Mean Heart Research Articles

Electrocardiographic parameters of chemically immobilized giant anteaters (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) is a vulnerable species that is threatened mostly due to anthropogenic pressure. The anteater is a highly specialized insectivore, challenging the species' ex situ maintenance and conservation efforts. Several dietary-associated health issues have been reported in captive anteaters, including heart conditions such as dilated cardiomyopathy. On the other hand, cardiopathy is mainly diagnosed only on necropsy, and lack of clinical reference is one of the constraints. This work describes electrocardiographic parameters in twelve zoo-kept giant anteaters (Myrmecophaga tridactyla). The giant anteaters were evaluated after chemical immobilization. Surface electrocardiography using a digital electrocardiograph was performed to acquire data on the six frontal plane leads. Four animals were placed in both left and right recumbencies to assess changes in waveforms. Nine anteaters were considered healthy and included in the statistics. The mean heart rate and electrical axis were 37.8bpm ± 3.45 and 75.6º ± 11.43, respectively. ECG parameters results were P wave duration (ms) 89.7 ± 9.2, P wave amplitude (mV) 0.14 ± 0.05, PR segment duration (ms) 148.6 ± 23, R wave amplitude (mV) 1.55 ± 0.56, QRS complex duration (ms) 88.6 ± 12.0, QT interval duration (ms) 529.6 ± 71.2, and T wave amplitude (mV) 0.76 ± 0.21. There was no difference between left or right recumbency. Heart parameters of giant anteaters are similar to other mammals and seem to be influenced both by size and metabolic rate when comparing with other species. This is the first description of ECG parameters in giant anteaters.

Safety and Efficacy of opioid-sparing Anesthesia Compared with Traditional opioid-anesthesia

Objectives: The rationale of adoption opioid sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioid combined to non-opioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA) and the present scoping review (ScR) aims at providing the clinical evidence of safety and efficacy of OSA with respect to OA. Methods: This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed, EMBASE databases were utilized to find relevant studies. Search strategy included the following keywords: “opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety”. The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed. Results: In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy endpoints include hemodynamic stability and anesthetic/analgesic requirements. Postoperative endpoints include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, chronic postsurgical pain. The studies reported a lower intraoperative mean arterial pressure and heart rate fluctuations when α2 agonists are adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrocloride and locoregional anesthesia techniques with a positive impact on most of the endpoints considered. Discussion: The clinical implementation of OSA encompasses the perioperative use of non-opioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient’s safety.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION.

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Ciprofol versus propofol for anesthesia induction in cardiac surgery: a randomized double-blind controlled clinical trial.

Ciprofol, a novel intravenous general anesthetic with a chemical structure similar to propofol, exhibits significantly enhanced potency. It offers a rapid onset, reduced incidence of injection pain, and has comparable effects on heart rate and blood pressure to propofol. However, clinical data on its use for anesthesia induction in cardiac surgery remain limited. Seventy-eight patients undergoing coronary artery bypass grafting or valve replacement surgery were randomly assigned to receive either ciprofol (N = 40) or propofol (N = 38) for anesthesia induction. Variables recorded included changes in mean arterial pressure and heart rate during anesthesia, alterations in the oxygenation index and lactic acid concentration before and 10min after anesthesia induction, and the incidence of adverse events such as bradycardia, hypotension, and injection pain. The incidence of anesthesia-induced injection pain was significantly lower in the ciprofol group compared to the propofol group (3% vs. 18%, P < 0.05). The incidence of other adverse events was similar between the groups. No significant differences in hemodynamics or oxygenation index were observed during anesthesia induction between ciprofol and propofol. Ciprofol demonstrated a significantly lower incidence of injection pain compared to propofol, potentially improving patient comfort during anesthesia induction. Additionally, ciprofol showed comparable circulatory stability to propofol during anesthesia induction in cardiac surgery, suggesting it may be a suitable alternative to propofol for this application. The trial was registered at the ClinicalTrials.gov on 03/10/2024 (NCT06312345).

Effect of Properly Describing the Borg Rating of Perceived Exertion (RPE) Scale on Heart Rate Response

Introduction: The Rating of Perceived Exertion (RPE) scale is often used to guide intensity during exercise. The purpose of this study was to determine if a thorough explanation of the scale is necessary to achieve optimal heart rate during indoor group cycling. Methods: The study consisted of a familiarization visit and two 60-minute instructor-led group cycling classes. The cycling sessions were identical in procedure; the only difference was that during one session, there was no explanation of the RPE scale (RPE-NE), and in the other, it was fully described in detail (RPE-E). Heart rate (HR) was continuously monitored. Maximal and average HR were calculated for each stage of the class. Repeated measures ANOVAs (condition x stage) were used to compare the mean HR, HRmax and %HRmax between conditions. Paired-samples t-tests were used to compare session RPE between conditions. Results: There were no differences between conditions for average HR (p=.436), HRmax (p=.086), or %HRmax (p=.084). There was also no difference between conditions in session RPE (RPE-NE: 15.7±1.4; RPE-E: 16.0±1.3; p=.432) Conclusions: A detailed explanation of the RPE scale before a group cycling class elicits a HR response similar to simply having a poster of the RPE scale posted and referenced.

Comparative efficacy of ciprofol and propofol in reducing respiratory depression during ERCP anesthesia: a randomized controlled trial

BackgroundPropofol is one of the important drug causes of respiratory depression in endoscopic retrograde cholangiopancreatography (ERCP) anesthesia. This study aims to clarify whether Ciprofol in ERCP anesthesia reduces the respiratory depression rate.MethodsIn this randomized controlled trial performed at the Surgical Endoscopy Center, the First Hospital of Lanzhou University between Jun 01, 2022 and Feb 20, 2024, patients undergoing ERCP anesthesia were randomly assigned into ciprofol (study group) or propofol (control group). Primary outcomes included respiratory depression rate during anesthesia, and secondary outcomes included body movement and hypoxemia, awakening time, mean arterial pressure and heart rate changes at key points during surgery.Results20 of the 306 patients had respiratory depression (6.5%). The frequency of respiratory depression was 3.3% in the group C and 9.8% in the group P, with a difference of 6.5% between the two groups (P = 0.035). Ciprofol anesthesia decreased the hyoxemia, injection pain, and circulation and heart rate fluctuations. Multivariable logistic regression analyses showed that Propofol (OR 1.970; 95% CI, 1.121–3.461, P = 0.018), mallampati classification>II (OR 1.594; 95% CI, 1.129–2.249, P = 0.008), and fasting time>10.5 h (OR 3.184; 95% CI, 1.531–6.621, P = 0.002) were independent risk factors for incidence of respiratory depression in ERCP anesthesia.ConclusionsFor patients undergoing anesthesia for ERCP, Ciprofol, compared to Propofol, has been shown to effectively reduce the incidence of intraoperative respiratory depression, thereby enhancing the safety of the anesthesia process.Trial registrationThis study was registered in the Chinese Clinical Trial Registry on 15/01/2022 (ChiCTR2200055629).

Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation.

BACKGROUND Intravenous ciprofol is a short-acting sedative with minimal respiratory and circulatory suppression and limited analgesia. Intravenous lidocaine provides analgesia during surgical procedures. This study included 70 patients who underwent gastroscopy with analgesia and aimed to evaluate the effects of intravenous lidocaine on the dose of ciprofol required to produce 50% of the maximal effect (ED50). MATERIAL AND METHODS Seventy patients scheduled for elective painless gastroscopy were randomly assigned into 2 groups: group L (n=35, received ciprofol and 1.5 mg/kg lidocaine) and group S (n=35, received ciprofol and normal saline). The primary outcomes measured were the ED50 and the 95% effective dose (ED95) of ciprofol, determined using the modified up-down sequential method and Probit analysis. Secondary outcomes included induction, operation, and recovery times; monitoring of vital signs such as mean arterial pressure, heart rate, and oxygen saturation; and evaluation of postoperative adverse reactions, including sore throat, nausea, vomiting, abdominal pain, and satisfaction scores from endoscopists and anesthesiologists. RESULTS The ED50 of ciprofol in group L was 0.315 mg/kg (95% CI, 0.291-0.342 mg/kg), which was significantly lower than that in group S, 0.42 mg/kg (95% CI, 0.371-0.491 mg/kg). Additionally, group L exhibited shorter induction and recovery times, a lower incidence of postoperative sore throat, and a temporary drop in blood pressure following induction. CONCLUSIONS Intravenous lidocaine during painless gastroscopy reduces the required ciprofol dose, shortens induction and recovery times, and lowers the incidence of postoperative complications, such as sore throat. These findings support its effective role in improving sedation quality and patient outcomes during gastroscopy.

Polygenic risk for psychotic disorders in relation to cardiac autonomic dysfunction in unmedicated patients with schizophrenia.

Cardiac autonomic dysfunction (CADF), mainly characterized by increased heart rate, decreased heart rate variability, and loss of vagal modulation, has been extensively described in patients with schizophrenia (SCZ) and their healthy first-degree relatives. As such, it represents an apparent physiological link that contributes to the increased cardiovascular mortality in these patients. Common genetic variation is a putative underlying mechanism, along with lifestyle factors and antipsychotic medications. However, the extent to which CADF is associated with genetic factors for SCZ is unknown. A sample of 83 drug-naive SCZ patients and 96 healthy controls, all of European origin, underwent a 30-minute autonomic assessment under resting conditions. We incorporated parameters from several domains into our model, including time and frequency domains (mean heart rate, low/high frequency ratio) and compression entropy, each of which provides different insights into the dynamics of cardiac autonomic function. These parameters were used as outcome variables in linear regression models with polygenic risk scores (PRS) for SCZ as predictors and age, sex, BMI, smoking status, principal components of ancestry and diagnosis as covariates. Of the three CADF parameters, SCZ PRS was significantly associated with mean heart rate in the combined case/control sample. However, this association was was no longer significant after including diagnosis as a covariate (p = 0.29). In contrast, diagnostic status is statistically significant for all three CADF parameters, accounting for a significantly greater proportion of the variance in mean heart rate compared to SCZ PRS (approximately 16% vs. 4%). Despite evidence for a common genetic basis of CADF and SCZ, we were unable to provide further support for an association between the polygenic burden of SCZ and cardiac autonomic function beyond the diagnostic state. This suggests that there are other important characteristics associated with SCZ that lead to CADF that are not captured by SCZ PRS.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring. Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis. The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2years. During a mean follow-up of 46.9months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between -2% and 29%, nighttime systolic BP variability below 32mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below -10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above -11%, nighttime mean systolic BP < 144mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below -11% and a morning surge ≥ 14mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis. These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

Diagnostic performance of high and ultra-high-resolution photon counting CT for detection of coronary artery disease in patients evaluated for transcatheter aortic valve implantation.

We assessed the diagnostic performance of both ultra-high-resolution (UHR) and high-resolution (HR) modes of photon-counting detector (PCD)-CT within the confines of standard pre-TAVI CT scans, as well as the performance of UHR mode adjusted specifically for coronary imaging, using quantitative coronary angiography (QCA) as the reference. We included 60 patients undergoing pre-TAVI planning CT scans. Patients were divided into 3 groups: 20 scanned in HR mode, 20 in UHR mode, and 20 in adjusted UHR mode, on a dual-source PCD-CT. The adjusted UHR mode employed a lower tube voltage (90kV vs. 120kV) and a higher image quality level (65 vs. 34) to enhance coronary artery visualization. Patients underwent invasive coronary angiography as part of clinical routine. CCTA and QCA were reviewed to assess CAD presence defined as stenosis ≥ 50% in proximal and middle coronary segments. We included 60 patients (mean age 79 ± 7 years; 39(65%) men). Mean heart rate during scanning was 72 ± 13bpm. Median coronary calcium score was 973[379-2007]. QCA identified significant CAD in 24 patients (40%): 9 patients scanned with HR mode, 10 patients with the UHR mode, and 5 patients with the UHR adjusted mode. Per-patient area under the curves were 0.57 for HR, 0.80 for UHR, and 0.80 for adjusted UHR, with no significant differences between the scan modes, and per-vessel the area under the curves were 0.73 for HR, 0.69 for UHR, and 0.87 for adjusted UHR, with significant differences between UHR and adjusted UHR (p = 0.04). UHR and adjusted UHR modes of dual source PCD-CT show potential for improved sensitivity and negative predictive value for detecting CAD in patients undergoing pre-TAVI scans, however, no statistically significant difference from HR mode was observed.

Sex influence on serotonergic modulation of the vascular noradrenergic drive in rats.

In male rats, the serotonergic system modulates sympathetic outflow at vascular levels, causing sympatho-inhibition and sympatho-excitation, mainly via 5-HT1D/1A and 5-HT3 receptors, respectively. However, sex influence on vascular serotonergic regulation has not yet been elucidated. This study aimed to analyse the 5-HT sympatho-modulatory role in female rats, characterising the 5-HT receptors involved. Female Wistar (14- to 16-week-old) rats were prepared for sympathetic stimulation. Mean blood pressure (MBP) and heart rate (HR) were continuously measured. Vasopressor responses were obtained by electrical stimulation of the sympathetic outflow (0.1-5 Hz) or i.v. noradrenaline (0.01-0.5 μg·kg-1). 5-HT-related drug effects on adrenergic system were determined. Age-matched male rats were used as control. Basal MBP in females was lower than in male rats, whereas electrical-induced increases in MBP were similar. In females, 5-HT exerted a dose-dependent inhibition on the sympathetic-evoked vasoconstrictions, that was reproduced by some agonists; 5-CT (5-HT1/5/7) and L-694,247 (5-HT1D), whereas the selective 5-HT2A/2B/2C (α-methyl-5-HT) and 5-HT3 agonist (1-PBG) increased the electrically-produced vasopressor responses. None of the other drugs tested (targeting 5-HT1A/1B/1F, 5-HT2B/2C, 5-HT4, 5-HT5A or 5-HT7) modified these vasoconstrictions. Only 1-PBG (5-HT3) modified the vasoconstrictions induced by exogenous noradrenaline. In female rats, vascular serotonergic sympatholytic effects are due to prejunctional 5-HT1D receptor activation, whereas pre and/or postjunctional 5-HT3 and prejunctional 5-HT2A receptor activation is involved in the potentiating effect of vascular sympathetic neurotransmission. These findings may open novel sex-differential therapeutic strategies for treating cardiovascular conditions.

Third-Man-Passing Small-Sided Games Induce Higher Anaerobic Energy Contributions Than Regular-Passing Small-Sided Games in Football Players.

This study compared the physiological profiles and energy-system contributions of trained football players engaged in regular-passing and third-man-passing small-sided games (SSGs) that included 4 versus 4 and a goalkeeper. Ten maletrained football players participated in this crossover study. All participants were randomly assigned to either regular-passing SSG or third-man-passing SSG (4 vs 4 with a goalkeeper, 35-m × 17-m pitch size, and 6-min match duration). During these SSGs, physiological parameters including peak and mean heart rate, oxygen uptake (V˙O2peak and V˙O2mean), metabolic equivalents in V˙O2peak and V˙O2mean, and blood lactate concentrations (peak La- and delta La- [Δ La-]), were measured. Energy contributions (oxidative [WOxi], glycolytic [WGly], and phosphagen [WPCr] systems) and Global Positioning System (GPS)variables (total distance, total acceleration counts, mean speed, and maximum speed) were also analyzed. No significant differences in physiological parameters and GPS variables were found between regular- and third-man-passing SSGs. WOxi in kilojoules and percentages was significantly higher during both SSGs than WPCr and WGly (P < .0001, respectively). WPCr and WPCr + WGly values during third-man-passing SSGs were significantly higher than those during regular-passing SSGs (P < .05). Additionally, low to moderate positive correlations were observed between WOxi, WGly in kilojoules, V˙O2peak, V˙O2mean, peak La-, Δ La-, total acceleration counts, and mean speed (r = .39-.64). Third-man-passing SSGs may be useful for increasing anaerobic capacity. More third-man-passing SSG sessions in preparation for football games may support high metabolic power and repeated powerful anaerobic performances in trained football players.

Efficacy and safety of different antiarrhythmic protocols used for rate control in dogs with secondary atrial fibrillation

Introduction/ObjectiveStudies comparing the effects of antiarrhythmic protocols used for rate control in dogs with secondary atrial fibrillation (AF) are currently limited. Therefore, this study aimed to report detailed data on the efficacy and therapy-related side effects (TRSEs) of different antiarrhythmic protocols in dogs with secondary AF. Animals, Materials, and MethodsDogs with secondary AF treated with combination therapy with diltiazem and digoxin (CTDilt+Digox), diltiazem monotherapy (MTDilt), digoxin monotherapy (MTDigox), or amiodarone monotherapy (MTAmiod) were retrospectively evaluated. Signalment, clinical, diagnostic, therapeutic, and outcome data were retrieved. Electrocardiographically, antiarrhythmic efficacy was defined by a reduction in the mean heart rate on Holter monitoring ≤125 beats/minutes. Statistical analysis was performed to compare selected data, including the rate of efficacy and TRSEs as well as the median survival time, between dogs treated with different antiarrhythmic protocols. ResultsFifty-four dogs were included, 28 receiving CTDilt+Digox and 26 receiving monotherapies (MTDigox=16; MTDilt=5; MTAmiod=5). The efficacy rate documented in dogs treated with CTDilt+Digox was significantly higher than that observed in dogs from the composite monotherapy group (i.e., MTDilt+MTDigox+MTAmiod) (P = 0.048). The rate of TRSEs documented in dogs treated with CTDilt+Digox was similar to that observed in dogs from the composed monotherapy group (P = 0.129). The median survival time documented in dogs treated with CTDilt+Digox was significantly longer than that observed in dogs of the MTDigox group (P = 0.01). ConclusionsIn dogs with secondary AF, CTDilt+Digox is generally well tolerated and provides clinically relevant benefits compared to the use of a single antiarrhythmic drug.

Efficacy of administering a sugar-free flavor before dental injections on pain perception in children: A split-mouth randomized crossover clinical trial.

Sweet taste administration before dental injections helps to control associated pain in children. To evaluate the efficacy of using a sugar-free flavor on pain perception during dental injections. Children (n = 84) aged 4-9 (mean 6.71 ± 1.55) years who required buccal infiltration bilaterally participated in this split-mouth randomized crossover study. On the test side (flavor visit), infiltration injections were applied after receiving a sugar-free flavor. On the control side (no flavor visit), sterile water was administered. Demographic characteristics, body mass index (BMI), and sweet taste preference (STP) were recorded. Pain perception during injection was measured using heart rate (HR), sound, eyes, and motor (SEM) scale, and Wong-Baker Faces pain scale (WBFPS). Most children had healthy weight (72.6%) and equal STP (32.1%). In the test side, mean HR during injection, HR differences before and during injection, and SEM scores were significantly lower (p < .001, for all). There was no significant difference in the WBFPS between both visits. Flavor had a significant effect on pain reduction (p = .001 for HR, p = .000 for SEM), whereas age, gender, BMI, STP, and treatment side did not. Treatment sequence had a significant effect on total SEM scores (p = .021); children who received the flavor during their first visit had lower SEM scores. Using a sugar-free flavor before dental injections helps in reducing associated pain in children.

Unraveling the effect of recreational fear on inflammation: A prospective cohort field study

A fear reaction is fundamental for survival and naturally activates the adrenergic system, prompting an acute and vital flight-or-fight response. While sustained stress is associated with unhealthy low-grade inflammation, more acute and transient activation of the adrenergic system has been suggested to impact the immune system and subsequently attenuate low-grade inflammation, e.g. through cold exposure or hyperventilation. Voluntary exposure to frightening stimuli, such as scary entertainment, is another reliable activator of the adrenergic system, yet its impact on the immune system and low-grade inflammation is unknown.The objectives of this study are to i. assess proportional changes of participants with low-grade inflammation at and three days after a voluntary frightening event, and ii. explore mean value alterations in inflammatory markers and immune cells over time.We recruited adult participants among visitors to a real-life intense frightening haunted house attraction, located in Vejle, Denmark. The overall fright potential of the exposure was estimated through heart rate (HR) monitoring and self-reported levels of fear. Low-grade inflammation (defined as high sensitive C-reactive protein (hs-CRP) > 3 mg/L)) and immune cells (subtypes of leukocytes) were measured from blood samples immediately before, immediately after, and three days after the haunted house event.A total of 113 participants, 69 females (61.1 %), and 44 males (38.9 %), with a mean age of 29.7 (SD 10.1) were included in the analyses. The average duration of exposure was 50 min and 51 s, while the mean HR throughout the event was 111.1 BPM (mean SD 10.1), and the mean subjective reported scare level was 5.4 (SD 1.9) on a Likert scale ranging from 1 to 9. Twenty-two participants exhibited low-grade inflammation (hs-CRP > 3 mg/L) at the event, with 10 participants normalizing their hs-CRP levels three days post-event. Seven participants had normal hs-CRP levels at the event, but low-grade inflammation three days post-event. Thus, we found no proportional difference between participants with low-grade inflammation at the event (19.5 %) and three days after the event (16.8 %) (diff. −2.7 %; 95 % CI: −10.7 to 5.4, p = 0.47). For the 22 participants exhibiting low-grade inflammation at the event, 18 participants (82 %) decreased their hs-CRP levels, with a mean decrease in hs-CRP from 5.7 mg/L pre-event to 3.7 mg/L three days post-event (diff. −2.0, 95 % CI: −3.2 to −0.7, p = 0.003). Supporting an overall attenuation of inflammation, total leukocytes and lymphocytes decreased for both participants with low-grade inflammation and with normal inflammatory levels, when comparing levels pre- and three days post-event, although all mean levels remained within the normal range.Conclusively, we find no proportional differences in participants exhibiting low-grade inflammation (hs-CRP > 3) when comparing levels at and three days after exposure to a voluntary frightening event. However, explorative analyses suggest that recreational fear exposure may attenuate immune cells across the entire cohort (N = 113) and decrease hs-CRP levels for participants who exhibit low-grade inflammation at the event (N = 22).

Role of prophylactic intravenous calcium in prevention of post-spinal hypotension among women with preeclampsia undergoing caesarean delivery: a placebo controlled randomized clinical trial: Randomized clinical trial of calcium vs placebo for prevention of post-spinal hypotension

BackgroundPreeclamptic women, in addition to traditional anti-hypertensive medications, often receive magnesium supplementation and are at increased risk of post-spinal hypotension Post-spinal hypotension increases the risk of fetomaternal morbidity. Calcium is a physiological antagonist of magnesium in vascular smooth muscle. Therefore, the study hypothesized that calcium is better suited for preserving systemic vascular resistance and preventing post-spinal hypotension during cesarean delivery. ObjectivesThe study aimed to evaluate the effect of prophylactic calcium administration on post-spinal hypotension in preeclamptic women receiving magnesium supplementation. MethodsThis prospective, randomized, placebo-controlled, double-blinded, two-arm parallel trial was conducted in preeclamptic women receiving magnesium sulfate supplementation undergoing cesarean delivery. The women were randomized to receive intravenous calcium or a placebo (normal saline) before spinal anesthesia. The study drug (calcium gluconate 500 mg or normal saline) was administered over 15 minutes and ended immediately before spinal anesthesia. The primary outcome measure was the incidence of post-spinal hypotension, and secondary outcome measures were postpartum blood loss and maternal and neonatal outcomes. Results100 women (50 each calcium and placebo arm) completed the study. The baseline demographic variables, mean blood pressure and heart rate were comparable. The incidence of post-spinal hypotension was significantly lower in the calcium arm compared to the placebo arm {(32% vs 60%; Relative risk (95% CI); 1.87 (1.18-2.97); p=0.007)}. The mean phenylephrine requirement (5.60±14.59 vs 14.80 ±22.42 mcg; p=0.01) and mephentermine requirement (3.30 ±5.11 mg vs 5.82 ±4.97 mg; p=0.008) was significantly lower in the calcium group. Furthermore, the calcium group's mean postpartum blood loss was significantly lower (406.90 ±94.34 vs 472.20±122.49 ml, p= 0.004). However, the Neonatal Intensive Care Unit admission rate, Apgar score, umbilical artery PH, and maternal serum calcium were comparable. ConclusionProphylactic calcium infusion significantly reduces the incidence of post-spinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation. Furthermore, the effect of prophylactic calcium in decreasing postpartum blood loss is encouraging. However, large trials are required to validate the findings of this study.

Effects of a synergic interaction between magnesium sulphate and ketamine on the perioperative nociception in dogs undergoing tibial plateau leveling osteotomy: a pilot study.

Magnesium Sulphate (MgSO4) is commonly used in human medicine for the management of perioperative pain in different types of procedures. However, in veterinary medicine, the use of MgSO4 has not been evaluated for its analgesic efficacy in dogs, which has generated conflicts of opinion in this area of veterinary anesthesiology. The aim of this study was to evaluate the perioperative analgesic efficacy of MgSO4 in combination with Ketamine in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO). Our hypothesis is that MgSO4 plus ketamine have a synergistic action in the management of intra-and postoperative pain. Twenty adult mixed breed dogs with average age 5.9 ± 2.6 years and weight 27.8 ± 9.2 kg were included in this prospective, clinical, randomized study. Dogs were randomly assigned to two groups. The MK group received ketamine (0.5 mg/kg as starting bolus followed by continuous infusion rate at 1 mg/kg/h). At the end of the ketamine bolus, MgSO4 (50 mg/kg over 15 min) was administered by the same route, followed by a constant rate infusion (CRI) at 15 mg/kg/h, IV. K group received a bolus of ketamine followed by a CRI at the same dosage described in MK group. Main cardiorespiratory parameters were recorded 10 min before the start of surgery (BASE), after the ketamine bolus (T1) and the MgSO4 bolus (T2), during the skin incision (SKIN), the osteotomy (OSTEOTOMY) and skin suturing (SUTURE). In the postoperative period, the short form of Glasgow Composite Pain scale (SF-CMPS) was used to assess pain at 30, 60, 120, and 180 min after extubation (Post30, Post60, Post120, and Post180, respectively). The main blood electrolytes (Mg2+, Ca2+, Na+, K+) were analyzed at BASE, T2, OSTEOTOMY, SUTURE and T3 (one hour after stopping MgSO4 infusion). Number of rescue analgesia and administration times were recorded both in the intra-and postoperative period. In K group 7 out of 10 dogs required intraoperatory rescue analgesia compared to MK group (3/10). Furthermore, mean arterial pressure (MAP) and heart rate (HR) were significantly higher at OSTEOTOMY compared to BASE time in both groups. In the postoperative period, at T120, ICMPS-SF score was higher in K group than MK group. The administration of MgSO4 could guarantee better analgesia in the perioperative period in dogs undergoing TPLO, performing a synergistic action with ketamine.

Thermal physiological characteristics of the Xizang people in asymmetrical dressing exposures on the plateau

The Xizang people, living in the “Third Pole of the World,” have long-formed asymmetrical dressing habits that pose unique challenges to their physiological mechanisms. This study examined the physiological parameters of the Xizang people under symmetrical and various asymmetrical dressing angles to analyze the influence of these dressing styles on their thermal responses. Partial correlation analysis was used to further clarify the physiological thermal assessment indicator of the Xizang people. The results showed that, compared to symmetrical dressing, the Xizang people exhibited higher blood perfusion index and core temperature under asymmetrical dressing. In cold environments, those with symmetrical dressing had higher mean arterial pressure, heart rate, and relative activity ratio of sympathetic to parasympathetic nervous system, indicating dominant sympathetic nerve activity. At an ambient temperature of 15 °C, the Xizang people demonstrated a mean skin temperature difference of 2.6 °C and a right wrist temperature difference of 4.5 °C between symmetrical and the asymmetrical dressing angle with 50° Skin temperature was identified as the physiological thermal assessment indicator for the Xizang people considering asymmetrical dressing styles. This study provided a physiological foundation for the accurate design of plateau built environments suitable for the Xizang people.

The Cardiometabolic Multimorbidity Risk Profile of Females Living in Glendale, ILembe District of Kwa-Zulu Natal

Background: Empirical studies have indicated that cardiometabolic multimorbidity risk profiles are upsurging among the South African population. However, there is a limited number of studies that have been conducted to validate these findings in rural communities. Aim: To study the prevalence of cardiometabolic risk factors of females residing in rural Glendale in the ILembe District, South Africa. Methods: One hundred females (aged 18–40 years) voluntarily participated in a cross-sectional observational study. All participants completed an ISAK somatotype profiling, and measured their fasting cholesterol, glucose, blood pressure and resting heart rate. Results: Participants’ average age, body mass index, stature, and body mass, were 28.34 ± 7.07 years, 29.5 ± 8.06 kg/m2, 157.26 ± 6.09 cm, and 72.9 ± 21.12 kg, respectively. The cohort had a mean waist circumference of 94.2 ± 22.1 cm, hip circumference of 108.4 ± 20.9 cm, and waist-to-hip ratio of 0.86. Participants’ mean heart rate, systolic blood pressure, and diastolic blood pressure were 86.31 ± 8.68 bpm, 116.79 ± 16.34 mmHg, and 82.14 ± 10.87 mmHg, respectively. Eleven participants recorded a resting heart rate greater than 100 bpm. Average blood glucose, total cholesterol, low-density lipoprotein, and high-density lipoprotein recorded were 4.87 ± 1.26 mmol/L, 3.78 ± 0.94 mmol/L, 1.76 ± 1.86 mmol/L, and 1.31 ± 0.4 mmol/L. Eighty-three participants HDL-C were below the recommended normative value of 1.55 mmol/L. Conclusion: The average participant presented as overweight, with elevated diastolic blood pressure, and a resting heart rate that has been proven to increase one’s cardiometabolic multimorbidity risk profile. Additionally, a small portion of the cohort were identified to be prediabetic and diabetic. Large proportion of participants had low HDL-C levels suggestive of poor cardiovascular disease protection.