shams University. FAMSU MS 155/2020 (FWA 000017585) 23/2/2020. Results: In our study, there is statistically significant difference between the studied groups regarding dose of vasopressor use. About 53.3% and 46.7% of those within ondansteron 4mg group received 10 and 12.5mg respectively. About 51.1% and 48.9% of those within ondansteron 8mg group received 12 and 15mg respectively. In terms of side effects, no patient within either group developed shivering, vomiting or bradycardia. Regarding nausea, there is statistically non-significant difference between the studied groups regarding occurrence of nausea. Conclusion: Prophylactic bolus of intravenous onandsetron 8mg and to a lesser extent 4mg could decrease the fall in the MBP of parturients following spinal anesthesia as well as ephedrine needed dose that could decrease neonatal acidosis associated with ephedrine use.

Clinical value of emergency endovascular embolization in the interventional treatment for oral hemorrhage caused by carcinoma

To evaluate the clinical value of emergency endovascular embolization in the interventional treatment for oral hemorrhage caused by carcinoma, 32 patients with oral hemorrhage caused by carcinoma, who received emergency endovascular embolization due to unsatisfactory hemostatic effect of conventional conservative treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2019, were included in this study and their clinical data, laboratory data and imaging information were retrospectively analyzed. There were 16 males and 16 females, aged (60.6±13.6) years (34-88 years). Technical successful rate of emergency endovascular embolization, immediate successful rate of controlling hemorrhage, blood pressure before and after operation, hemoglobin before and after operation, postoperative complications and recurrence rate of oral hemorrhage were statistically analyzed. Results showed that technical successful rate of operation and immediate successful rate of controlling oral hemorrhage are both 100% (32/32). Recurrent oral hemorrhage occurred in 4 patients (13%). The hemorrhagic shock symptoms of all patients were significantly improved after interventional therapy. After operation, local swelling happened in 34% (11/32) patients and intermittent local pain happened in 22% (7/32) within 24 hours; the swelling and the pain gradually disappeared from 2nd to 5th days. Mild complications of transient fever happened in 9% (3/32) patients and disappeared spontaneously in the short term. No serious complications such as blindness, cerebrovascular accident or central nervous system disturbance occurred in all patients after operations. During the whole follow-up period (1 to 12 months), a total of 8 patients died. The causes of death were progression and metastasis of carcinoma (n=4), heart failure (n=2), severe pneumonia (n=1) and respiratory failure caused by recurrent oral hemorrhage (n=1). Owing to the remarkable short-term curative effect, repeatable operation, low recurrence rate of oral hemorrhage and low incidence of complications, emergency endovascular embolization can be used in the clinical therapy and application of oral hemorrhage caused by carcinoma.

Reversible alteration of brainstem auditory evoked potential in iron deficient anemic patients in response to treatment

Background: Iron deficiency anemia is associated with central and peripheral nervous system disturbances. Iron is an essential component of brain growth, myelination, nerve impulse conduction, protein synthesis, hormone production, fundamental aspects of cellular energy metabolism and is involved in neurotransmitter synthesis including serotonin, norepinephrine and dopamine. Hence, its deficiency adversely affects motor performance, mental development as well as cognitive and behavioral functions. Since myelination is concerned with conduction in nerve fibers, iron deficiency potentially impairs neuronal transmission and leads to functional neurodeficit like hearing loss.Methods: BAEP was recorded using RMS EMG EP MK2 machine in patients of iron deficiency anemia with haemoglobin less than 10.9 g/dl between 18-50 years of age who were followed up after 3 months of treatment and compared with 30 age and sex matched controls.Results: BAEP absolute and interpeak latencies were prolonged in IDA patients as compared to the control groups which was reversible with iron replacement therapy.Conclusions: Increased absolute and interpeak latencies of BAEP indicates impairment of auditory pathways in IDA patients. Thus, the electrophysiological study of BAEP provides an objective method for monitoring the function of CNS, especially the auditory function in iron deficiency anemia patients before and after iron replacement therapy. It is a non-invasive test for early diagnosis and therefore early treatment to prevent complications.

TTP488 ameliorates NLRP3-associated inflammation, viability, apoptosis, and ROS production in an Alzheimer's disease cell model by mediating the JAK1/STAT3/NFκB/IRF3 pathway.

Alzheimer's disease (AD), the most prevalent dementia, is identified as a neurodegenerative disease arising from a degenerative disturbance in the central nervous system. A previous study reported that TTP488 could ameliorate symptoms in patients with mild AD, but the underlying mechanisms need to be studied further. Therefore, the objective of this study was to explore the role of TTP488 in the development of an AD cell model. Administration of TTP448 in an AD cell model reduced the expression of pro-inflammatory cytokines [interleukin (IL)-1β, IL-6, and TNF-α], reversed the inhibitory role of Aβ on cell proliferation and viability, and decreased Aβ-triggered cell apoptosis and reactive oxygen species (ROS) production. Furthermore, Aβ treatment induced activation of JAK1/STAT3/NFκB/IRF3 pathway as well as NLRP3 expression, and TTP488 administration partially reversed the activation of this pathway and NLRP3 expression. Use of WP1160, a STAT3 agonist, re-activated the downstream STAT3/NFκB/IRF3 pathway and NLRP3 expression. Moreover, we found that WP1160 counteracted the role of TTP488 in Aβ-induced SH-SY5Y cells' viability, inflammation, apoptosis, and ROS production. SIGNIFICANCE OF THE STUDY: This study explores the role of TTP488 in the development of an Alzheimer's disease (AD) cell model and confirms that TTP488 administration notably promotes cell proliferation and reduces apoptosis, inflammatory factor expression, and reactive oxygen species generation. Further, this study suggests that the NLRP3-relevant JAK1/STAT3/P65/IRF3 signalling pathway is related to AD pathogenesis.

What is in a name? Autonomic imbalance and medically unexplained symptoms in Taiwan

Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in‐depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a ‘real thing’. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by ‘diagnosis’.

517 Racial differences in modified finnegan neonatal abstinence scoring for neonatal opioid withdrawal syndrome

Neonates exposed in-utero to opioids are commonly evaluated for neonatal opioid withdrawal syndrome (NOWS) using modified Finnegan Neonatal Abstinence Scoring System (FNASS). FNASS includes 21 different components of central nervous system, metabolic, vasomotor, respiratory, and GI disturbances. Consecutive cumulative scores ≥8 are suggestive for starting pharmacologic treatment. Our objective was to identify significant differences in FNASS scoring in neonates stratified by race. Retrospective cohort study of patients with opioid use disorder (OUD) who received co-located prenatal and addiction care from 2013 to 2020 at a large academic institution. Non-Hispanic Black (NHB) patients were matched to non-Hispanic White (NHW) patients by year and gestational age at delivery. Race and ethnicity were self-reported by the mother. The primary outcome was differences in individual scoring components. 42 NHB mother-newborn dyads were compared to 42 matched NWH dyads. There were no significant differences in baseline demographics between the groups. NHB newborns were significantly less likely than NHW to be scored for observed red, blotchy skin changes consistent with skin mottling (79% vs 100%, P<0.01). All NHB and NHW newborns were scored for mild tremors when disturbed and increased muscle tone; there were no significant scoring differences in the remaining FNASS components. NHB newborns were less likely to receive a FNASS ≥8 (69% vs. 81%, RR 0.85, CI 0.66-1.09) compared to NHW infants, and to receive pharmacological treatment for NOWS (76% vs. 98%, RR 0.78, CI 0.66-0.93) compared with NHW newborns. However, within this cohort of NHB newborns, receiving a score for mottling would have resulted in earlier and/or increased rates of pharmacologic treatment for NOWS in 36% (n=15) of patients. Infants born to NHB patients were less likely to receive score for skin mottling on modified FNASS. Lack of recognition of mottling maybe due to skin pigmentation differences and could potentially result in underscoring and delay of pharmacological treatment for NOWS.

Heart rate variability response to a mobile phone call in a Greek adult population

This pilot study aimed to evaluate the autonomic nervous system (ANS) disturbance before, during and after a cell phone call, in healthy adults. The opted ANS biomarker was heart rate variability (HRV), as it has been previously related to cardiovascular morbidity, mortality and depression. Twenty-four healthy volunteers (aged 34.5 ± 11.5y) entered this prospective study, after providing written informed consent. Their characteristics are presented in Table 1 . All were free of medication and underwent measurement of linear HRV parameters (RRI, LF, HF, LF/HF, SDNN, SDANN, NN50, RMSSD) with CNS Task Force Monitor in supine position, in the cardiovascular lab, in the same time of the day (15.30–16.30). Measurements were recorded during baseline relaxation (15 min), while speaking on their own cell phone (5 min) and after cell phone call end (20 min) ( Fig. 1 ). Alterations along the successive phases were statistically evaluated with repeated measures analysis in SPSS 17. Only mean sinus rhythm of RR intervals was significantly changed ( P < 0.01). This finding persisted during the 20 minutes of relaxation period following call. Even a 5 minute call causes a subtle but persisting response of HRV. This study may stimulate further research on cell phone use impact on healthy and patient subjects.

Post-Acute Sequelae of SARS-Cov-2 Infection Associating Peripheral, Autonomic and Central Nervous System Disturbances: Case Report and Review of the Literature

Aim: To describe post-infectious neurological aspects of COVID-19 in a patient with progressive post-infectious peripheral (PNS), autonomic (ANS) and central nervous system (CNS) involvement due to SARS-CoV-2 infection. Background and Purpose: A variety of neurological manifestations have been described in association with Covid-19, however, progressive multisystem neurological aspects have not been described. Methods: A case report detailing the history, examination, and infectious serology associated with SARS-CoV-2, and subsequent neurodiagnostic laboratory testing and treatment. Results: Neurodiagnostic laboratory studies showed large-fiber demyelinating sensorimotor and painful small fiber sensory polyneuropathy, orthostatic hypotension, and hypometabolism of bilateral anterior and mesial temporal lobes with a possible frontal seizure focus. Treatment was initiated with high-dose immune globulin therapy. Conclusions: The combination of PNS, ANS and CNS involvement in this patient was associated with post-infectious acquired immunity to SARS-CoV-2.

PND72 Measuring the IMPACT of Almitrine Marketing Authorisation Withdrawal on Public Health in France

Impact of pharmacovigilance (PV) actions such as marketing authorisation (MA) withdrawal on public health is not normally measured quantitatively. Removing medicines from market may reduce adverse drug reactions (ADRs) significantly affecting public health (PH), which should be measured quantitatively if possible. This study identified a method to quantify impact of MA withdrawal in terms of morbidity and mortality changes. Almitrine's MA withdrawal throughout France (2013) due to cases of peripheral nervous system (PNS) disturbance and severe weight loss, demonstrates the model. Patients exposed to almitrine were counted in quarterly periods for 12 months pre- and post-MA withdrawal, in IQVIA Medical Research Data (IMRD)-France electronic health record database; annual exposure was estimated. Reason for MA withdrawal (ADR of interest) was obtained from EMA records. Quantitative research addressing the ADR of interest was identified by systematic review, allowing an estimation of absolute risk in exposed patients. PH impact of PV action, expressed as crude annual prevention of ADRs, was estimated by modelling product usage figures and ADR risk. At the time of almitrine's withdrawal, 7,456,368 patients were active in IMRD-France. Prevalence of almitrine exposure during the 12 months before withdrawal was 0.82 per 100,000 IMRD-France patients. Exposure to almitrine decreased by 51.9% in the population after its withdrawal, but some exposure remained after 12 months. Risk of PNS disturbance was 15.5% and severe weight loss was 7.8%, estimated from published studies. Based on risk and usage, withdrawal of almitrine from market could prevent up to 13 cases of PNS disturbance and 3 cases of severe weight loss annually amongst IMRD-France patients if exposure were eliminated. This model quantifies PH impact of almitrine’s MA withdrawal in terms of serious morbidity, assuming exposure was eliminated. This method can be applied to other products in a range of settings.

Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation

Abstract Introduction The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system. Purpose We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes. Methods We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes. Results At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI &amp;lt;15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI&amp;lt;15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN&amp;lt;70ms and MHR&amp;lt;80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure). Conclusions Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation

The association between hypoparathyroidism and cognitive impairment: a systematic review.

Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism. A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge. The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions. Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.

Pharmacological evaluation of the hydro-alcoholic extract of Campomanesia phaea fruits in rats.

Campomanesia phaea (Myrtaceae), popularly known as cambuci, is one of several species of plants producing comestible fruits, largely used in human nutrition. Despite its consumption and economic potential, limited scientific research is available on the Campomanesia, especially those related to its therapeutic benefits. It is reported by traditional medicine the use of the plant in the treatment of different disorders, such as cardiovascular and nervous system disturbances. So, the aim of this study was to carry out the pharmacological evaluation of the hydro-alcoholic extract (HAE) of Campomanesia fruits in rats by screening consisting of tests: a) neuropharmacological observation, b) test on the cardiovascular system. The HAE, prepared from the extraction of fruits with water/ethanol, was concentrated and freeze-dried. Behavioral responses in rats were investigated in open field test and the cardiovascular actions were investigated by a register of indirect blood pressure and the register of spontaneous beating rate right atrium. The results revealed that HAE induced grooming, hypotension and bradycardia. So, this study identified an action on the central nervous system, represented by grooming, and a cardiovascular activity of Campomanesia. The hypotension, attributed in part to bradycardia, was not related to a cholinergic effect, discarding a possible cholinomimetic action of the plant that could justify both cardiovascular and central actions.