Hear Rate Research Articles

Effect of ultrasound-guided stellate ganglion block on lung protection for patients undergoing one-lung ventilation.

To explore the potential effect of ultrasound-guided stellate ganglion block (SGB) on lung protection for patients undergoing one-lung ventilation (OLV). A total of 123 patients undergoing elective one-lung ventilation surgery were selected as research subjects in this prospective study. These patients were randomly divided into the SGB group, control group and blank group on average. Stellate ganglion block was carried out in the SGB and control groups. Patients in the SGB group were injected with 6 ml mixture of 0.25% ropivacaine hydrochloride and 1% lidocaine hydrochloride, while those in the control group were injected with 6 mL of 0.9% saline. Punctures weren't performed for patients in the blank group. The same induction and maintenance of general anesthesia was adopted for all three groups. Hemodynamics, respiratory parameters and arterial blood gas analysis were recorded after entering the operation room (T0), pre-OLV (T1), 30 min after OLV (T2), 60 min after OLV (T3), at the end of surgery (T4), and 30 min after extubation (T5). Oxygenation index (OI), pulmonary shunt fraction (Qs/Qt) and pH value were compared at different time points. Intravenous serum was collected at T0, T3 and T5 for the detection of surfactant proteins A (SP-A), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels, respectively. The complications related to SGB after surgery and the postoperative pulmonary complications within 72 h were recorded. At T1, T2, and T3, MAP level in SGB group was lower than that in blank and control groups (P<0.05). At T2, and T3, SGB group had lower hear rate (HR), peak airway pressure (Ppeak) and tidal volume (TV) than blank and control groups (all P<0.05). From T2 to T5, SGB group had higher OI but lower Qs/Qt than blank and control groups (both P<0.05). At T3 and T5, SGB group had lower SP-A, IL-6, and MDA levels but higher IL-10 and SOD levels than blank and control groups (all P<0.05). There was one case of hypoxemia in the blank group within 72 h after surgery. Ultrasound-guided SGB has lung-protective effects on patients undergoing OLV, which significantly improves patients' OI, reduces intrapulmonary shunts, declines ventilator-induced lung damage, and inhibits inflammatory response as well as oxidative stress (China Clinical Trial Registry, registration number ChiCTR2000033385, https://www.chictr.org.cn).

Heart rate variability and syncope free survival after endocardial ablation of ganlionated plexi in patiens with recurrent vasovagal syncope and functional sinus node dysfunction and AV block

Abstract Introduction Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope Conclusions: (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB), however long term effects of this technique are not well defined. The aim of the present study was to describe our initial experience with this technique and to assess long term hear rate (HR) variability. Methods Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test and 24-hour holter monitoring. Heart rate variability was assessed at 3 and 6 months with repeated 24-hour holter monitoring. Survival from syncope and pacemaker implantation was calculated in the cohort. Results 24 patients (52 ± 10 years, 70.8% males) were included in the study. 83.3% of the cohort had history of syncope (1.3 ± 3.4 episodes/month) and 95.8% of presyncope. Indication for CNA was SND 29.2%, AVB 25% and recurrent VVS in 45.8%. After a median follow up of 9.9 (4.3-20.7) months, 91.7% were free from syncope recurrence and only 29.2% had presyncope (p&amp;lt;0.001) (Figure 1). There was also a significant increase in minimum HR (p=0.01) and medium HR (p=0.02), without any differences in the maximum HR (p=NS). There was also a decrease in all the parameters used to assess HR variability (SDNN24 p=0.02; rMSSD p=0.017; pNN50 p&amp;lt;0.01) that was constant during the 6 months (Figure 2). Conclusions In our cohort, CNA was associated with a syncope free survival of 91.7% and could be a reasonable choice for patients with functional SND or AVB and recurrent VVS. There was an increase in the maximum and medium HR and a decrease in HR variability that remained constant at 6 months.Figure 1Figure 2

Phenotypes of hemodynamic response to fluid challenge during anesthesia: a cluster analysis.

The fluid challenge (FC) response is usually evaluated as binary, which may be inadequate to describe the complex interactions between heart function and vascular tone response after fluid administration. We applied a clustering approach to assess the different phenotypes of cardiovascular responses to FC administration, considering the associations of all the baseline variables potentially influencing pressure and flow response to a FC. Secondarily, we evaluated the reliability of baseline hemodynamic variables in discriminating fluid responsiveness, which is considered the standard approach at the bedside. Five merged datasets from elective surgical patients receiving a FC dose ≥4 mL/kg, infused over 10 minutes. In a principal component approach, hierarchical clustering was used to define hemodynamic phenotypes of response to FC administration. Hierarchical cluster analysis with Ward linkage was carried out to define similar patient groups using the Gower distance for the mixed combination of continuous and categorical variables. No a priori criteria of fluid responsiveness were applied. The area (AUC) under the pre-FC variables' receiver operating characteristic curves (ROC) was also built to predict fluid responsiveness, defined as SVI ≥10% after FC. We analyzed 223 patients. The cluster analysis identified three hemodynamic clusters of patients: cluster 1 (98 patients, 44.0%) showed an average increase of mean arterial pressure (MAP) and Stroke Volume Index (SVI) of 17.3% (11.9-23.1) and 13.1% (0.5-23.4) at the end of FC, respectively. These patients showed baseline flow and pressure variables slightly below physiological ranges, with high pulse pressure variation (PPV). Cluster 2 (68 patients, 30.5%) showed no increase of MAP and SVI at the end of FC. These patients showed baseline flow and pressure variables within physiological ranges, with low hear rate (HR) and PPV. Cluster 3 (57 patients, 25.5%) showed no MAP increase and an SVI increase of 13.1 (2.1-19.6). These patients showed baseline pressure variables within physiological ranges, low flow variables associated to high HR and PPV. The pulse pressure variation (PPV) showed an AUC of 0.82 (0.03), with a grey zone ranging from 6% to 12%, including 86 (38.5%) patients. Clustering analysis identified three hemodynamic clusters with different response phenotypes to FC. This promising approach may enhance the ability to detect fluid responsiveness at the bedside, by considering the specific association of parameters and not the presence of a single one, such as the PPV. In fact, in our cohort the reliability of the PPV was limited, showing high sensibility and specificity only above 12% and below 6%, respectively, and a grey zone including 38.5% of patients.

Retrospective analysis of autonomic dysfunction in epilepsy patients from neurophysiological recordings

Autonomic dysfunction is often associated with seizures in patients with epilepsy. Autonomic dysfunction during seizures can cause serious events like cardiac arrest and sudden unexplained death. Early detection of autonomic dysfunction is crucial to avoid such medical emergencies. In our study, we analyzed the heart rate variability (HRV) in physiological recording during the preictal, ictal and postictal periods. A total of 142 seizures with various semiologies recorded from 49 epilepsy patients were included. Time-domain measurements including mean hear rate (HR), RR interval (RRI), root-mean-square of successive R-R interval differences (RMSSD), The standard deviation of N-N intervals (SDNN) and percentage of successive RR intervals that differ by more than 50 ms(pNN50) were analyzed at different time points, 20 minutes before the seizure, 1 minute before the seizure, during the seizure and 20 minutes after the seizure. We observed there was a significant difference in HRV parameters during and just before the seizure onset (RMSSD with p-value&lt;0.001 and SDNN with p-value&lt;0.001). We also observed that there was a suppression of parasympathetic activity and activation of sympathetic stimulation in the ictal and peri-ictal period, which was characterized by an elevation in the mean heart rate (HR), whereas the mean RRI showed an inversely proportional trend. There was a reduction in mean RMSSD, SDNN and pNN50 prior to seizure onset and was more pronounced in generalized seizures as compared to focal seizures with preserved or impaired awareness. There was a greater sympathetic activation and parasympathetic inhibition during an epileptic seizure in females as compared to male patients. These findings suggest that autonomic dysregulation was increased during a generalized seizure when compared to a focal seizure. HRV analysis can be used as a valid method for quantifying central influences on the autonomic nervous system and its cardiac control. A major advantage of electrocardiogram (ECG)-based seizure detection is that the ECG is an essentially easier signal to obtain, with a higher signal-to-noise ratio than EEG (electroencephalogram). Based on the inferences from this study future studies could be done to build machine learning models which could form the base for the development of wearable seizure prediction devices.

Leptin And Prolactin Responses During And After Exercise At Constant Or Alternating Intensity

Differential hormonal responses have been reported during exercise and recovery depending on the intensity and/or duration of exercise. PURPOSE: The aim of the present study was to examine leptin and prolactin responses during and after exercise protocols of the same mean intensity and duration but performed at constant (CON) or alternating (ALT) intensity in healthy participants. METHODS: Ten healthy males (age: 24.7 ± 4.7 yrs, body mass: 78.5 ± 8.9 kg, height: 180.8 ± 6 cm, body fat: 9.1 ± 3.1%, VO2max: 47.9 ± 6.5 ml/kg/min, lactate threshold (LT): 67.4 ± 3.6% of VO2max, hear rate (HR)max: 188 ± 12 b/min) underwent in a random order two cycling exercise protocols, each lasting 1 hour. On one occasion, exercise intensity was alternated between 47% of VO2max for 40 seconds and 120% of VO2max for 20 seconds, so as the mean intensity was the same, i.e., at 105% of LT. On the other occasion, exercise was constant at 105% of LT. Two-way ANOVA with repeated measures was used for statistics and data are presented as mean ± SD. RESULTS: No significant differences were observed in leptin and prolactin concentrations between the two protocols at any time point measured (p = 0.77 and p = 0.80, respectively). However, in CON leptin decreased (p < 0.05) between Rest and 30 min and 60 min Exercise, as well as 60 min Post Exercise, in contrast with ALT, where leptin values did not significantly alter over time (Rest: 1.70 ± 1.22 ng/ml vs 1.36 ± 1.14 ng/ml, 30 min Exercise: 0.84 ± 0.51 ng/ml vs 1.38 ± 1.10, 60 min Exercise: 0.70 ± 0.47 ng/ml vs 0.86 ± 0.50 ng/ml, 60 min Post Exercise: 1.03 ± 0.71 vs 1.21 ± 1.01 ng/ml in CON and ALT, respectively). In ALT, prolactin levels decreased (p = 0.01) at 60 min Exercise (1.30 ± 0.64 ng/ml), compared to Rest (2.20 ± 0.88 ng/ml), while in CON there were not significantly changes over time (Rest:1.94 ± 0.95 ng/ml, 30 min Exercise: 1.57 ± 0.51 ng/ml, 60 min Exercise: 1.52 ± 0.73 ng/ml, 60 min Post Exercise: 1.61 ± 0.74 ng/ml). CONCLUSIONS: CON and ALT exercise performed at mean intensity of 70% of VO2max appeared to induce similar leptin and prolactin responses during and 1 hour after the end of exercise. These findings suggest that specific hormonal responses to cycling exercise protocols of the same mean intensity and duration are not affected by the form (constant or alternating intensity) of exercise.

A New Approach for Evaluation of Cardiovascular Fitness and Cardiac Responses to Maximal Exercise Test in Master Runners: A Cross-Sectional Study.

The aim of this study was to analyze the cardiac autonomic function at rest, at maximum exercise, and in recovery after exercise and to determine sex-specific and age-specific values for resting heart rate (RHR), hear rate (HR)-peak, HR recovery (HRR), and HR variability at rest in master runners. Fifty endurance runners (21 women) participated in this study (43.28 ± 5.25 years). The subjects came from different athletic clubs in Andalusia (Spain), and the testing protocol was performed in-season. A 3-km running test was performed and the cardiovascular response was monitored. Regarding sex, no significant differences were found regarding cardiovascular autonomic function at rest, during exercise, and following maximal exercise, only at rest, the standard deviation of all R-R intervals and low frequency values displayed significantly (p < 0.05) lower scores in women. 46% of athletes showed an RHR < 60 bpm. Additionally, HR-peak showed a significant correlation with age (r = −0.369; p = 0.009) and HRR5min (r = 0.476, p = 0.001). Also, endurance performance was inversely associated with obesity traits and cardiometabolic risk factors. In summary, age, sex, fitness, or anthropometrics characteristics did not show a relevant influence on cardiovascular autonomic modulation in master runners. However, the 3-km performance displayed a significant negative association with several factors of cardiometabolic risk.

Effect Evaluation of Dexmedetomidine Intravenous Anesthesia on Postoperative Agitation in Patients with Craniocerebral Injury by Magnetic Resonance Imaging Based on Sparse Reconstruction Algorithm.

The effect of dexmedetomidine on postoperative agitation of patients with craniocerebral injury was investigated based on magnetic resonance imaging (MRI) with the sparse reconstruction algorithm. Sixty patients with craniocerebral injury who underwent tracheal intubation and craniotomy hematoma removal under general anesthesia in hospital were selected as the research objects. Patients were randomly and averagely divided into the normal saline group (group A) and the dexmedetomidine (DEX) group (group B). DEX was added to patients in group A during anesthesia. Other operations in group B were the same as those in group A, where DEX needed to be used was replaced by an equal amount of the normal saline. All patients received the MRI examination, and the images were processed by using the sparse reconstruction algorithm. After the surgery, some indexes, such as hemodynamics (mean arterial pressure (MAP) and hear rate (HR)), the Riker sedation agitation score, the Ramsay sedation score, and the visual analogue scale (VAS) score were recorded and compared. The results showed that the MRI image quality processed by sparse reconstruction algorithm was observably improved. After reconstruction, the sharpness of the image was significantly improved, and the distinction between lesions and tissues was also increased. The Riker sedation agitation score and the incidence of agitation in group A were greatly lower than those in group B (16% VS 76%, P < 0.05). The Ramsay sedation score of group A was manifestly higher than that of group B. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group A were 2, 1, 1, 0, and 1, respectively. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group B were 3, 9, 6, 5, and 0, respectively. The cases of chills and delirium in group A were observably less than those in group B (P < 0.05). In conclusion, based on the sparse reconstruction algorithm, the MRI technology and DEX had high adoption value in preventing postoperative agitation of patients with craniocerebral injury. Compared with group B, the hemodynamics of patients in group A was more stable.

RED BLOOD CELL DISTRIBUTION IS INDEPENDENTLY ASSOCIATED WITH DAILY DIASTOLIC BP VARIABILITY

Objective: Previously it was shown that in a large cohort of unselected outpatients there was a strong independent association between elevated red blood cell distribution width (RDW) and increased incidence of cardiovascular events which may be associated with inflammation. The aim of our analysis was to evaluate whether RDW was independently associated with any of proven cardiovascular diagnostic markers. Design and method: We included 171 patients with arterial hypertension who had underwent all diagnostic procedures: office BP measurement, ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (cfPWV), cardio-ankle vascular index (CAVI), haematology test with RDW, vascular ultrasound and echocardiography. The results of Spearman correlation was after that tested in a multivariant regression model. Results: Results. Mean age of our patients was 52,9 ± 1,1 y/o, mean BP was 154,4 ± 2,4/93,3 ± 1,3 mmHg, mean hear rate (HR) 78,3 ± 1,3 bits per min, 37% men and 63% women, mean RDW was 14,8 ± 0,7%. Among all the parameters we have obtained, RDW was significantly inversely associated only with office systolic and diastolic BP (r = -0,189, p = 0,023 and r = -0,206, p = 0,013 respectively), daily diastolic BP (DBP) variability (r = -0,270, p = 0,02) and daily HR variability (r = -0,314, p = 0,027). Moreover, the association RDW with DBP variability remained significant even after the adjustment for office DBP, hemoglobin and erythrocytes level (beta = -0,587, p = 0,022), but correlation of RDW with HR variability after the adjustment for office HR and hemoglobin was not significant (beta = -0,437, p = 0,116) which underlines that HR variability is more associated with blood hemoglobin level. Also we did not find any significant correlations of RDW with any of arterial stiffness, vessel wall thickness, echocardiographic left ventricle mass index and other parameters. Conclusions: A significant correlation of RDW with office systolic and diastolic BP, but more an independent correlation of RDW with DBP variability may demonstrate is role as a potential interesting biomarker which may be used in future studies.

External temperature sensor assisted a new low power photoplethysmography readout system for accurate measurement of the bio-signs.

This study presents an external temperature sensor assisted a new low power, time-interleave, wide dynamic range, and low DC drift photoplethysmography (PPG) signal acquisition system to obtain the accurate measurement of various bio signs in real-time. The designed chip incorporates a 2-bit control programmable transimpedance amplifier (TIA), a high order filter, a 3:8 programmable gain amplifier (PGA) and 2 × 2 organic light-emitting diode (OLED) driver. Temperature sensor is used herein to compensate the adverse effect of low-skin-temperature on the PPG signal quality. The analog front-end circuit is implemented in the integrated chip with chip area of 2008 μm × 1377 μm and fabricated via TSMC T18 process. With the standard 1.8 V, the experimental result shows that the measured current sensing range is 20 nA–100 uA. The measured dynamic range of the designed readout circuit is 80 dB. The estimated signal to noise ratio is 60 dB@1 uA, and the measured input referred noise is 60.2 pA/Hz½. The total power consumption of the designed chip is 31.32 µW (readout) + 1.62 mW (OLED driver@100% duty cycle). The non-invasive PPG sensor is applied to the wrist artery of the 40 healthy subjects for sensing the pulsation of the blood vessel. The experimental results show that for every 1 °C decrease in mean ambient temperature tends to 0.06 beats/min, 0.125 mmHg and 0.063 mmHg increase in hear rate (HR), systolic (SBP) and diastolic (DBP), respectively. Similarly, for every 1 °C increase in mean ambient temperature tends to 0.13 beats/min, 0.601 mmHg and 0.121 mmHg increase in HR, SBP and DBP, respectively. The measured accuracy and standard error for the HR estimation are 96%, and − 0.022 ± 2.589 beats/minute, respectively. The oxygen stauration (SpO2) measurement results shows that the mean absolute percentage error is less than 5%. The resultant errors for the SBP and DBP measurement are − 0.318 ± 5.19 mmHg and − 0.5 ± 1.91 mmHg, respectively.Electronic supplementary materialThe online version of this article (10.1007/s00542-020-05106-y) contains supplementary material, which is available to authorized users.

Hypotensive effect of Eugenia dysenterica leaf extract is primarily related to its vascular action: The possible underlying mechanisms.

Eugenia dysenterica (ED) leaves are used in Brazil to treat cardiac diseases; however, there are no scientific data describing the effects of this species on cardiac activity. To investigate the effect of ED aqueous leaf extract (EDLE) on hear rate (HR) and mean arterial pressure (MAP) of anaesthetised rats and its underlying mechanism of action. EDLE was analysed, and its proanthocyanidin composition was determined. After performing dose-effect curves for EDLE on HR and MAP, EDLE-induced hypotension was evaluated before and after atropine (AT), L-N(ω)-nitro-L-arginine methyl ester (L-NAME), hexamethonium (HXT), indomethacin (IND), carbenoxolone (CBX), or nifedipine (NFD) administration. The effect of proanthocyanidin-depleted extract (EDLE/P-) was also determined and compared to that of the EDLE with proanthocyanidins. EDLE decreased the MAP in a dose-dependent manner; HR was decreased only with the highest and most toxic dose. Only CBX and NFD decreased EDLE-induced hypotension. Five polymeric series of proanthocyanidins were identified, which were mainly constituted by procyanidin and prodelphinidin units with B-type linkage and up to 12 flavan-3-ol units. EDLE/P- induced hypotension did not differ from that induced by EDLE. The cardiovascular effects of EDLE were primarily related to its vascular action. EDLE-induced hypotensive effect appeared to involve L-type calcium channel blockage as well as myoendothelial gap junction signalling. The higher molecular weight proanthocyanidins from EDLE are unlikely to contribute to its cardiovascular effect.

Perioperative hypertension associated neurohumoral stress response in craniotomy patients: Effects of β-blocker and angiotensin converting enzyme inhibitor

BackgroundDevelopment of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. MethodsEighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. ResultsPerioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p < 0.01) persisted till 12 h postoperatively and this was associated with low plasma renin levels at the extubation. MAP was lowered by lisinopril and both aldosterone and norepinephrine levels were significantly lower (p < 0.01) at dural incision and extubation periods. ConclusionsPretreatment with atenolol or lisinopril significantly attenuated perioperative hypertension in patients undergoing craniotomy procedures. Lisinopril was better in lowering perioperative MAP while atenolol attenuated HR changes. RAAS inhibition may be the possible mechanism responsible for this hypertension effect in craniotomy procedures.

The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data.

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

The development of a novel high-precision major depressive disorder screening system using transient autonomic responses induced by dual mental tasks

12.6% of major depressive disorder (MDD) patients have suicide intent, while it has been reported that 43% of patients did not consult their doctors for MDD, automated MDD screening is eagerly anticipated. Recently, in order to achieve automated screening of MDD, biomarkers such as multiplex DNA methylation profiles or physiological method using near infra-red spectroscopy (NIRS) have been studied, however, they require inspection using 96-well DNA ELIZA kit after blood sampling or significant cost. Using a single-lead electrocardiography (ECG), we developed a high-precision MDD screening system using transient autonomic responses induced by dual mental tasks. We developed a novel high precision MDD screening system which is composed of a single-lead ECG monitor, analogue to digital (AD) converter and a personal computer with measurement and analysis program written by LabView programming language. The system discriminates MDD patients from normal subjects using heat rate variability (HRV)-derived transient autonomic responses induced by dual mental tasks, i.e. verbal fluency task and random number generation task, via linear discriminant analysis (LDA) adopting HRV-related predictor variables (hear rate (HR), high frequency (HF), low frequency (LF)/HF). The proposed system was tested for 12 MDD patients (32 ± 15 years) under antidepressant treatment from Shizuoka Saiseikai General Hospital outpatient unit and 30 normal volunteers (37 ± 17 years) from Tokyo Metropolitan University. The proposed system achieved 100% sensitivity and 100% specificity in classifying 42 examinees into 12 MDD patients and 30 normal subjects. The proposed system appears promising for future HRV-based high-precision and low-cost screening of MDDs using only single-lead ECG.

OS 29-01 TRANS-GENERATIONAL PROGRAMMING OF OBESITY RELATED HYPERTENSION

Objective: Obesity during pregnancy is associated with a greater risk of developing hypertension in the offspring. Plasma leptin levels correlate strongly with blood pressure and renal sympathetic nerve activity (RSNA). The ventromedial hypothalamus (VMH) is a key centre of energy homeostasis, haemodynamic and sympathetic tone to renal vasculature. It is possible that exposure to over-nutrition during development change the activity of the neurons, amplifying sympathetic output leading to hypertension in the offspring. We assessed the contribution of leptin and melanocortin (MC) signaling pathway in the VMH of offspring that were born from obese mothers. Design and Method: Female New Zealand White rabbits were fed a high fat diet (13%; mHFD) or a control diet (4%; mCD) during pregnancy and lactation. Offspring received CD after weaning. All offspring received a VMH cannula and a renal nerve recording electrode. Experiments were conducted in conscious rabbits and mean arterial pressure (MAP), hear rate (HR) and RSNA were measured. Rabbits received increasing doses of αMSH (α-Melanocortin stimulating hormone, 0.3, 1nmol), SHU9119 (melanocortin receptor antagonist, 0.02, 0.04nmol), leptin receptor antagonist (5, 10 μg) or insulin receptor antagonist (0.01, 0.05U). Results: mHFD rabbits exhibited higher MAP and RSNA than mCD rabbits (P < 0.05). αMSH injection into the VMH increased MAP (+6%), HR (+12%) and RSNA(+80%) and SHU9119 reduced MAP (−7%) in mHFD rabbits. Leptin receptor antagonist normalised hypertension in mHFD rabbits (P < 0.05). By contrast, no changes were observed following insulin receptor antagonist injections into the VMH. mCD did not respond to any drug injections into the VMH. Conclusions: Exposure to over-nutrition during development alters leptin and MC signaling pathway in the VMH of the offspring.

57-01: Electrical remodeling of repolarization abnormality after surgical treatment in pheochromocytoma: a retrospective analysis

Background: Pheochromocytoma, a rare neuroendocrine tumor, clinically characterized by high blood pressure, palpitations and headache, is often associated with abnormalities of the ventricular repolarization phase(1), in particular with the presence of U wave(2). This dispersion of ventricular repolarization is the basis of ventricular arrhythmias. Method: We analyzed a series of ECG of 10 patients (9M/1F, 43 ± 18 years aged) affected by pheochromocytoma, collected before and after surgical treatment. We evaluated hear rate (HR), P wave, PR, QRS, QTc, number of U wave present in each twelve lead ECG, electrolytes values, systemic blood pressure and 24-hour urinary excretion of 3-methoxytyramine, normetanephrine and metanephrine. Results: All patients were in sinus rhythm, without any brunch block. There was no difference in term of electrolytes, duration of P wave, PR, QRS, QTc, HR. We found clear presence of U wave in all patients before surgery, while there was a significative reduction/suppression in number of U wave counted in 12 lead ECG after surgery. After surgery, as expected, we observed a clear drop in systemic blood pressure and 3-methoxytyramine, normetanephrine and metanephrine urinary level. We observed a linear correlation between number of U wave in 12 lead ECG and 3-methoxytyramine levels (r= 0.615, p =0.015). Conclusion: A careful analysis of the electrocardiogram is mandatory in patients with hypertensive crisis, particularly the phase of ventricular repolarization characterized by U wave; this finding should lead the clinician to suspect the diagnosis of pheochromocytoma.

Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes

We present prospective blood pressure (BP) and hear rate (HR) changes in smokers invited to switch to e-cigarettes in the ECLAT study. BP and HR changes were compared among (1) different study groups (users of high, low, and zero nicotine products) and (2) pooled continuous smoking phenotype classification (same phenotype from week 12 to -52), with participants classified as quitters (completely quit smoking), reducers (≥50 % reduction in smoking consumption) and failures (<50 % or no reduction in smoking consumption). Additionally, the latter comparison was repeated in a subgroup of participants with elevated BP at baseline. No significant changes were observed among study groups for systolic BP, diastolic BP, and HR. In 145 subjects with a continuous smoking phenotype, we observed lower systolic BP at week 52 compared to baseline but no effect of smoking phenotype classification. When the same analysis was repeated in 66 subjects with elevated BP at baseline, a substantial reduction in systolic BP was observed at week 52 compared to baseline (132.4 ± 12.0 vs. 141.2 ± 10.5 mmHg, p < 0.001), with a significant effect found for smoking phenotype classification. After adjusting for weight change, gender and age, reduction in systolic BP from baseline at week 52 remains associated significantly with both smoking reduction and smoking abstinence. In conclusion, smokers who reduce or quit smoking by switching to e-cigarettes may lower their systolic BP in the long term, and this reduction is apparent in smokers with elevated BP. The current study adds to the evidence that quitting smoking with the use of e-cigarettes does not lead to higher BP values, and this is independently observed whether e-cigarettes are regularly used or not.

Cardiovascular Parameters of Nigerian Physiotherapy Students Dur-ing an End of Semester Examination

Examination and tests are routine academic task during which students engage in mental exercis-es, writing, and/or practical demonstrations under pressure with stress placed on the cardiovascu-lar system. This study was aimed at investigating the cardiovascular parameters of students before, during and after an examination. The baseline hear rate (HR) and blood pressures (BPs) of 75 un-dergraduates physiotherapy students in a Nigerian university were measured one month to the be-ginning of a second semester examination, and also before, during and after a session of test in core subjects. This study shows higher HR, and systolic and diastolic BPs5 minutes to the start of the examination compared to the baseline resting values. This heightened cardiovascular parame-ters remained steady until the time remaining till the end of exam was announced, when the pa-rameters spiked to levels higher than both the baseline and pre-examination levels. While the sys-tolic, diastolic and mean arterial BPs returned to baseline levels shortly before or at about 15 minutes after exam, HR and rate pressure product did not return to the baseline levels 15 minutes after examination. Cardiovascular parameters were higher few minutes before exam than the base-line resting values and continue so until the remaining time left for the exam was announced. Fu-ture studies on aerobic fitness and physiological adaptations conferred by exercises and regular physical activity can influence cardiovascular parameters during examination are suggested. Keywords : Cardiovascular problems, Examination, Students, professional, Nigeria

Antihypertensive and Antihyperlipidemic Activities of Thymoquinone in L-Name Hypertensive Rats

Objective: of this study was to evaluate the antihypertensive potential of Thymoquinone TQ and to investigate the underlying mechanism of action. Method: Hypertension was induced in in Sprague Dawley rats (n = 40) by administration of L-Nitro-Arginine Methyl Ester (L-NAME) in drinking water for 4 weeks. At the end of induction period, rats were divided into 6 groups (n = 8); TQ2.5+L-NAME, TQ5+L-NAME, TQ10+L-NAME, captopril+L-NAME, L-NAME only and control. Mean arterial pressure (MAP) and hear rate (HR) were recorded by the non-invasive tail cuff technique weekly for 28 days. Then animals were sacrificed and blood was collected for determination of ACE activity and aldosterone concentration using ELISA. Lipid profile (total cholesterol, LDL, HDL, TRG) was assayed twice; at the end of induction period and at the end of treatment period. Results: TQ reversed the established hypertension in TQ5 and TQ10 groups, and prevented further increase in MAP in TQ2.5 group. Unlike captopril treated group, TQ antihypertensive activity was associated with an increase in serum aldosterone concentration and ACE activity. TQ treatment at the high dose significantly lowered total cholesterol and LDL levels in comparison with the healthy control group at the end of the 4th week of treatment. Conclusion: This study confirms the antihypertensive effect of TQ which did not take place through inhibition of ACE, but probably through blocking angiotensin II receptors.

Training load quantification in elite swimmers using a modified version of the training impulse method

Prior reports have described the limitations of quantifying internal training loads using hear rate (HR)-based objective methods such as the training impulse (TRIMP) method, especially when high-intensity interval exercises are performed. A weakness of the TRIMP method is that it does not discriminate between exercise and rest periods, expressing both states into a single mean intensity value that could lead to an underestimate of training loads. This study was designed to compare Banister's original TRIMP method (1991) and a modified calculation procedure (TRIMPc) based on the cumulative sum of partial TRIMP, and to determine how each model relates to the session rating of perceived exertion (s-RPE), a HR-independent training load indicator. Over four weeks, 17 elite swimmers completed 328 pool training sessions. Mean HR for the full duration of a session and partial values for each 50 m of swimming distance and rest period were recorded to calculate the classic TRIMP and the proposed variant (TRIMPc). The s-RPE questionnaire was self-administered 30 minutes after each training session. Both TRIMPc and TRIMP measures strongly correlated with s-RPE scores (r = 0.724 and 0.702, respectively; P < 0.001). However, TRIMPc was ∼9% higher on average than TRIMP (117 ± 53 vs. 107 ± 47; P < 0.001), with proportionally greater inter-method difference with increasing workload intensity. Therefore, TRIMPc appears to be a more accurate and appropriate procedure for quantifying training load, particularly when monitoring interval training sessions, since it allows weighting both exercise and recovery intervals separately for the corresponding HR-derived intensity.

Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury

BackgroundThe Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury.MethodsFifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2 mg iv and midazolam 1 mg iv that be repeated up to 0.05 mg/kg followed with a bolus dose of remifentanil 1.5 μg/kg then a continuous remifentanil infusion of 0.15 μg/kg/min for 3 min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO2 < 90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded.ResultsIntubating time was significantly lower in G group compared with F group (26 ± 5 versus 72 ± 11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups.ConclusionThe GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation.