Increase In HR Research Articles

The Effects of an Acute Bout of Subconcussive Head Impacts on Sympathetic Reactivity

Symptomatic concussed athletes (tested within ~7 d of injury) exhibit an attenuated rise in blood pressure and heart rate during the cold pressor test (CPT), which is indicative of sympathetic hyporeactivity. However, resting blood pressure is elevated following a sports season that has a high incidence of repetitive subconcussive head impacts (SHI) which suggests autonomic or vascular dysfunction. A single session of experimentally induced repetitive SHI increases circulating biomarkers of neuronal injury. In this context, it is unknown if a session of repetitive SHI alters autonomic function.PURPOSEWe tested the hypothesis that the sympathetically‐mediated rise in heart rate and blood pressure during the CPT would be attenuated following a session of repetitive SHI in healthy young adults.METHODSTen healthy participants (age: 20±2 y; 6 females) with ≥3 years of soccer heading experience completed three separate study visits. The CPT (left hand submerged up to the wrist in agitated 0°C water for 120 s) was conducted before soccer heading (0h) and at 2 h (2h), 24 h (24h), and 72 h (72h) after soccer heading. 20 SHI were completed using a soccer heading protocol (ball projected at ~11.2 m/s from 12.2 m every 30 s). Heart rate (HR; 5‐lead electrocardiogram) and beat‐to‐beat blood pressure (MAP; finger photoplethysmography) were continuously recorded at 1 kHz. Mean HR and MAP were extracted during the final minute of the CPT baseline (BL) and every 30 s throughout the CPT. We used mixed‐effects ANOVAs to compare the change (∆) from BL between and within experimental visits. Values are reported as ∆ BL (mean ± SD).RESULTSThere were no differences across timepoints at BL for HR (0h: 58±9 vs. 2h: 60±7, 24h: 59±8, 72h: 62±9 bpm; P=0.19) or MAP (0h: 98±15 vs. 2h: 99±9, 24h: 89±8, 72h: 95±8 mmHg; P=0.09). There was a main effect of time post SHI for ∆ HR (P<0.01) but multiple comparisons did not reveal where differences occurred between 0h (8±6 bpm) vs. 2h (9±7 bpm; P>0.99), 24h (10±7 bpm; P=0.19), and 72h (8±6 bpm; P<0.99). The mean ∆MAP throughout the CPT was lower at 0h (17±13 mmHg) vs. 2h (21±15 mmHg; P<0.01), 24h (23±17 mmHg; P<0.01), and 72h (20±16 mmHg; P<0.01). The ∆MAP during the CPT was lower at 60 s of 0h vs. 24h (24±12 vs. 31±13 mmHg; P<0.01), at 90 s of 0h vs, all post‐SHI (0h: 28±14 vs. 2h: 34±12, 24h: 38±12, 72h: 33±13 mmHg; P<0.01), and at 120 s of 0h vs. all post‐SHI (0h: 27±15 vs. 2h: 33±12, 24h: 37±10, 72h: 34±13 mmHg; P<0.01).CONCLUSIONContrary to our hypothesis, these preliminary data indicate that a single session of repetitive SHI does not attenuate sympathetically‐mediated cardiovascular responses to the CPT. The increase in HR was similar before and after soccer heading; however, the increase in MAP was exacerbated during the CPT at all post‐SHI time points. Thus, there appears to be sympathetic hyperreactivity following a single session of repetitive SHI. This sympathetic hyperreactivity might explain the increase in blood pressure following a sports season associated with a high incidence of repetitive SHI.

Impact of sodium citrate ingestion during recovery after strenuous exercise in the heat on heart rate variability: A randomized, crossover study

Changes in hydration status influence plasma volume (PV) which is associated with post‐exercise parasympathetic reactivation. The present study hypothesized that, after dehydrating cycling exercise in the heat (DE), stimulation of PV expansion with sodium citrate (CIT) supplementation would promote heart rate variability (HRV) recovery in endurance‐trained men. Twelve participants lost 4% of body mass during DE. During subsequent 16‐h recovery, participants consumed water ad libitum (CIT =5.5‐L, PLC =5.1‐L) and ate prescribed food supplemented with CIT or placebo in a randomized, double‐blind, crossover manner. Relative changes in PV were assessed across DE and 16‐h recovery. HRV was analyzed before and 16 h after DE in three conditions for altogether four 5‐min periods: supine in a thermoneutral environment, supine in the heat (32°C, 46% relative humidity; 2 periods), and standing in the heat. A larger expansion of PV across 16‐h recovery occurred in CIT compared to placebo trial (p < 0.0001). However, no between‐trial differences appeared in HRV parameters (lnRMSSD, lnSDNN, lnLF/HF) in any 5‐min period analyzed before or 16 h after DE (in all cases p > 0.05). Increases in HR (p < 0.001) and lnLF/HF (p = 0.005) and decreases in lnRMSSD (p < 0.001) and lnSDNN (p < 0.001) occurred following DE in both trials. Larger PV expansion induced by CIT supplementation after DE does not improve recovery of HRV at rest and has no influence on HRV responsiveness in endurance‐trained men.

Systemic Interleukin‐1β Elicits Cyclooxygenase‐Independent Fever

Interleukin‐1β (IL‐1β) induces neuroimmune responses that help to fight infections. IL‐1β‐induced fever is not abolished by cyclooxygenase (COX) inhibitors used to treat inflammation and the neural pathways responsible for COX‐independent fever are still unknown. Considering that neurons that reside in the rostral raphe pallidus area (rRPa) and in the dorsomedial hypothalamus (DMH) play a key role in the control of thermoeffectors, we hypothesized that neurons in these areas contribute to COX‐independent fever elicited by intravenous (iv) IL‐1β. Female and male Sprague Dawley rats were anesthetized with urethane and α‐chloralose (ur/ch) or isoflurane (iso) and treated with saline or indomethacin, prior to receiving iv IL‐1β. Systemic IL‐1β increased brown adipose tissue (BAT) sympathetic nerve activity (SNA) (+2852 ± 2020% baseline (BL), p = 0.003), BAT temperature (TBAT; +2.6 ± 1.3°C, p &lt; 0.001), expired CO2 (+1.0 ± 0.4%, p &lt; 0.001), core body temperature (TCORE; +0.6 ± 0.2°C, p &lt; 0.001), heart rate (HR; +102 ± 42 bpm, p &lt; 0.001), mean arterial pressure (MAP; +11 ± 7 mmHg, p = 0.002), and paw temperature (TPAW; ‐6.9 ± 1.2°C, p &lt; 0.001), which is an index of cutaneous vasoconstriction (CVC). Indomethacin did not prevent IL‐1β‐evoked increases in BAT SNA (+2545 ± 756% BL, p &lt; 0.001), TBAT (+2.9 ± 1.3°C, p &lt; 0.001), expired CO2 (+1.2 ± 0.6%, p = 0.003), TCORE (+0.9 ± 0.5°C, p = 0.005), HR (+117 ± 47 bpm, p &lt; 0.001), MAP (+27 ± 20 mmHg, p = 0.01), or TPAW (‐5.9 ± 3.4°C, p = 0.02). Nanoinjection of muscimol in the rRPa prevented IL‐1β‐evoked increases in BAT SNA (p &lt; 0.01), TBAT (p &lt; 0.01), expired CO2 (p &lt; 0.01) and TCORE (p &lt; 0.01), but not in HR (p = 0.08), in comparison to the group that received IL‐1β only. Nanoinjection of muscimol in the rRPa in indomethacin‐pretreated rats prevented IL‐1β‐evoked increases in BAT SNA (p &lt; 0.01), TBAT (p &lt; 0.01), expired CO2 (p &lt; 0.01), TCORE (p &lt; 0.01), and TPAW (p = 0.03), but not in HR (p = 0.12), in comparison to an indomethacin‐pretreated group that received IL‐1β. Nanoinjections of glutamate receptor antagonists in the DMH markedly reduced IL‐1β‐evoked increases in BAT SNA (‐838 ± 542% BL, p = 0.03), TBAT (‐1.1 ± 0.4°C, p = 0.003), expired CO2 (‐0.4 ± 0.1%, p = 0.009) and HR (‐38 ± 20 bpm, p = 0.01), and reduced MAP (‐4 ± ‐2 mmHg, p = 0.02). Plasma PGE2 levels following iv IL‐1β were significantly higher (by ~3 fold) in rats that were not anesthetized when receiving IL‐1b (263.1 ± 136.4 pg/ml) compared to all other groups of rats that were maintained under anesthesia for 2 h (ur/ch anesthetized, saline pretreated: 96.7 ± 30.8 pg/ml, p = 0.007, or indomethacin pretreated: 119.7 ± 51.9 pg/ml, p = 0.02; iso anesthetized, saline pretreated: 82.5 ± 21.2 pg/ml, p = 0.003, or indomethacin‐pretreated: 108.4 ± 39.1 pg/ml, p = 0.01). Therefore, we suggest that the anesthetics used inhibited the systemic production of PGE2. Together, our data suggest that a glutamatergic input to the DMH is necessary for providing the excitatory drive for increasing BAT thermogenesis and tachycardia in response to circulating IL‐1β, likely via rRPa neurons. Additionally, IL‐1β‐evoked CVC requires activation of neurons in the rRPa. These data define critical components of the neural circuit for systemic IL‐1β‐induced fever and provide a foundation for elucidating additional brain mechanisms responsible for COX‐independent fever.

Effect of oral hormonal contraceptive pill use on the hemodynamic response to the cold pressor test.

Acute increases in sympathetic nervous system activity (SNA) often elicit peripheral vasoconstriction and increases in blood pressure (BP). Given sympathetic support of BP is modulated by ovarian sex hormones (e.g., estradiol), we sought to examine the effect of menstrual cycle and oral hormonal contraceptive pill (OC) phase on the hemodynamic response to acute increases in SNA. We hypothesized sympathoexcitation via cold pressor test (CPT) would elicit greater peripheral vasoconstriction and increases BP in females with natural menstrual cycles (NC) compared with females taking OC. We further hypothesized that SNA-mediated vasoconstriction would be attenuated during the high estradiol (HE) phase versus the low estradiol (LE) phase of the menstrual/pill cycle. Female NC (n = 11, 25 ± 1 yr) and OC (n = 10, 24 ± 1 yr) participants were studied during the LE (early follicular, placebo pill) and HE (late follicular, active pill) phase of the menstrual/pill cycle. BP (finger photoplethysmography), heart rate (HR, ECG), and forearm blood flow (FBF, venous occlusion plethysmography) were measured during a 5-min baseline and a 2-min CPT. CPT elicited an increase in BP in both groups (time, P < 0.01). During CPT, OC participants exhibited greater and sustained increases in HR compared with NC participants (group × time, P < 0.01). Higher HRs were met with increases in FBF in OC participants during the CPT, which was not observed in NC participants (group × time, P < 0.01). OC participants exhibit greater increases in HR, and paradoxical vasodilation during acute sympathetic activation compared with NC participants. Group differences are unaffected by menstrual/pill phase.NEW & NOTEWORTHY Acute increases in sympathetic nervous system activity often elicit peripheral vasoconstriction and increases in blood pressure (BP). Given sympathetic support of BP is modulated by ovarian sex hormones (e.g., estradiol), we sought to examine the effect of menstrual cycle and oral hormonal contraceptive pill (OC) phase on the hemodynamic response to acute increases in sympathetic nervous system activity via the cold pressor test. We show OC participants exhibit paradoxical vasodilation during acute sympathetic activation compared with participants with natural menstrual cycles; notably, group differences were unaffected by menstrual/pill phase.

Different characteristics of cortical spreading depression in the sleep and wake states.

The objective of this study is to characterize the effects of the sleep-wake cycle on neurovascular and behavioral characteristics of cortical spreading depression (CSD). There is an important bi-directional relationship between migraine and the sleep-wake cycle, but the basic mechanisms of this relationship are poorly understood. We have developed a minimally invasive microchip system to continuously monitor cerebral blood volume (CBV) with optical intrinsic signal (OIS), head movement, and multiple other physiological and behavioral parameters in freely behaving mice over weeks. Behavior is also monitored with simultaneous video recording. This system can also be used to intermittently trigger and record CSD and accompanying neurovascular and behavioral responses. CSD was triggered optically in different stages of the sleep-wake cycle. The optical stimulus threshold to trigger CSD was significantly higher in the wake state compared to sleep (stimulation duration=16.4±9.7s vs. 10.8±5.8s, p=0.037, n=6mice). CSD evoked in the wake versus sleep state produced changes in CBV that were smaller (largest relative change -4.5±5.0% ∆OIS vs. -14.3±8.5% ∆OIS, p=0.001) and shorter in duration (33:22±6:37 vs. 49:42±8:05min:s, p=0.012, n=6mice). The threshold for CSD and kinetics of associated CBV changes were correlated with the time since falling asleep or awakening (n=47 CSDs in 6mice). CSD triggered in the wake state was associated with a transient freezing behavior. CSD triggered during sleep typically caused a transient awakening and behavioral response. This was followed by a return to sleep until recovery from the sustained phase of decreased CBV that occurred 30-60min later, at which time there was consistent awakening with behaviors similar to those that occurred at CSD onset. CSD triggered in the wake state evoked a transient decrease in heart rate (from 11.9±0.8 to 9.6±0.8Hz, p=0.002, n=5), whereas when triggered in the sleep state there was a transient increase in HR (from 7.5±0.4Hz to 9.3±1.1Hz, p=0.016, n=5). The sleep-wake cycle has significant effects on CSD that may have relevance to the clinical presentations of migraine and brain injury.

Assessment on R-410A saturated flow boiling heat transfer subject to periodic oscillating heat flux inside an annular duct

The objective of this study is concerned with assessing experimentally the heat transfer of time-dependent saturated flow boiling (TDSFB) for refrigerant R-410 A stemming from oscillations in the heat flux inside an annular duct with the gap of δ = 2 mm in order to improve the energy efficiency of heat exchanger system. The influences of operating parameters, such as mean applied heat flux q‾, heat flux oscillation amplitude Δq/q‾, mass flux of refrigerant G, oscillation period tp, and saturation temperature Tsat, on heat transfer characteristics of TDSFB are systematically explored. From the present experimental results, it is found that increasing mean applied heat flux enhances the average wall superheat and boiling heat transfer coefficient (BHTC, hr); while an increase in either Δq/q‾ or tp exerts very minor influence on the boiling curve and hr. As the q‾ oscillates in the triangular waveform, the wall temperature (Tw) varies in sinusoidal waves at the same frequency of q‾. At low, intermediate, and high q‾, three different flow patterns versus time are observed and named single-phase flow (SPF), intermittent boiling flow (IBF), and persistent boiling flow (PBF). The oscillation amplitudes of Tw and hr are increased with the increases of Δq/q‾. Enhancing either G or Tsat tends to result in a slight decrease in Tw, but an increase in hr. Moreover, the Tw does not fluctuate with the oscillation of lower q‾ under a shorter tp due to the tube thermal inertia, but oscillates significantly as the tp is raised. Finally, a correlation equation is presented to identify the bounds, distinguishing the three different flow patterns of R-410 A TDSFB subject to oscillatory heat flux inside horizontal annuli.

Neighborhood environmental exposures and incidence of attention deficit/hyperactivity disorder: A population-based cohort study.

Emerging studies have associated low greenspace and high air pollution exposure with risk of child attention deficit/hyperactivity disorder (ADHD). Population-based studies are limited, however, and joint effects are rarely evaluated. We investigated associations of ADHD incidence with greenspace, air pollution, and noise in a population-based birth cohort. We assembled a cohort from administrative data of births from 2000 to 2001 (N∼37,000) in Metro Vancouver, Canada. ADHD was identified by hospital records, physician visits, and prescriptions. Cox proportional hazards models were applied to assess associations between environmental exposures and ADHD incidence adjusting for available covariates. Greenspace was estimated using vegetation percentage derived from linear spectral unmixing of Landsat imagery. Fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were estimated using land use regression models; noise was estimated using a deterministic model. Exposure period was from birth until the age of three. Joint effects of greenspace and PM2.5 were analysed in two-exposure models and by categorizing values into quintiles. During seven-year follow-up, 1217 ADHD cases were diagnosed. Greenspace was associated with lower incidence of ADHD (hazard ratio, HR: 0.90 [0.81-0.99] per interquartile range increment), while PM2.5 was associated with increased incidence (HR: 1.11 [1.06-1.17] per interquartile range increment). NO2 (HR: 1.01 [0.96, 1.07]) and noise (HR: 1.00 [0.95, 1.05]) were not associated with ADHD. There was a 50% decrease in the HR for ADHD in locations with the lowest PM2.5 and highest greenspace exposure, compared to a 62% increase in HR in locations with the highest PM2.5 and lowest greenspace exposure. Effects of PM2.5 were attenuated by greenspace in two-exposure models. We found evidence suggesting environmental inequalities where children living in greener neighborhoods with low air pollution had substantially lower risk of ADHD compared to those with higher air pollution and lower greenspace exposure.

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

Background: Music based interventions have been found to improve wellbeing for people with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate using simulation modelling analysis. Results: In study 1, the singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster tempos. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during singing compared to a baseline control. In study 2 EDA (p < 0.0001 for 14/18 data points [3 music conditions across 6 participants]) and ST (p < 0.001 for 10/18 data points) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 data points). EDA was higher during slower music (p < 0.0001 for 13/18 data points), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different music genre. Conclusions: Physiological measures provide valuable information about the experiences of people with dementia participating in musical activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures. video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.

A Combined Analysis of Peak and Submaximal Exercise Parameters in Delineating Underlying Mechanisms of Sex Differences in Healthy Adolescents.

Peak exercise parameters are considered the gold standard to quantify cardiac reserve in cardiopulmonary exercise testing (CPET). We studied whether submaximal parameters would add additional values in analyzing sex differences in CPET. We reviewed CPET of age-matched healthy male and female adolescents by cycle ergometer. Besides peak parameters, submaximal CPET parameters, including ventilatory anaerobic threshold (VAT), oxygen uptake efficiency slope (OUES), and submaximal slopes of Δoxygen consumption (ΔVO2)/Δwork rate (ΔWR), Δheart rate (ΔHR)/ΔWR, ΔVO2/ΔHR, and Δminute ventilation (ΔVE)/ΔCO2 production (ΔVCO2), were obtained. We studied 35 male and 40 female healthy adolescents. Peak VO2 (pVO2), peak oxygen pulse (pOP), and VAT were significantly lower in females than males (1.9 ± 0.4 vs. 2.5 ± 0.6 L/min; 10 ± 2.0 vs. 13.2 ± 3.5ml/beat; 1.23 ± 0.3 vs. 1.52 ± 0.5 L/min, respectively, all p < 0.005). Females showed significantly lower pVO2, VAT, and OUES with the same body weight than males, implying higher skeletal muscle mass in males. When simultaneously examining ΔHR/ΔWR and pOP, females showed higher dependency on increases in HR than in stroke volume. Females demonstrated significantly lower pOP with the same levels of ΔVO2/ΔHR, suggesting more limited exercise persistence than males under an anaerobic condition at peak exercise. Oxygen uptake efficiency in relation to peak VE was significantly higher in males. There was no sex difference in either ΔVO2/ΔWR or ΔVE/ΔVCO2. Combinational assessment of peak and submaximal CPET parameters delineates the multiple mechanisms that contribute to the sex differences in exercise performance.

Classification of Artificial Intelligence Based Coronary Artery Stenosis

Background: Despite major advances in diagnoses and treatments, cardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality worldwide. To improve and optimize CVD results, AI techniques have the potential to radically revolutionize the way we practice cardiology, especially in imaging and provide with new tools to interpret data and make clinical decisions. Aim: Establishing strategies are necessary to improve the diagnosis and treatment of CVD in the future. Nowadays, artificial intelligence (AI) may have the potential to solve this problem. The application of AI in heart diseases aims to facilitate the detection of radiology patients. Methods: The machine learning algorithms used in this study are K-Nearest Neighbor (KNN), Support Vector Machines (SVM), Naive Bayes, and Decision Tree. In our study, a total of 600 patients, 300 female and 300 male, who were diagnosed with IHD as a result of the findings obtained from the reports of the patients who underwent CAG in the Fırat University Hospital were included in our study. Accuracy, precision, sensitivity, specificity, and F1-score performance values were obtained by the classification. Results: Among the algorithms we have used, KNN had the highest success rate. It was followed by SVM in the second success rate. The success rate of RCA was 83% in KNN, and it was 75% in SVM. While the success rate of LCx in KNN was 76%, it was 68% in SVM. Similarly, the success rate of LAD in KNN was 73%, and it was 71% in SVM. Conclusion: The demand for CAG will be rising in the coming years, owing to an increase in HR. Therefore, new strategies will be sought to reduce the duration of CAG. We consider the application of AI in routine clinical practice. Keywords: Right coronary artery, Left coronary artery, Stenosis, Artificial intelligence

Acute Effects of Heart Rate-Controlled Exergaming on Vascular Function in Young Adults.

Objective: Acute and regular moderate-intensity endurance exercise (MIEE) is known to positively affect vascular function. The present study assessed if an exercise session in an innovative exergame called the ExerCube can induce similar vascular reactions as an MIEE session. Materials and Methods: Twenty-eight healthy recreationally active participants (13 females and 15 males; aged 24.8 ± 3.9 years; with body mass index 23.2 ± 2.3 kg/m2) completed an exergaming session (EGS) in the ExerCube (25 minutes) and an MIEE session on a treadmill (35 minutes, 65%-70% of maximal heart rate [HR]) in a randomized order. Both before and throughout the 45 minutes after the training sessions, pulse wave velocity (PWV), total peripheral resistance (TPR), stroke volume (SV), and HR were recorded. The study was approved by the Research Ethics Board of the Martin-Luther-Universität Halle-Wittenberg (Medical Faculty of the Martin-Luther-Universität 2019-177). Results: There were different hemodynamic responses to both types of exercises. PWV was significantly decreased 45 minutes after the EGS (P < 0.001). No significant changes were detected after MIEE (P = 0.109). TPR was significantly lower after both exercise sessions (P < 0.01). Only the EGS resulted in a significant decrease in SV 15 minutes after exercise (P < 0.001). The HR was significantly (P < 0.05) higher after both exercise sessions. After the EGS, the increase in HR was still significantly higher (P = 0.011) 45 minutes after the session. The interaction effects revealed significant differences in PWV (15 minutes, P = 0.035; 30 minutes, P = 0.004; and 45 minutes, P < 0.001), favoring the EGS. Conclusion: The EGS seems to induce a relevant exercise stimulus that can modulate vascular function. Therefore, this exergame may present an effective tool for prevention of cardiovascular diseases.

Hydroxychloroquine in a COVID-19 patient on chronic Pregabalin therapy- Is it safe?

Dear Editor, A 58-year-old male patient, weighing 90 kg presented with fever, shortness of breath, and cough for one week. The RT-PCR was tested positive for COVID-19. Patient had hypertension for past 15 years and controlled on amlodipine 5-mg OD and pregabalin 75-mg and clonazepam 0.5-mg OD for cervical spondylosis for the last 4 years. Pulse rate was 106/min, blood pressure 118/74 mm Hg, and respiratory rate was 28 breaths/min. His condition deteriorated and was shifted to ICU where his oxygen saturation improved to 98% on partial rebreathing face mask from 83% on room air. On auscultation, crepitations were present in bilateral lower lung fields. All routine investigations were within normal limit except for high WBC count (15000/µL) and electrocardiogram (ECG) demonstrating a heart rate of 150/min and QTc interval of 480ms(Bazett’sformula). Chest X-ray revealed bilateral lower zone infiltrates. He received tazobactam-piperacllin, teicoplanin, ivermectin, enoxaparin, dexamethasone, salmeterol MDI, vitamin C, zinc and had already received azithromycin. Considering the ECG changes, hydroxychloroquine (HCQ) was not administered. It was revealed that he was on both pregabalin and clonazepam till a day before and was immediately stopped. The ECG changes resolved on next day i.e. within 36 h. Following which, HCQ was administered in a dose of 400-mg OD for 5 days; ECG on all days was normal. Patient improved clinically and discharged thereafter. Cardiac events with pregabalin are rarely reported and is related to its binding to a2d2 subunits of voltage-gated calcium channel causing potassium-evoked accentuation of calcium influx. Recently, a population-based database concluded the relation between new exposure to pregabalin and initiating AF treatment with the incidence of 8.6 per 1000 and RR 2.79 (95% CI 1.05–7.40) when compared to the patients started on opiates.[1] Also, in an animal model, increase in HR and QTc prolongation was observed with pregabalin.[2] The role of HCQ has been controversial in the therapeutic management of COVID19. However, it is shown to significantly reduce the viral load in COVID-19 patients further reinforced by coadministration of azithromycin.[3] This particular evidence led to the exponential increase in its use for therapeutic management in the initial few months of this pandemic and was the time the present case was managed. Recently, a cohort study observed significant QTc prolongation in patients on HCQ and azithromycin combination therapy; however, did not report any arrhythmogenic deaths.[4] In this case, we attribute QTc prolongation to chronic pregabalin and/or clonazepam therapy. The oral bioavailability of pregabalin is approximately 90% and is not plasma protein bound with elimination half-life of 6.3 h. The steady-state plasma concentration is achieved within 24–48 h.[2] This explains the normalization of ECG approximately within 36 h of the last pregabalin dose. Similarly, literature search reveals only a single case report implicating clonazepam, a long-acting benzodiazepine to be a potential cause of QTc prolongation in a paediatric patient.[5] To conclude, the judicious and cautious use of proarrhythmic drugs like hydroxychloroquine and/or azithromycin in patients with COVID-19 on chronic pregabalin and/or clonazepam therapy as it may potentiate the risk of arrhythmia. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Impact of depth ratio on flow structure and turbulence characteristics of compound open channel flows

Compound open channel flows appear in most natural rivers are of great importance in river management and flood control. In this study, large eddy simulations were carried out to simulate the compound open channel flows with four different depth ratios (hr = 0.10, 0.25, 0.50, and 0.75). The main flow velocity, secondary flow, Reynolds stress, and bed shear stress were obtained from numerical simulations. The depth-averaged streamwise momentum equation was used to quantify the lateral momentum exchange between the main channel and floodplain. The instantaneous coherent structures were presented by the Q criterion method. The impact of hr on flow structure and turbulence characteristics was analyzed. The results showed that with the increase of hr, the high velocity area in the main channel shifted to the floodplain, and the dip phenomenon became more obvious; the Reynolds stress largely contributed to the lateral momentum exchange within the flows near the side walls of floodplain; and the vortex structures were found to significantly increase in the floodplain region.

Comparison the Effect of Etomidate vs. Thiopentone on Left Ventricular Strain and Strain Rate at the Time of Anesthesia Induction in Patients Undergoing Elective Coronary Artery Bypass Surgery: A Randomized Double Blind Controlled Trial

AbstractMyocardial strain imaging with speckle tracking echocardiography (STE) is getting popularity because it does not depends on insonation angle and has shown good correlation with intraoperative and postoperative ventricular function in patients with coronary artery disease. The impact of thiopentone and etomidate induction on myocardial function was studied and compared on sixty patients undergoing elective coronary artery bypass grafting. Three loops for each views (apical 4 chamber, apical 2 chamber, and apical long axis ) were acquired at base line (T0) and 1 minute (T1) after induction for offline analysis. In Group T, significant increase in HR from the base line values (67.8 ± 13.8 vs 79.2 ± 15.6, p = 0.001) occurred post induction, where as in Group E it remain near to the base line (71.7 ± 8.3 vs 70.1± 8.9, p = 0.345). A reduction in mean arterial pressure (MAP) was noted in both the groups after the injection of the allocated drug. There was no significant difference in the index of contractility (ICON) (T0 vs T1: 48.7 ± 10.6 vs 47.0 ± 11.7, p = 0.120) in Group E where as in Group T there was a reduction in the ICON value (T0 vs T1: 45.0 ± 10.7 vs 41.0 ± 8.4, p = 0.005). A similar picture was also noted in systemic vascular resistance index. A significant decrease in cardiac index (CI) was seen in Group E (T0 vs T1: 2.7 ± 0.4 vs 2.5 ± 0.4, p = 0.027), however it remain near to the base line in Group T. There occurred no changes in stroke index (SI) in Group E (T0 vs T1: 38.7 ± 6 vs 37.0± 5.3, p = 0.134), where as a significant decrease was noted after injection of thiopental (T0 vs T1: 38.0 ± 6.2 vs 36.1± 4.9, p = 0.049). A significant decline in cardiac performance index (CPI) was also recorded in Group E (T0 vs T1: 0.57 ± 0.15 vs 0.52 ± 0.12, p = 0.032), and not in Group T. There was decrease in left ventricular ejection fraction (LVEF) after the injection of both the drugs (Group E, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p= 0.001; and Group T, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p = 0.001). In Group E, global longitudinal peak systolic strain (GLPSS) showed no change after the injection of the drug (T0 vs T1: −13.2 ± 2.2 vs −13.1± 2.3, p = 0.631). However, a significant decrease in GLPSS (T0 vs T1: −13.5 ± 1.5 vs – 10 ± 1.8, p = 0.001) after injection of thiopental. Longitudinal peak systolic strain rate (LPSSR) was significantly decreased in all echocardiographic views after the injection of respective drugs. However, the decrease in LPSSR was significantly less in Group E in comparison to Group T.To conclude, STE provides accurate and reliable real time quantitative regional and global LV assessment. Use of thiopentone for anesthesia induction is associated with more profound impairment of LV function in comparison to etomidate as assessed by a decreased longitudinal peak systolic strain rate and global longitudinal peak systolic strain. Further studies are warranted to understand the exact clinical impact, which may influence the choice of intravenous induction agent based upon preoperative patient characteristics.

Abstract 12778: A High Physiological Stress Response is Dependent on Call Type in Firefighters

Introduction: CVD and impaired cardiovascular health is noticeably more prevalent in firefighters (FF) than the general population, with over 50% of line-of-duty deaths being cardiovascular related. Many FF have hypertension but less than 25% have their BP under control. The BP and HR response to different calls and job activity in FF is unknown. Thus, we aimed to evaluate and quantify the physiological stress resulting from different types of calls and job activity (fire, medical, riding apparatus) through ambulatory blood pressure (ABP) monitoring. Hypothesis: We hypothesize that fire calls will result in the largest BP surge in FF compared to other types of calls and work conditions. Methods: FF (n=41; 37M, 4F) wore an ABP monitor for at least 12-hours while working. BP was measured every 30 min during daytime and 60 min during nighttime, if worn overnight. Data was analyzed when &gt; 70% of readings were captured. FF were instructed to force an ABP reading when the pager sounded and whenever they felt they entered a stressful situation. Activity and call type were documented on a log sheet for each measurement. Results: The FF were experienced (16.9 ± 11.9 yrs as FF), overweight (BMI: 30.3 + 4.6 kg/m 2 ), middle aged (41.2 ± 13.1 yrs), and hypertensive with average ABP over the 12 hr shift at 131 ± 13.4 / 79.3 ± 8.8 mmHg and HR 75.7 ± 8.8 bpm. Systolic BP surged 19.2 ± 12.2 with fire calls and 18.7 ± 8.1 mmHg with medical calls. Diastolic BP surged 10.5 ± 9.9 with fire and 16.5 ± 10.5 mmHg with medical calls. There were no differences in BP, HR, or BP surge levels ( P &gt;0.05 for all) between the types of measurements (fire, medical, apparatus, alarms). Compared to average ABP values, the response was higher with fire calls (143.9/85.5 mmHg, 85.5 bpm) than medical calls (139.0/87.0 mmHg, 90.5 bpm). Physiological responses were also high when FF rode apparatus (139.8/83.7 mmHg, 81.9 bpm) and received false alarms (137.6/82.6 mmHg, 83.4 bpm). Conclusion: Fire and medical calls resulted in the greatest CV response. On average, fire calls resulted in a 9% increase in systolic BP and medical calls a 9% increase in diastolic BP and a 16% increase in HR. Further investigation in a larger population is warranted to substantiate these results as well as study other variables that may affect BP and HR responses in FF.

Impact of Maintenance Arm on Prognostic Value of MRD after Induction Treatment in MCL R2 Elderly Trial, a Mantle Cell Lymphoma Network Study

Impact of Maintenance Arm on Prognostic Value of MRD after Induction Treatment in MCL R2 Elderly Trial, a Mantle Cell Lymphoma Network Study

A Comprehensive and Systematic Analysis of Minimal Residual Disease (MRD) Monitoring in Follicular Lymphoma: Results from the Fondazione Italiana Linfomi (FIL) FOLL12 Trial

A Comprehensive and Systematic Analysis of Minimal Residual Disease (MRD) Monitoring in Follicular Lymphoma: Results from the Fondazione Italiana Linfomi (FIL) FOLL12 Trial

Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age.

BackgroundIrritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated.Materials and methodsIn this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests.ResultsParents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect.ConclusionThe pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product.Trial registrationSwiss registry of clinical trial: CER-VD 2019-02155.How to cite this articleLerond C, Hudry J, Zahar S, et al. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021;14(4):525–530.

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

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

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

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