Normal Heart Rate Research Articles

О проблеме количественной оценки тяжести и напряженности труда водителей технологического автотранспорта

The working conditions of technological vehicle drivers in terms of severity and intensity are regulated by the normative documents «P 2.2.2006—05. Labor hygiene. Guidelines for the hygienic assessment of factors of the working environment and the labor process. Criteria and classification of working conditions» and Federal Law № 426-FZ of December 28, 2013 «On a special assessment of the working conditions». In these documents, a quantitative assessment of working conditions by severity and tension factors is made conditionally, without considering all influencing factors, using a points system. At the same time, these documents indicate that the work is safe if the changes in the functional state of the body as a result of work are restored during rest, or by the beginning of the next shift. At the same time, there are no ways to determine them, since the research methods in biology and medicine are mostly based on observations and experiments, which does not allow obtaining an objective quantitative assessment of the working conditions. The paper considers methods and equipment for determining the duration of recovery of the functional state of the body of technological vehicle drivers during rest and quantitative assessment of the severity and intensity of their work according to this criterion. To study the severity of driver work, the regularities and duration of changes in the frequency of their heartbeats during rest were analyzed using the test loads. And to study the intensity of labor, the regularities, and durations of the processes of changing the time of driver reactions to light and sound were studied. As a result of the studies, the regularity of the processes of restoring the functional state of the body of technological vehicle drivers was established, and the possibility of quantitatively assessing the severity of labor by the criterion of the duration of restoration of the normal heart rate, and its intensity - by the duration of the restoration of the reaction time of drivers to light and sound, was shown.

Bioreactor-grown exo- and endo-β-glucan from Malaysian Ganoderma lucidum: An in vitro and in vivo study for potential antidiabetic treatment.

This study aims to identify the roles of exo-β-glucan (EPS-BG) and endo-β-glucan (ENS-BG) extracted from Ganoderma lucidum (GL) in inhibiting the alpha-glucosidase enzyme, a target mechanism for postprandial hyperglycaemia regulation. Upscale production of GL was carried out using a 10 L bioreactor. The zebrafish embryo toxicity test (ZFET) was carried out based on OECD guidelines. The hatching rate, survival rate, heart rate, morphological malformation, and teratogenic defects were observed and determined every 24 h from 0–120 h of post-exposure (hpe). For diabetes induction, adult zebrafish (3–4 months of age) were overfed and induced with three doses of 350 mg/kg streptozotocin (STZ) by intraperitoneal injection (IP) on three different days (days 1, 3, and 5). The oral sucrose tolerance test (OSTT) and anti-diabetic activity of EPS-BG and ENS-BG were evaluated (day 7) using the developed model (n = 15). This study showed that EPS is the most potent compound with the highest inhibitory effect toward the alpha-glucosidase enzyme with an IC50 value of 0.1575 mg/ml compared to ENS extracts (IC50 = 0.3479 mg/ml). Both EPS-BG and ENS-BG demonstrated a strong inhibition of alpha-glucosidase activity similar to the clinically approved alpha-glucosidase inhibitor, acarbose (IC50 = 0.8107 mg/ml). ENS-BG is non-toxic toward zebrafish embryos with LC50 of 0.92 mg/ml and showed no significant changes in ZE hatching and normal heart rate as compared to untreated embryos (161 beats/min). Teratogenic effects of ENS-BG (<1.0 mg/ml) on zebrafish embryonic development were not observed. The DM model of zebrafish was acquired after the third dose of STZ with a fasting BGL of 8.98 ± 0.28 mmol/L compared to the normal healthy group (4.23 ± 0.62 mmol/L). The BGL of DM zebrafish after 30 min treated with EPS-BG and ENS-BG showed a significant reduction (p < 0.0001). Both EPS-BG and ENS-BG significantly reduced DM zebrafish’s peak blood glucose and the area under the curve (AUC) in OSTT. Hence, EPS-BG and ENS-BG extracted from GL showed promising inhibition of the alpha-glucosidase enzyme and are considered non-toxic in ZE. Moreover, EPS-BG and ENS-BG reduced blood glucose levels and inhibited hyperglycemia in DM zebrafish.

Investigating the feasibility of recruitment to an observational, quality-of-life study of patients diagnosed with atrial fibrillation (AF) who have experienced a bleed while anticoagulated: EQUAL-AF feasibility study protocol

BackgroundOral anticoagulation therapies (OATs) are often prescribed in conjunction with medications to restore normal heart rate rhythm which can limit the risk of an atrial fibrillation (AF) related stroke and systemic thromboembolism. However, they are associated with the serious side effect of bleeding. Both clinically relevant nonmajor bleeding (CRNMB) and major bleeding while anticoagulated are believed to have a significant impact on patient quality of life (QoL). There is currently limited research into the effect bleeding has on QoL. The aim of this study is to evaluate the feasibility of identifying and recruiting patients diagnosed with AF, who are taking OATs and have recently experienced a bleed and collecting information on their QoL.MethodsWe will recruit a minimum of 50 patients to this cross-sectional, observational study. We will recruit from general practices, secondary care, and through an online AF forum. We will ask participants to complete three validated patient-reported outcome measures (PROMs), EQ5D, AFEQT, and PACT-Q, approximately 4 weeks following a bleed and again 3 months later. We will randomly select a subset of 10 participants (of those who agree to be interviewed) to undergo a structured interview with a member of the research team to explore the impact of bleeding on their QoL and to gain feedback on the three PROMs used. We will undertake a descriptive analysis of the PROMs and demographic data. We will analyse the qualitative interviews thematically to identify key themes.DiscussionWe aim to establish if it is possible to recruit patients and use PROMs to collect information regarding how patient QoL is affected when they experience either a clinically relevant non-major bleed (CRNMB) or major bleed while taking OATs for the management of AF. We will also explore the appropriateness, or otherwise, of the three identified PROMs for assessing quality of life following a bleed.PROMsThree PROMs were selected following a literature review of similar QoL studies and using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for comparison. A review of the current literature produced no suitable validated PROM to record QoL experiences in patients who have been diagnosed with AF and have experienced a bleed while anticoagulated. As such, the EQ5D, AFEQT, and PACT-Q (part 2) were deemed most appropriate for use in this feasibility study.Trial registrationThe trial has been adopted onto the NIHR Portfolio (ID no. 47771) and registered with www.ClinicalTrials.gov (no. NCT04921176) retrospectively registered in June 2021.

Prognostic factors for successful induction of labor in intrauterine growth restriction after 36 weeks of gestation

ObjectiveIn comparison to eutrophic fetuses, intra uterine growth restriction fetuses (IUGR) have a higher risk of perinatal morbi-mortality. There are no guidelines on the labor induction of labor (IOL) method to be performed in IUGR. The main objective was to determine fetal and maternal predictive factors of successful induction in IUGR fetuses from 36 weeks.Study designWe conducted a retrospective cohort single-center study including 320 women with a cephalic fetal presentation. Labour was induced after 36 weeks for suspected IUGR between January 2013 and December 2019. ResultsAmong the 320 patients, 246 were delivered vaginally (76.9 %) and 74 had a cesarean (23.1 %). Prognostic factors for successful IUGR induction were nonscarring uterus (OR 8.41; 95 %CI [2.92–24.21]), absence of preeclampsia (OR 7.14; 95 %CI [2.42–21.03]), multiparity (OR 4.32; 95 %CI [1.83–10.18]), normal fetal heart rate before IOL (OR 2.99; 95 %CI [1.24–7.22]) and BMI < 30 (OR 3.54; 95 %CI [1.62–7.72]). Doppler abnormalities, method and number of line of IOL, cervical evaluation were not significant in our study. ConclusionThe prognostic factors for successful IUGR induction are essentially maternal. Thus, a low BMI, multiparity, nonscarring uterus, absence of preeclampsia, and a normal FHR are good prognostic factors in IUGR induction.

Alternative to intensive management of the active phase of the second stage of labor: a multicenter randomized trial (Phase Active du Second STade trial) among nulliparous women with an epidural

There is no consensus on an optimal strategy for managing the active phase of the second stage of labor. Intensive pushing could not only reduce pushing duration, but also increase abnormal fetal heart rate because of cord compression and reduced placental perfusion and oxygenation resulting from the combination of uterine contractions and maternal expulsive forces. Therefore, it may increase the risk of neonatal acidosis and the need for operative vaginal delivery. This study aimed to assess the effect of the management encouraging "moderate" pushing vs "intensive" pushing on neonatal morbidity. This study was a multicenter randomized controlled trial, including nulliparas in the second stage of labor with an epidural and a singleton cephalic fetus at term and with a normal fetal heart rate. Of note, 2 groups were defined: (1) the moderate pushing group, in which women had no time limit on pushing, pushed only twice during each contraction, and observed regular periods without pushing, and (2) the intensive pushing group, in which women pushed 3 times during each contraction and the midwife called an obstetrician after 30 minutes of pushing to discuss operative delivery (standard care). The primary outcome was a composite neonatal morbidity criterion, including umbilical arterial pH of <7.15, base excess of >10 mmol/L, lactate levels of >6 mmol/L, 5-minute Apgar score of <7, and severe neonatal trauma. The secondary outcomes were mode of delivery, episiotomy, obstetrical anal sphincter injuries, postpartum hemorrhage, and maternal satisfaction. The study included 1710 nulliparous women. The neonatal morbidity rate was 18.9% in the moderate pushing group and 20.6% in the intensive pushing group (P=.38). Pushing duration was longer in the moderate group than in the intensive group (38.8±26.4 vs 28.6±17.0 minutes; P<.001), and its rate of operative delivery was 21.1% in the moderate group compared with 24.8% in the intensive group (P=.08). The episiotomy rate was significantly lower in the moderate pushing group than in the intensive pushing group (13.5% vs 17.8%; P=.02). We found no significant difference for obstetrical anal sphincter injuries, postpartum hemorrhage, or maternal satisfaction. Moderate pushing has no effect on neonatal morbidity, but it may nonetheless have benefits, as it was associated with a lower episiotomy rate.

First description of the Burmeister porpoise (Phocoena spinipinnis) electrocardiogram.

The aim of this study was to make the first characterization of the electrocardiogram (ECG) of the Burmeister porpoise (Phocoena sipinipinnis). A total of three ECGs were made in one, wild juvenile female (body weight = 32.5 kg, Lt = 1.45 m), temporarily held in captivity for rehabilitation at Mar del Plata Aquarium (Argentina). ForECG recordings, the animal was removed from its pool on a stretcher under constant veterinary supervision. A traditional six-lead system in the frontal plane was used, with the typical four "extremities" electrodes positioned bilaterally. ECGs were readable and all waves were detectable. The QRS complexes were characterized by Q wave absence in all leads. The ECG characteristically displayed distinctly defined STs, with a T wave clearly differentiated from the QRS complex. An STs elevation was detected in leads II and III. The mean electrical axis was -79°, meaning a cranial left axis orientation. The animal showed normal sinus rhythm and heart rate (HR) showed a continuous oscillation between tachycardia and bradycardia. Mean HR from all recordings was 147.02 ± 24.95 bpm (range = 71-176, n = 178). Evidence of the occurrence of respiratory sinus arrhythmia was detected through HR variations and RR interval differences, which suggested an adequate cardiovascular system compensation to handling conditions. This study has reported ECG amplitude and duration measurements of a potentially healthy specimen, which represents the starting point for the determination of normal ECG values for this species. Also, it has confirmed that ECG is a valuable noninvasive tool for rapid cardiac health assessment in small cetaceans.

Study of cardiovascular dysfunction in chronic liver disease in a tertiary care hospital in eastern India

Background: Chronic liver disease (CLD) exhibits characteristic hemodynamic changes along with pathological changes in the myocardium. Compensated by the decreased systemic vascular resistance, overt heart failure is usually not seen, and thus cardiac pathology is frequently overlooked. Aims and Objectives: The objectives of the study were to study the presence, types, and severity of cardiovascular (CV) dysfunction in patients of CLD. Materials and Methods: An observational cross-sectional study on 50 patients of CLD at Calcutta National Medical College and Hospital, with all relevant investigations. Results: Out of a sample of 50 patients, of which 14.3% were mild, 34.3% moderate and 51.4% severe CLD (by Child-Pugh Class), 28.6% had a high normal heart rate (90 to 100/min), 45.7% had increased stroke volume index, and 42.9% increased cardiac index, reflecting hyperdynamic circulation. In 42% cases, left ventricular ejection fraction was increased more than 65%, reflecting hyperdynamic circulation, but decreased &lt;55% in 23% cases, which may be an indicator of cirrhotic cardiomyopathy. Ejection fraction is significantly (P=0.016) increased after paracentesis in 33.3% patients, reflecting the mechanical effect of ascites on cardiac function. Diastolic dysfunction was present in 60% (P=0.012) and left ventricular mass index was increased in 45.7% cases. All the parameters correlated with increasing Child-Pugh Class severity of CLD. Conclusion: A high level of awareness is needed to take into account the presence of CV dysfunction and cirrhotic cardiomyopathy in patients of CLD and predict the risk of adverse cardiac events. Specific treatment modalities need further study to improve prognosis in these patients.

PATIENT PROFILING IN ACUTE DECOMPENSATED HEART FAILURE

Objective: To evaluate the frequency of various profiles in patients, ospitalised with acute decompensated heart failure. Design and method: 351 patients (72% males, mean age 66 (58; 76) years old) with ADHF were included. Coronary artery disease had 60%, arterial hypertension 94%, diabetes mellitus 40%, obesity-61%, cardiomyopathy-5%, rheumatic heart disease-4%. HFpEF was found in 31% of patients, HFmrEF – in 25%, HFrEF – in 44%. All patients were distributed according to the following phenotypes: 1 - low blood pressure (&lt;90 mm Hg) and high heart rate (&gt;90 bpm); 2 - low blood pressure (&lt;90 mm Hg) and low heart rate (&lt;60 bpm); 3 - paients with low blood pressure (&lt;90 mm Hg) and normal heart rate (60–90 bpm); 4 - normal blood pressure (&gt;90 mm Hg) and high heart rate (&gt;90 bpm); 5 - normal blood pressure (&gt;90 mm Hg) and low heart rate (&lt;60 bpm); 6 - normal blood pressure (&gt;90 mm Hg) and normal heart rate (60–90 bpm); 7 - atrial fibrillation and normal blood pressure (&gt;90 mm Hg), 8- atrial fibrillation and low blood pressure (&lt;90 mm Hg), 9 - high blood pressure (&gt;140/90 mm Hg); 10 - chronic kidney disease (eGFR &lt;60 ml/min/1,72). Results: The frequency of profile in patients, ospitalised with acute decompensated heart failure were the following: patients with low blood pressure and high heart rate - 0,85%; low blood pressure and low heart rate - 0,56%; patients with low blood pressure and normal heart rate - 1,13%; patients with normal blood pressure and high heart rate - 24,78%; normal blood pressure and low heart rate - 3,13%; patients with normal blood pressure and normal heart rate - 37,03%; patients with atrial fibrillation and normal blood pressure - 42,16%; atrial fibrillation and low blood pressure - 0,85%; high blood pressure - 22,22%; patients with chronic kidney disease - 65,81%. Conclusions: The most common profile in patients ospitalised with acute decompensated heart failure were patients with chronic kidney disease (65,81%), normal blood pressure (64,94%), atrial fibrillation (59,24%), normal blood pressure and normal heart rate (37,03%), high blood pressure (22,22%).

Hemodynamic monitoring in pediatric anesthesia

Perioperative mortality and morbidity in childhood essentially depend on the quality of the anesthesia. The Safe Anesthesia for every Tot (SafeTots) initiative takes this into account and has defined normotension, normovolemia and normal heart rate as quality criteria in pediatric anesthesia. Appropriate monitoring of pediatric hemodynamics is necessary to fulfil these criteria. This article provides an overview of currently used methods and techniques for instrumental and non-instrumental cardiovascular monitoring in children. The current study situation, recommendations and guidelines on the application as well as practical aspects of the measurement methods are explained as far as possible. For a better understanding, procedures not routinely used in clinical practice are described in more detail.

P424 SMALL HEART AND SINGLE CORONARY ARTERY IN A YOUNG PATIENT WITH CHRONIC FATIGUE SYNDROME: A CASE REPORT

Abstract Introduction Chronic fatigue syndrome/Myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by severe and disabling fatigue limiting normal daily activities for at least 6 months accompanied by multiple unexplained symptoms including self–reported impairments in concentration and short–term memory, sleep disturbances, and musculoskeletal pain. Although rarely considered to have cardiac dysfunction, CFS/ME patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and post–exertional malaise severity. We describe a case of a young man affected by CFS/ME and small heart with incidental findings of anomalous origin of the left main coronary artery (LMCA). Case Presentation A 19–year–old Caucasian male presented to our clinic complaining weakness, lack of concentration and excessive daytime sleepiness. Medical history included CFS/ME, D hypovitaminosis, inflammatory bowel disease associated with pancreatic insufficiency. Physical examination including cardiovascular auscultation was unremarkable, with normal blood pressure and heart rate. Electrocardiogram showed sinus rhythm at 75 bpm without any repolarization abnormalities. Echocardiogram revealed reduced diameters of left ventricle (LV) (end–diastolic diameter 36 mm), normal aortic root dimensions and, in a five–chamber apical view, a binary structure that seemed to cross the aorta perpendicularly to its long axis. Cardiac magnetic resonance (CMR) found significantly reduced LV stroke volume (34 ml/m2; normal values 44–68 ml/m2) and end–diastolic volume (57 ml/m2; normal values 68–103 ml/m2) together with reduced end–diastolic wall mass (51 g/m2; normal values 59–93 g/m2). Also, right ventricle (RV) volumes were reduced: stroke volume (32 ml/m2; normal values 40–72 ml/m2), end–diastolic volume (62 ml/m2; normal values 68–114 ml/m2). In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro–aortic course. Conclusions Not sufficient consideration was given to cardiovascular involvement in patients with CFS/ME, although many of signs and symptoms are suggestive of cardiovascular dysfunction. This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association with cardiac congenital anomalies and CFS/ME.

An Observational Study on Long Term Safety and Efficacy of Ivabradine in Patients with Chronic Heart Failure

The chief objective of the study is to find out the safety and efficacy of ivabradine in patients with chronic heart failure. A prospective observational study has been guided in the cardiology department of tertiary care hospital. The data is collected from the out-patient and in- patient department after considering inclusion and exclusion principles for 6 months and a total of 220 patients were analyzed with data collection form by interviewing to the patients about the Socio-demographic questionnaire, MLHFQ (Minnesota Living and Heart Failure Questionnaire) for the evaluation of safety and efficacy of ivabradine and quality of life after Heart Failure. Statistical tools like the Chi-square test were applied to the data by using SPSS software. A total amount of 220 Heart Failure patients, males 148 (67.3%) patients were predominant over female patients of 72 (32.7%). The majority of the Heart Failure patients were under the peer group of &gt;60 years (100%), symptoms were more in males (46%), past medical history i.e. Hypertension and Diabetes mellitus were more in number (128), Coronary Artery Disease (Anterior Wall Myocardial Infraction) (32), Non ST Elevated Myocardial Infraction (8). Most of the patients were treated with the dose of ivabradine i.e. 5mg rather than 2.5mg or 7.5mg. Among 5mg (90.9%), 2.5mg (5.5%) and 7.5mg (3.6%). The ivabradine is used for decreasing Heart Rate among all age groups i.e. &gt;35 years are having more Heart Rate before ivabradine intake. After ivabradine intake, the normal Heart Rate is seen in age groups of 35- 40 years. Adverse effects of ivabradine are bradycardia (10%), Hypertension (8.9%), atrial fibrillation (8.3%), and luminous phenomenon (2.8%). Heart Failure is mostly seen in males and elderly people. The present study shows the safety and efficacy with respect to ivabradine in patient with congestive Heart Failure. After intake of ivabradine, the Heart Rate was bought to normal which shows the efficacy of the drug and the adverse effects are bradycardia, hypertension, atrial fibrillation, luminous phenomenon. But these adverse reactions were not seen in the sample size. This shows the safety of the drug.

Study on the radial sectional velocity distribution and wall shear stress associated with carotid artery stenosis

Atherosclerosis is an important cause of cardiovascular disease. The wall shear stress (WSS) is one of the key factors of plaque formation and dislodgement. Currently, WSS estimation is based on the measurement of the blood velocity gradient. However, due to the lack of flow field measurements in carotid stenosis vessels, the two distribution forms (parabolic and non-parabolic) commonly considered in numerical simulations could cause WSS estimates to differ by more than 40%, which could seriously affect the accuracy of mechanical analysis. This study applied three-dimensional (3D) printing technology to create an experimental model of real-structure carotid arteries. Microparticle image velocimetry was adopted to comprehensively measure blood velocity field data at the stenosis location, providing experimental validation of numerical simulation (Fluent; finite volume method) results. Then, the flow field was simulated at a normal human heart rate (45–120 beats per minute). The radial sectional velocity exhibited a plateau-like distribution with a similar velocity in the central region (more than 65% of the total channel width). This study provides an accurate understanding of the WSS at the carotid stenosis location and proposes a reliable method for the study of flow fields under various blood flow conditions.

A Closed Loop Feature Detection Platform for Automated Neonate Cardio‐Respiratory Measurements and Data Analysis

BackgroundSudden Infant Death Syndrome is thought to partly result from unseen brain abnormalities affecting cardio‐respiratory function, but for which no clear genetic or environmental mechanisms are known. Mouse genetic and exposure models present an opportunity to uncover molecular and environmental mechanisms. However, measuring cardio‐respiratory function in neonate mice is expensive, difficult, and inefficient. One major challenge is the time needed to carry out such measurements. The neonate autoresuscitation assay, consisting of repeated anoxic exposures followed by recovery, requires the full attention of an observer for the multi‐hour duration of a single‐subject assay, limiting throughput. To address this, we developed a closed‐loop feature detection platform for automated neonate cardio‐respiratory measurements.MethodsOur platform design consists of:1) a pneumotachograph face‐mask for precise respiratory measurements. 2) a micro‐controller automated bell‐housing gas switching system for rapid induction of respiratory challenges. 3) a micro‐computer‐based data‐acquisition system with real‐time feature detection and outputs for controlling gas exposure. 4) a data analysis suite that assists with study recordkeeping and provides a facile method to extract key outcome measures from acquired data.ResultsGas challenges are administered via the rotating bell housing system. A python program detects waveform features in real‐time, such as apnea and bradycardia. Upon apnea detection, the system switches to a rescue gas. Resumption of normal breathing and heart rate can also be detected and incorporated into criteria for automated initiation of the next anoxic exposure trial. Data is stored for later offline automated analysis using the data analysis suite.ConclusionsThe system offers a relatively inexpensive approach for automated high throughput neonate cardio‐respiratory assessment for facile screening to yield important clues in developmental pathophysiology.

A prospective study of myeloperoxidase levels in water immersion

IntroductionWe aimed to compare myeloperoxidase levels in cord blood samples of mothers undergoing water immersion or conventional labor. MethodWe enrolled 52 pregnant women to this case control study meeting the following criteria: uneventful gestational follow-ups, no history of known chronic or pregnancy-associated diseases, cesarean section or uterine operation, BMI <29.9 kg/m2, single vertex presentation, normal fetal heart rate pattern, 37–41 weeks of gestation, estimated fetal weight of 2500–4000 g. The subjects were either undergoing immersion in water (n = 26) or conventional labor (n = 26) and their myeloperoxidase levels were measured from cord blood samples. ResultsThe mean age of the study population was 24.55 ± 4.9 years. The mean BMI and weight gain during pregnancy were 26.8 ± 2.7 kg/m2 and 11.6 ± 5.3 kg, respectively. The mean age of gestation at birth was 39.6 ± 1.1 weeks, with a mean birth weight of 3205.5 ± 433.2 g. The subjects in water immersion and conventional labor groups showed no difference in terms of age, gestational age, BMI, and birth weight. The mean myeloperoxidase level was significantly lower in the water immersion group (759.8 ± 391.5 U/L) compared to that in the conventional labor group (1832.2 ± 1011.9 U/L, p = 0.004). DiscussionImmersion in water during the first stage of labor seems to be associated with low myeloperoxidase levels, suggesting reduced oxidative stress in this delivery method.

Progressive Reduction in Right Ventricular Contractile Function Attributable to Altered Actin Expression in an Aging Mouse Model of Arrhythmogenic Cardiomyopathy.

Arrhythmogenic cardiomyopathy (ACM) is an inherited genetic disorder of desmosomal dysfunction, and PKP2 (plakophilin-2) has been reported to be the most common disease-causing gene when mutation-positive. In the early concealed phase, the ACM heart is at high risk of sudden cardiac death before cardiac remodeling occurs because of mistargeted ion channels and altered Ca2+ handling. However, the results of pathogenic PKP2 variants on myocyte contraction in ACM pathogenesis remain unknown. We studied the outcomes of a human truncating variant of PKP2 on myocyte contraction using a novel knock-in mouse model with insertion of thymidine in exon 5 of Pkp2, which mimics a familial case of ACM (PKP2-L404fsX5). We used serial echocardiography, electrocardiography, blood pressure measurements, histology, cardiomyocyte contraction, intracellular calcium measurements, and gene and protein expression studies. Serial echocardiography of Pkp2 heterozygous (Pkp2-Het) mice revealed progressive failure of the right ventricle (RV) in animals older than 3 months. By contrast, left ventricular function remained normal. ECGs of 6-month-old anesthetized Pkp2-Het mice showed normal baseline heart rates and QRS complexes. Cardiac responses to β-adrenergic agonist isoproterenol (2 mg/kg) plus caffeine (120 mg/kg) were also normal. However, adrenergic stimulation enhanced the susceptibility of Pkp2-Het hearts to tachyarrhythmia and sudden cardiac death. Histological staining showed no significant fibrosis or adipocyte infiltration in the RVs and left ventricles of 6- and 12-month-old Pkp2-Het hearts. Contractility assessment of isolated myocytes demonstrated progressively reduced Pkp2-Het RV cardiomyocyte function consistent with RV failure measured by echocardiography. However, aging Pkp2-Het and control RV myocytes loaded with intracellular Ca2+ indicator Fura-2 showed comparable Ca2+ transients. Western blotting of Pkp2-RV homogenates revealed a 40% decrease in actin, whereas actin immunoprecipitation followed by a 2,4-dinitrophenylhydrazine staining showed doubled oxidation level. This correlated with a 39% increase in troponin-I phosphorylation. In contrast, Pkp2-Het left ventricular myocytes had normal contraction, actin expression and oxidation, and troponin-I phosphorylation. Last, Western blotting of cardiac biopsies revealed that actin expression was 40% decreased in RVs of patients with end-stage ACM. During the early concealed phase of ACM, reduced actin expression drives loss of RV myocyte contraction, contributing to progressive RV dysfunction.

Atypical fetal junctional ectopic tachycardia: a case report and literature review

BackgroundJunctional ectopic tachycardia (JET) is caused by ectopic rhythms, originating in the atrioventricular node, typically with heart rate between 200 and 250 bpm. Herein, we present a case of fetal JET with normal fetal heart rate and a review of nine cases.Case presentationA 32-year-old, gravida 2, para 1, woman in whom fetal JET could not be diagnosed prenatally because the fetal heart rate was within the normal range. The fetus was diagnosed with premature restriction of the foramen ovale, and a cesarean section was performed, owing to the right heart overload that was characterized by fetal ascites and abnormal fetal Doppler velocity. Postnatally, the female neonate was diagnosed with JET on a 12-lead electrocardiogram, which revealed a neonatal heart rate of 158 bpm with narrow QRS and atrioventricular dissociation. After failure to respond to amiodarone therapy, she was treated with flecainide, which controlled the JET rate from 120 to 150 bpm. Fetal tachycardia with ventriculo-atrial (VA) dissociation or 1:1 VA conduction with a shorter VA interval than that of atrioventricular reentrant tachycardia confirmed the diagnosis of fetal JET.ConclusionsJET should be suspected even in the absence of tachycardia in patients with ductus venosus and pulmonary vein retrograde flow or tricuspid and mitral regurgitation without a cardiac anomaly, as tachycardia might sometimes be intermittent in cases of JET.

Pathophysiology, Treatment and Long-Term Consequences of Heart Failure in Infancy

Introduction: Infants have the highest risk to die from heart failure. However, innovations like beta-blocker treatment introduced more than 50 years ago are not recorded in the guidelines if the clinical trials are missing or be ignored, like propranolol in infants with severe heart failure to congenital heart disease. Methods: We re-analyse our data with propranolol and the ACE-inhibitor captopril in infants with severe heart failure due to congenital heart disease as published 20 years ago and the current long-term follow up data. Results: Propranolol but not Captopril significantly reduces clinical heart failure and neurohormonal activation of the renin angiotensin aldosterone system. Propranolol significantly improve dysautonomia measured by heart rate variability. In contrast to grown up with congenital heart disease – preoperatively treated with digoxin and diuretics - our patients up to the age of 15 years – preoperatively treated with propranolol without frusemide – have normal myocardial function and heart rate variability. Discussion: The evidence-based data of propranolol to treat severe heart failure in infants with congenital heart disease are the best we have. There is no reason to withheld infants from this effective therapy of early life stress due to heart failure. Conclusion: Further studies are needed to proof the impact of propranolol in infants with severe heart failure on long-term neurodevelopment, endothelial- and myocardial function.

Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late...

Colostrum feeding induced alkaline indigestion syndrome in riverine buffaloes- clinical assessment and therapeutic management

The present study was undertaken to elucidate the alkaline indigestion syndrome in riverine buffaloes caused by inadvertent colostrum feeding, clinical pattern and its therapeutic management. Fifteen recently parturited buffaloes with history of feeding average 2.96 kg (1 to 5 kg) of colostrum immediately after parturition followed by sudden onset of anorexia, decrease in milk yield and nervous signs were investigated. Clinical examination showed normal body temperature (100.26±0.42 vs 100.62±0.18), respiration (23.73±3.53 vs 24.13±0.66) and heart rate (57.26±3.30 vs 53.20±1.79) compared to healthy buffaloes. Examination of rumen revealed impaction with highly significant (P&lt;0.01) reduction in rumen motility (0.80±0.24 vs 3.80±0.17 per five minutes). Similarly, highly significant (P&lt;0.01) increase in rumen pH (8.10±0.16 vs 6.25±0.07) and decrease in protozoal density (5.00±0.88 vs 32.93±1.72) with sluggish (+) to no (-) protozoal motility was observed in ailing buffaloes. Haematological analysis showed normal blood profile with significant (P&lt;0.05) increase only in neutrophil count (51.60±5.1 vs 42.06±3.4). Prominent clinical signs of anorexia, congested conjunctival mucosae, decreased milk yield and varied nervous signs like restlessness, head pressing, staggering gait, incoordination, circling, convulsions, dummy syndrome, apparent blindness and coma were observed in affected buffaloes. Postural abnormalities like sternal / lateral recumbency and lateral deviation of neck were also observed in two buffaloes. All the ailing buffaloes were treated with Dextrose Normal Saline, single dose of preparation containing calcium, phosphorus and magnesium, vitamin B complex, antihistaminic, sedatives, laxatives, pre, probiotics, and oral antibiotics. All the treated buffaloes showed satisfactory improvement from 1st to 3rd day with complete clinical recovery by 4.93 (3 to 9) days of treatment. Buffalo owners should be made aware of unscientific practice of colostrum feeding in adult animals and accidentally intoxicated buffaloes could be successfully treated with the standardized treatment protocol.

Status epilepticus caused by canine distemper virus in a striped hyena (Hyaena hyaena)

AbstractA 6‐month‐old free‐living female striped hyena (Hyaena hyaena) was referred to the Veterinary Teaching Hospital of Ferdowsi University of Mashhad, Mashhad, Iran with lethargy and seizures. The general and neurological examinations revealed normal heart rate, polypnoea, abnormal respiratory sounds, decreased consciousness and no postural reactions in limbs. The animal had generalised seizures every 20 minutes, lasting about 1 minute. To control seizures, 10 mg diazepam (0.7 mg/kg) was injected intravenously four times every 2 minutes. With this treatment, the animal's seizures stopped. Based on characteristic clinical signs, lymphopaenia, and positive rapid kit and RT‐PCR results, canine distemper virus (CDV) was confirmed. The animal developed general seizures again 12 hours after referral and died during the seizures. This is the first case report of status epilepticus due to CDV in a striped hyena that did not respond to anticonvulsant therapies and caused the death of the animal.