Improvement In Heart Rate Research Articles

Association of beta blockers and mortality in adults with septic shock: systematic review and meta-analysis of randomized clinical trial.

Septic shock still entails significant morbidity and mortality, with the heart being affected due to catecholamine overexpression and direct injury from sepsis. Therefore, the effect of β-blocking the receptors to improve performance is promising when attempting to reverse tachycardia and reduce mortality. We conducted a comprehensive search across five databases for studies published up to 28 January 2024, using a PICO strategy. Ten studies were identified for quantitative analysis and included in our meta-analysis. Our meta-analysis evaluated 28-day in-hospital mortality risk across nine randomized controlled trials (RCTs) involving a total of 1,121 adults with septic shock. We found an association between β-blocker use and reduced overall mortality (OR 0.57; 95% CI 0.34-0.98; I 2: 56%). This effect was significant in the esmolol subgroup (OR 0.47; 95% CI 0.26-0.82; I 2: 32%), but not in the landiolol subgroup (OR 0.98; 95% CI 0.0-1,284.5; I 2: 72%). Additionally, the intervention group shows a significant reduction in HR and lactate levels, as well as an increase in stroke volume index (SVI). In adults with septic shock, β-blockers are associated with a reduction in 28-day in-hospital mortality, a benefit primarily observed with esmolol rather than landiolol. Furthermore, improvements in heart rate (HR) control, lactate levels, and SVI were noted. However, these findings should be interpreted with caution, and further high-quality RCTs comparing different β-blockers are necessary to better elucidate these effects. https://www.crd.york.ac.uk/prospero/, identifier CRD42024513610.

A matched analysis of the use of high flow nasal cannula for pediatric severe acute asthma.

The high-flow nasal cannula (HFNC) device is commonly used to treat pediatric severe acute asthma. However, there is little evidence regarding its effectiveness in real-world practice. We sought to compare the physiologic effects and clinical outcomes for children treated for severe acute asthma with HFNC versus matched controls. This was a single-center retrospective matched cohort study at a quaternary care children's hospital. Children ages 2-18 hospitalized for severe acute asthma from 2015 to 2022 were included. Encounters receiving treatment with HFNC within the first 24 h of hospitalization were included as cases. Controls were primarily treated with oxygen facemask. Logistic regression 1:1 propensity score matching was done using demographics, initial vital signs, and medications. The primary outcome was an improvement in clinical asthma symptoms in the first 24 h of hospitalization measured as percent change from initial. Of 693 eligible cases, 443 were matched to eligible controls. Propensity scores were closely aligned between the cohorts, with the only significant difference in clinical characteristics being a higher percentage of patients of Black race in the control group (54.3% vs. 46.6%; p = 0.02). Compared to the matched controls, the HFNC cohort had smaller improvements in heart rate (-11.5% [-20.9; -0.9] vs. -14.7% [-22.6;-5.7]; p < 0.01), respiratory rate (-14.3% [-27.9;5.4] vs. -16.7% [-31.5;0.0]; p = 0.03), and pediatric asthma severity score (-14.3% [-28.6;0.0] vs. -20.0% [-33.3;0.0]; p < 0.01) after 24 h of hospitalization. The HFNC cohort also had longer pediatric intensive care unit (PICU) length of stay (LOS) (1.5 days [1.1;2.1] vs. 1.2 days [0.9;1.8]; p < 0.01) and hospital LOS (2.8 days [2.1;3.8] vs. 2.5 days [1.9;3.4]; p < 0.01). When subgrouping to younger patients (2-3 years old), or those with the highest severity scores (PASS > 9), those treated with HFNC had no difference in clinical symptom improvements but maintained a longer PICU LOS. Encounters using HFNC for severe acute pediatric asthma had decreased clinical improvement in 24 h of hospitalization compared to matched controls and increased LOS. Specific subgroups of younger patients and those with the highest severity scores showed no differences in clinical symptom improvement suggesting differential effects in specific patient populations.

Development of optimized resveratrol/piperine-loaded phytosomal nanocomplex for isoproterenol-induced myocardial infarction treatment

Cardiovascular disease is a significant and ever-growing concern, causing high morbidity and mortality worldwide. Conventional therapy is often very precarious and requires long-term usage. Several phytochemicals, including Resveratrol (RSV) and Piperine (PIP), possess significant cardioprotection and may be restrained in clinical settings due to inadequate pharmacokinetic properties. Therefore, this study strives to develop an optimized RSV phytosomes (RSVP) and RSV phytosomes co-loaded with PIP (RPP) via solvent evaporation method using Box-Behnken design to enhance the pharmacokinetic properties in isoproterenol-induced myocardial infarction (MI). The optimized particle size (20.976 ± 0.39 and 176.53 ± 0.88 nm), zeta potential (−33.33 ± 1.5 and −48.7 ± 1.6 mV), drug content (84.57 ± 0.9 and 87.16 ± 0.6%), and %EE (70.56 ± 0.7 and 67.60 ± 0.57%) of the prepared RSVP and RPP, respectively demonstrated enhanced solubility and control release in diffusion media. The oral administration of optimized RSVP and RPP in myocardial infarction-induced rats exhibited significant (p < 0.001) improvement in heart rate, ECG, biomarker, anti-oxidant levels, and no inflammation than pure RSV. The pharmacokinetic assessment on healthy Wistar rats exhibited prolonged circulation (>24 h) of RSVP and RPP compared to free drug/s. The enhanced ability of RSVP and RPP to penetrate bio-membranes and enter the systemic circulation renders them a more promising strategy for mitigating MI.

Optimizing the functional state of the cardiorespiratory system of female students aged 17-19 with the help of a modified program of distance classes in physical education

The article deals with the peculiarities of the impact of a modified program of distance training on physical education on the functional state of circulatory systems and external breathing of students of 17-19 years of higher education. The relevance and practical importance of this study is due to the complex modern conditions of life of our country, the inability to conduct full -fledged classes among student youth and the need to maintain the optimal level of physical and functional state of student youth. The use among female students of the experimental group of the program of remote classes proposed by us contributed to significantly higher rates of improvement in heart rate, all types of blood pressure, Robinson's index, total peripheral resistance of blood vessels, coefficient of efficiency of blood circulation, vital capacity of the lungs (in 2-3 times), breath retention time on inhalation and exhalation (3 and 5 times, respectively), Skibinsky index 5 times, hypoxia index (20 times) and almost 5 times the levels of the functional state of the cardiovascular system and the external system breath. The results of changes in their intragroup distribution by the levels of levels of functional state of circulatory and external respiration, which were reflected in the increase of their representation in functional classes high and above average, were significantly more optimal in the experimental group. Similar changes in the girls of the control group were insignificant. The results testified to the high efficiency of the proposed program of distance classes with the use of fitness and the possibility of its practical use among students of higher education.

Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth

BackgroundPhysiological changes during the insertion of a rescue nasopharyngeal tube (NPT) after birth are unclear.MethodsObservational study of very preterm infants in the delivery room. Data were extracted at predefined timepoints starting with first facemask placement after birth until 5 min after insertion of NPT. End-expiratory lung impedance (EELI), heart rate (HR) and SpO2/FiO2-ratio were analysed over time. Changes during the same time span of NIPPV via facemask and NIPPV via NPT were compared.ResultsOverall, 1154 inflations in 15 infants were analysed. After NPT insertion, EELI increased significantly [0.33 AU/kg (0.19–0.57), p < 0.001]. Compared with the mask period, changes in EELI were not significantly larger during the NPT period [median difference (IQR) = 0.14 AU/kg (−0.14–0.53); p = 0.12]. Insertion of the NPT was associated with significant improvement in HR [52 (33–96); p = 0.001] and SpO2/FiO2-ratio [161 (69–169); p < 0.001] not observed during the mask period.ConclusionsIn very preterm infants non-responsive to initial facemask ventilation after birth, insertion of an NPT resulted in a considerable increase in EELI. This additional gain in lung volume was associated with an immediate improvement in clinical parameters. The use of a NPT may prevent intubation in selected non-responsive infants.ImpactAfter birth, a nasopharyngeal tube may be considered as a rescue airway in newborn infants non-responsive to initial positive pressure ventilation via facemask. Although it is widely used among clinicians, its effect on lung volumes and physiological parameters remains unclear.Insertion of a rescue NPT resulted in a considerable increase in lung volume but this was not significantly larger than during facemask ventilation. However, insertion of a rescue NPT was associated with a significant and clinically important improvement in heart rate and oxygenation.This study highlights the importance of individual strategies in preterm resuscitation and introduces the NPT as a valid option.

Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence.MethodsRandomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form.ResultsThirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant.ConclusionThis study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.

KID-PPG: Knowledge Informed Deep Learning for Extracting Heart Rate from a Smartwatch.

Accurate extraction of heart rate from photoplethysmography (PPG) signals remains challenging due to motion artifacts and signal degradation. Although deep learning methods trained as a data-driven inference problem offer promising solutions, they often underutilize existing knowledge from the medical and signal processing community. In this paper, we address three shortcomings of deep learning models: motion artifact removal, degradation assessment, and physiologically plausible analysis of the PPG signal. We propose KID-PPG, a knowledge-informed deep learning model that integrates expert knowledge through adaptive linear filtering, deep probabilistic inference, and data augmentation. We evaluate KID-PPG on the PPGDalia dataset, achieving an average mean absolute error of 2.85 beats per minute, surpassing existing reproducible methods. Our results demonstrate a significant performance improvement in heart rate tracking through the incorporation of prior knowledge into deep learning models. This approach shows promise in enhancing various biomedical applications by incorporating existing expert knowledge in deep learning models.

Evaluating the Efficacy of Interventional Approaches for Cardiac Arrhythmias in Acute Myocardial Infarction

Objective: To assess the effectiveness of interventional treatments for cardiac arrhythmias in acute myocardial infarction (AMI). Methods: Eighty AMI patients admitted between August 2022 and August 2023 were selected and randomly assigned into groups using the random number table method. The control group (n = 40) received conventional thrombolytic treatment, while the observation group (n = 40) underwent percutaneous coronary intervention (PCI). Clinical effects were compared between the two groups. Results: Before treatment, there were no significant differences in heart rate indicators, cardiac function indicators, and physiological indicators between the two groups (P &gt; 0.05). After treatment, the observation group showed significantly improved heart rate indicators, cardiac function indicators, and physiological indicators compared to the control group (P &lt; 0.05). The adverse reaction rates in the observation group were lower than in the control group (P &lt; 0.05). Conclusion: PCI treatment demonstrated significant improvements in heart rate, cardiac function, and physiological indicators among AMI patients, leading to a reduced incidence of adverse reactions such as arrhythmia. The overall effect is deemed significant.

Abstract 18434: Amanita Muscaria and Pantherina Withdrawal as a Cause of Lone Atrial Fibrillation

Introduction: The Amanita mushroom family is known for use as a means of suicide or for psychedelic effects. The manifestations of Amanita mushroom poisoning include gastrointestinal poison, cholinergic effects and organ failure. In this paper, we will discuss the first observed study of a patient who developed new onset atrial fibrillation (AF) with rapid ventricular response (RVR) after withdrawal from accidental chronic poisoning of Amanita muscaria and pantherina over the course of three weeks. Case: A 29 year-old male with no prior past medical history presented with three days of palpitations. He began taking A. pantherina and muscaria three weeks prior to help treat sexual addiction. He started with 0.35 mcg twice a day, then doubled the dose after one week, then three days prior to presentation he started taking three grams twice per day. He noticed palpitations as he increased his dose, but then acutely worsened after he stopped taking mushrooms. In the emergency department, he was found to have new onset atrial fibrillation with rapid ventricular rate as well as frequent episodes of nonsustained ventricular tachycardia. An alcohol level and urine drug screen were unremarkable. Thyroid stimulating hormone was within range. His heart rate did not respond to intravenous diltiazem. He was transitioned to an esmolol infusion that responded with rapid improvement in heart rate as well as ventricular ectopy suppression. He eventually underwent a transesophageal echocardiogram and was transitioned to oral beta blocker therapy. He was discharged with no complications and near full recovery. Discussion: A report published in 1869 described the first description of the pharmacological effect of A. muscaria showing it is 143 times more toxic than acetylcholine due to the inability of cholinesterase to hydrolyse or inhibit its effect. The acute cardiovascular toxicities are well described, however, this case is the first description of chronic cardiac toxicity manifesting as new onset AF with RVR, caused by A. muscaria and pantherina withdrawal. We suggest that cardiovascular monitoring, including event monitors, are essential for complications of A. muscaria and pantherina . More detailed studies need to be done.

Effect of Aerobic/Strength Training on RANKL Gene DNA Methylation Levels.

The osteoclastogenesis RANKL gene plays a key role in bone remodeling. The hypomethylation of its promoter region may cause osteoporosis. The present study aimed to elucidate the influence of physical activity on DNA methylation changes of RANKL promoter cytosine-phosphate-guanine (CpG)-rich region in active and sedentary adults and to assess the effect of aerobic and strength training on RANKL DNA methylation changes among Tunisian-North African adults. A total of 104 participants including 52 adults (58% males and 42% females) and 52 adults (31% males and 69% females) were recruited for the observational and interventional part of the study, respectively. The intervention consisted of 12weeks of aerobic training (30min/session) followed by 10minutes of strengthening exercises. All participants completed the International Physical Activity Questionnaire and provided blood samples for quantitative methylation-specific polymerase chain reaction (PCR) analysis. The study revealed a significant difference (P = 6 × 10-10) in the methylation level of the RANKL promoter region between active and sedentary adults, with a 6.68-fold increase observed in the active group. After the intervention, both the trained (P = 41 × 10-5) and untrained (P = .002) groups displayed high methylation levels in the RANKL promoter region. In addition, the trained group exhibited significant improvements in heart rate (P = 2.2 × 10-16), blood pressure (P = 39 × 10-3), maximal oxygen uptake (P = 1.5 × 10-7), and fat mass (P = 7 × 10-4). Exploring epigenetic modifications in the RANKL promoter region may contribute to a more comprehensive understanding of the complexity of osteoporosis. This suggests that aerobic/strength training could potentially improve the bone system, reducing its vulnerability to osteoporosis by increasing RANKL DNA methylation.

Hemodynamic and Homeostasis Changes after Continuous Renal Replacement Therapy in Septic Shock Children at Vietnam National Children’s Hospital

Objectives: This study aims to describe changes in hemodynamics and homeostasis after continuous renal replacement therapy (CRRT) in septic shock children without acute kidney injury. Methods: An observational study was conducted in the pediatric intensive care unit (PICU) at Vietnam National Children’s Hospital from January 2018 to June 2022. Children aged under 18 years old with septic shock and without acute kidney injury who required CRRT were analyzed on demographic factors, baseline clinical and laboratory results, changes in hemodynamics and homeostasis at 6 hours, 12 hours, 24 hours, 48 hours, 72 hours, 4 days and 5 days after CRRT initiation. Results: A total of 125 children (male, 57.6%) were enrolled in the study. The median age was 11.5 months (IQR: 5 – 29). Overall PICU mortality rate at day 28 was 40.8%. Among survivors, there was a statistically significant improvement in heart rate, mean blood pressure, vasoactive inotropic score (VIS), and pH at all mentioned periods after CRRT initiation. Lactatemia statistically significantly decreased after 24 hours of CRRT initiation (p &lt; 0.05). Among non-survivors, there was a statistically significant improvement in heart rate at all the periods and in mean blood pressure at 6 hours and 12 hours, while there was no improvement in VIS, pH, and lactatemia. Conclusion: CRRT played an important role in stabilizing hemodynamics and homeostasis in septic shock children without acute kidney injury.&#x0D; &#x0D; &#x0D; &#x0D;

Mechanical thrombectomy for acute pulmonary embolism in lung transplant recipients

The rates of pulmonary embolism (PE) are high among lung transplant (LT) recipients. Management is challenging because of elevated bleeding risks and inadequacy of conventional PE risk stratification tools. New percutaneous large bore mechanical thrombectomy catheters are being increasingly used effectively to debulk thrombus and restore flow immediately. We describe the use of mechanical thrombectomy (MT) in 8 LT recipients. All patients were diagnosed with intermediate/high-risk proximal PE involving the allograft and underwent successful MT within 30hours of diagnosis. Estimated blood loss was between 200 and 450cc, with 3 patients requiring blood transfusions. Improvement in heart rate and oxygenation was seen in all 8 patients after the procedure. In the 30days after MT, 7 of 8 patients survived. One patient died from major bleeding occurred 16 days after MT and 5 days after venoarterial extracorporeal membrane oxygenator decannulation. Mechanical thrombectomy may provide a feasible management strategy in select LT recipients with pulmonary embolism.

Omecamtiv Mecarbil in Black Patients With Heart Failure and Reduced Ejection Fraction: Insights From GALACTIC-HF

BackgroundOmecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. ObjectivesThe purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. MethodsIn GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. ResultsBlack patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro–B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs −0.7 mm Hg, P for interaction = 0.02). ConclusionsGALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.

Abstract 14466: Recurrent Heart Block Due to Cardiac Sarcoidosis in a Patient With Interrupted Glucocorticoid Therapy

Background: Cardiac involvement is a major cause for mortality in patients with systemic sarcoidosis. Atrioventricular (AV) block caused by inflammation involving the conduction system is one of the major manifestations of cardiac involvement. The mainstay of management is immunosuppressive therapy and device implantation if high degree AV block is present. However, there is lack of evidence regarding the appropriate dose and duration of corticosteroids in the treatment of cardiac sarcoidosis. Case summary: We describe the case of a 62-year-old man who presented with symptoms of dyspnea and bradycardia and was found to be in second degree AV block type II. Computed tomography of the chest showed hilar lymphadenopathy. Echocardiography revealed reduced systolic function (LVEF of 35-40%). A FDG-PET scan showed hypermetabolic activity of the interventricular septum and pericardium consistent with sarcoidosis. Bronchoscopy with BAL and EUS biopsies revealed necrotizing granulomas consistent with pulmonary sarcoidosis. ICD/pacemaker implantation was discussed; however the patient deferred and ultimately underwent Boston Scientific ILR placement to monitor for arrhythmias. He was started on methotrexate and prednisone with improvement in heart rate from 2:1 AV block (rates 30's) to sinus rhythm with rates in the 60's. Subsequent stress testing demonstrated improvement in heart rate with exercise to 113 bpm. His AV block had decreased in frequency per Implantable loop recorder (ILR) monitoring. A month later, the patient stopped taking prednisone and methotrexate and developed a symptomatic recurrence of 2:1 AV block. He then underwent dual chamber pacemaker implantation with ILR explant. Discussion: This case highlights the importance of maintaining and educating patients about long term immunosuppressive treatment in cardiac sarcoidosis to prevent recurrence of conduction abnormalities. The initial dose for those receiving prednisone is typically 40mg daily, while for those patients receiving an additional immunosuppressive agent, the initial dose can be 20mg daily. Based on response to treatment after 1 to 3 months, immunosuppressive therapy should be continued for an additional 9 to 12 months.

Effects of Listening to Quran Recitation and Nature Sounds on Preoperative Anxiety Among Patients Undergoing Surgery

This study aimed to compare the effectiveness between listening to Quran and nature sounds on preoperative anxiety and physiological parameters. Using systematic random sampling, a randomized controlled trial study was conducted among 81 patients, which comprised of male and female patients allocated into three equal groups, that is, Quran recitation group, nature sounds group, and a control group. Preoperative state anxiety was measured using the State-Trait Anxiety Inventory (Embong, 2018), and physiological parameters were recorded before and after the intervention. After the intervention, the analysis within-subjects showed significant improvement in heart rate, respiratory rate, and state anxiety. However, post-hoc test showed that reduction in the mean state anxiety scores in all groups was the only significant factor. Paired analysis showed that only mean state anxiety level of nature sounds group has a significant reduction in comparison to control group; whereas there was nonsignificant difference in state anxiety of other paired groups when compared between both intervened groups and between Quran group and control group. The result concluded that listening to either the Quran or nature sounds were effective in reducing preoperative anxiety, however head-to-head comparison found no significant difference.

Effects of Interval Training Under Hypoxia on Hematological Parameters, Hemodynamic Function, and Endurance Exercise Performance in Amateur Female Runners in Korea.

Interval training under hypoxia (IHT) is commonly used to enhance endurance exercise performance. However, previous studies examining hematologic changes related to the immune system that affect health and conditioning are lacking. This study aimed to evaluate the effects of IHT for 6-weeks on hematological parameters, hemodynamic function, and endurance exercise performance in amateur Korean female runners. Twenty healthy amateur Korean female runners (age: 24.85 ± 3.84 years) were equally assigned to normoxic training group (NTG) for interval training under normoxia (760 mmHg) and hypoxic training group (HTG) for interval training under hypobaric hypoxia (526 mmHg, 3000 m simulated altitude) according to their body composition and endurance exercise performance. All participants performed 120-min of training sessions, consisting of 20-min of warm-up, 60-min of interval training, and 20-min of cool-down. The training program was performed 3-days per week for 6-weeks. Warm-up and cool-down were performed for 20-min at 60% maximal heart rate (HRmax). The interval training sessions comprised 10 repetitions of interval exercise (5-min of exercise corresponding to 90–95% HRmax and 1-min of rest) on a treadmill. All participants underwent measurements of hematological parameters, hemodynamic function, and endurance exercise performance before and after training. Both groups showed a significant increase in erythropoietin (EPO) level and a decrease in monocyte abundance, with EPO showing a greater increase in the HTG than in the NTG. B cell abundance significantly increased in the NTG; hematocrit and neutrophil counts significantly increased, and lymphocyte counts significantly decreased in the HTG. The HTG showed a significant improvement in oxygen uptake, stroke volume index, and end-diastolic volume index compared to the NTG. In addition, both groups showed significant improvements in heart rate, end-systolic volume index, and cardiac output index. The maximal oxygen uptake and 3000 m time trial record were significantly improved in both groups, and the HTG showed a tendency to improve more than the NTG. In conclusion, the IHT was effective in enhancing endurance exercise performance through improved hemodynamic function. Furthermore, hematological parameters of immune system showed a normal range before and after training and were not negatively affected.

Baicalein Ameliorates Myocardial Ischemia Through Reduction of Oxidative Stress, Inflammation and Apoptosis via TLR4/MyD88/MAPKS/NF-κB Pathway and Regulation of Ca2+ Homeostasis by L-type Ca2+ Channels.

Background: Baicalein (Bai) is the principal ingredient of Scutellaria baicalensis Georgi. Reports concerning the therapeutic advantages in treating cardiovascular diseases have been published. However, its protective mechanism towards myocardial ischemia (MI) is undefined. Objective: The aim of this study was to investigate the protective mechanisms of Bai on mouse and rat models of MI. Methods: Mice were pre-treated with Bai (30 and 60 mg/kg/day) for 7 days followed by subcutaneous injections of isoproterenol (ISO, 85 mg/kg/day) for 2 days to establish the MI model. Electrocardiograms were recorded and serum was used to detect creatine kinase (CK), lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA). Cardiac tissues were used to detect Ca2+ concentration, morphological pathologies, reactive oxygen species (ROS), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). In addition, the expression levels of Bcl-2-associated X (Bax), B cell lymphoma-2 (Bcl-2), Caspase-3, Toll-like receptor-4 (TLR4), myeloid differentiation protein 88 (MyD88), nuclear factor-kappa B (NF-κB), p-p38, p-extracellular signal-regulated kinase1/2 (p-ERK1/2) and c-Jun N-terminal kinase (p-JNK) were assessed by western blots in myocardial tissues. The effects of Bai on L-type Ca2+ currents (ICa-L), contractility and Ca2+ transients in rat isolated cardiomyocytes were monitored by using patch clamp technique and IonOptix system. Moreover, ISO-induced H9c2 myocardial injury was used to detect levels of inflammation and apoptosis. Results: Bai caused an improvement in heart rate, ST-segment and heart coefficients. Moreover, Bai led to a reduction in CK, LDH and Ca2+ concentrations and improved morphological pathologies. Bai inhibited ROS generation and reinstated SOD, CAT and GSH activities in addition to inhibition of replenishing MDA content. Also, expressions of IL-6 and TNF-α in addition to Bax and Caspase-3 were suppressed, while Bcl-2 expression was upregulated. Bai inhibited protein expressions of TLR4/MyD88/MAPKS/NF-κB and significantly inhibited ICa-L, myocyte contraction and Ca2+ transients. Furthermore, Bai caused a reduction in inflammation and apoptosis in H9c2 cells. Conclusions: Bai demonstrated ameliorative actions towards MI, which might have been related to attenuation of oxidative stress, inflammation and apoptosis via suppression of TLR4/MyD88/MAPKS/NF-κB pathway and adjustment of Ca2+ homeostasis via L-type Ca2+ channels.

Sotalol versus amiodarone for postoperative junctional tachycardia after congenital heart surgery.

Junctional ectopic tachycardia (JET) is a common arrhythmia after congenital heart disease surgery. There is variability in the choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent that may be useful for JET. The purpose of this study was to evaluate the safety and efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone. This is a retrospective single-center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children's Hospital from December 15, 2015, to December 15, 2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to <170 beats/min (or decrease by >20%), or conversion to sinus rhythm, with persistent control over 24 hours without requiring alternative antiarrhythmics or mechanical support. A total of 32 patients (median age 71 days; interquartile range 17-221 days) received IV amiodarone (n = 20 [62%]) or IV sotalol (n = 12 [38%]) for postoperative JET. Amiodarone was successful in treating JET in 75% of cases; sotalol was successful in 83%. The JET rate decreased faster over the first 90 minutes after a sotalol bolus (25 beats/min per hour) than after an amiodarone bolus (8 beats/min per hour) (P < .01); no heart rate difference was seen after 24 hours. Amiodarone infusion was discontinued early because of hypotension/bradycardia in 2 patients; this was not required in any patients receiving sotalol. For children with postoperative JET, both IV sotalol and amiodarone are safe and efficacious. IV sotalol may lead to a faster improvement in heart rate.

Learning based Quality Indicator Aiding Heart Rate Estimation in Wrist-Worn PPG.

Technological advancements and miniaturization of wearable sensors have enabled long-term pervasive physiological monitoring. Wrist-worn photoplethysmography (PPG) sensors, although quite popular owing to their form factor, suffer from poor signal quality in ambulatory settings due to motion artifacts. This affects the reliable estimation of vital cardiac parameters, especially during motion/activities of daily living. Hence, in this paper, we have developed a learningbased quality indicator engine (QIE), evaluating on 23 PPG records of the TROIKA database. The engine comprises the fundamental steps of frequency-domain feature extraction, feature selection and classification by an ensemble of decision trees, achieving an accuracy of 83% in the testing set. To the best of our knowledge, the proposed quality engine is the first to be evaluated on wrist-PPG data acquired during various physical activities and with respect to improvement in heart rate (HR) estimation. The QIE demonstrated an average improvement of 43% in HR estimation, when used in conjunction with state-ofthe-art WFPV algorithm.Clinical Relevance- The proposed quality indicator engine helps to increase the efficacy of vital parameter estimation (e.g. heart rate) from pervasive, wrist-worn PPG sensors on the backdrop of motion artifacts when used in ambulatory settings (e.g. activities of daily living).

Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial.

The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo. Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04-1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (-2; 14) vs. -1 µM/L (-11; 6), P < 0.001]. In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation.ClinicalTrials.gov identifier NCT02268903.