Significant Decrease In Heart Rate Research Articles

Long-Term Outcome of LVAD in Duchenne Population with End Stage Cardiomyopathy

Purpose The aim of this study was to report the effect of long-term use of VAD in patients affected by Duchenne Muscular Distrophy and end stage cardiomyopathy (DMD-DCM). Methods We collected data of end stage DMD-DCM patients who were implanted with LVAD in our center (group 1) and the ones in regular follow-up because not eligible for LVAD implantation (group 2). Each patient of group 1 underwent extensive pre-operative assessment, in-hospital treatment and was enrolled in a dedicated DMD heart failure (HF) clinic during the post-discharge period. Patients of group 2 were followed in a dedicated DMD HF clinic or as inpatient in case of need of inotropic support. All data during long-term follow-up were recorded including echocardiography, ECG examination, laboratory blood tests, BNP dosing and assessment of nutritional status and respiratory function. Survival of the groups was represented by Kaplan Meier analysis and compared by log rank. Results A total of eight DMD-DCM patients (group 1) were implanted with LVAD and treated at our center during the period from 2011 until 2018 (mean age at implantation was 16.9 ± 2.9 years)¸whilst 4 patients (group 2) were not eligible for LVAD implantation. At the time of the last follow-up, 4 out of 8 patients were alive and 2 out of 8 patients did not have post-operative complications. The most prominent complications were bleeding and infections with one episode of acute heart failure that was successfully treated. The principal causes of 3 deaths at the median follow-up of 22 months were sepsis, tracheal bleeding, and cerebral hemorrhage. After one year from implantation we noticed a significant decrease in heart rate (p=0.002), in LV volumes and diameters (LVEDD p=0.03, LVESD p=0.02, EDV p=0.01 and ESV p=0.02) together with a significant increase in ejection fraction (p=0.0036). However, relative wall thickness did not change over time, showing an eccentric remodeling pattern before and after LVADs. Analysis on short and long-term follow-up showed significant improvement of survival in DMD patients treated with LVAD compared to the group that was not implanted (log rank Conclusion Our data showed that cardiac atrophy is persistent in Duchenne cardiomyopathy despite the improvement of LV function. LVAD improved outcomes in patients with LVAD when compared to those without.

Evaluating the efficacy of alfaxalone in corn snakes (Pantherophis guttatus)

ObjectiveAlfaxalone is a popular veterinary anesthetic; however, research on this anesthetic in snakes has been limited to ball pythons, garter snakes and several Australian species. The objective was to evaluate the anesthetic effects of alfaxalone in corn snakes (Pantherophis guttatus), a popular pet snake. Study designProspective, randomized crossover study. AnimalsA total of eight corn snakes. MethodsIn phase I, snakes were subcutaneously administered three doses of alfaxalone (5, 10 and 15 mg kg–1) in the cranial third of the body to determine the most effective dose. In phase II, a dose of 15 mg kg–1 was administered in the cranial and caudal thirds of the snakes to determine if injection site affected anesthesia duration. Heart rate (HR), respiratory rate (fR), righting reflex, escape response, tail pinch, needle prick and tongue flick were monitored at baseline and 5 minute intervals until the snakes fully recovered. ResultsDuration of anesthesia differed significantly, with higher doses lasting longer than lower doses: 5 mg kg–1 [23.8 ± 4.4 (15–30) minutes]; 10 mg kg–1 [40.6 ± 9.4 (25–55) minutes]; and 15 mg kg–1 [56.9 ± 8.4 (50–70) minutes], mean ± standard deviation (range). The tail pinch reflex was not completely lost in phase 1. There was a significant change in fR over time, but this was not related to dose. HR was not different by time or dose. Duration of anesthesia was not different after administration of alfaxalone (15 mg kg–1) in the cranial third versus the caudal third of the body; however, there was a significant decrease in HR and fR at this dose, regardless of injection site. Conclusions and clinical relevanceBased on these results, alfaxalone (15 mg kg–1) provides adequate anesthesia for brief procedures or intubation; however, additional analgesia is required for painful procedures.

COMPARATIVE EVALUATION OF ONSET, DURATION AND SAFETY BETWEEN MIDAZOLAM, DEXMEDETOMIDINE SEDATION AND THEIR COMBINATION IN PRESCHOOLERS: A RANDOMIZED CLINICAL TRIAL

Introduction: Dental anxiety is a global problem in pediatric dentistry. Moderate sedation is an acceptable option for uncooperative preschoolers dental patients. Objective: To compare midazolam (MDZ), dexmedetomidine (DEX) and their combination (DEX/MDZ) as sedative drugs for preschoolers undergoing dental treatment regarding onset, duration and safety of sedation. Materials and methods: The study was a three-arm randomized clinical trial with a parallel design. Seventy-two healthy uncooperative preschoolers were selected from the Faculty of Dentistry, Alexandria University, Egypt. The participants were randomly allocated into, control group received 0.5mg/kg MDZ, study group I received 5µg/kg DEX, and study group II received 0.3mg/kg MDZ followed by 3µg/kg DEX. Each child received quadrant treatment. Time until optimum sedation and recovery were recorded. Vital signs were recorded throughout the treatment session. Results: All children were comparable regarding demography, physical status and baseline vital signs (blood pressure, heart rate, and oxygen saturation). There was a statistically significant difference regarding onset and duration of the effect of sedative drugs (P=<0.001). Dexmedetomidine had the most delayed onset of action (17.08 ± 5.88 min), while DEX/ MDZ had the longest duration of action (68.13 ± 17.12). There was a significant decrease in blood pressure throughout the sedation session for all children. Children who were sedated with DEX and DEX/MDZ had a significant decrease in heart rate than children sedated with MDZ. No statistically significant effect of drugs on oxygen saturation levels was recorded. Conclusion: Midazolam, Dexmedetomidine and their combination are safe drugs during moderate sedation for children undergoing dental treatment.

Music Use for Sedation in Critically ill Children (MUSiCC trial): a pilot randomized controlled trial

ObjectiveTo demonstrate feasibility of a music medicine intervention trial in pediatric intensive care and to obtain information on sedation and analgesia dose variation to plan a larger trial.Material and methodsPilot randomized controlled trial (RCT) was conducted at the Stollery Children’s Hospital general and cardiac intensive care units (PICU/PCICU). The study included children 1 month to 16 years of age on mechanical ventilation and receiving sedation drugs. Patients were randomized in a 1:1:1 ratio to music, noise cancellation or control. The music group received classical music for 30 min three times/day using headphones. The noise cancellation group received the same intervention but with no music. The control group received usual care.ResultsA total of 60 patients were included. Average enrollment rate was 4.8 patients/month, with a consent rate of 69%. Protocol adherence was achieved with patients receiving > 80% of the interventions. Overall mean (SD) daily Sedation Intensity Score was 52.4 (30.3) with a mean (SD) sedation frequency of 9.75 (7.21) PRN doses per day. There was a small but statistically significant decrease in heart rate at the beginning of the music intervention. There were no study related adverse events. Eighty-eight percent of the parents thought the headphones were comfortable; 73% described their child more settled during the intervention.ConclusionsThis pilot RCT has demonstrated the feasibility of a music medicine intervention in critically ill children. The study has also provided the necessary information to plan a larger trial.

Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study

BackgroundSeveral studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24 h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, such use remains challenging due to the difficulty in distinguishing between compensatory and non-compensatory tachycardia. Therefore, the Esmosepsis study was designed to study the effects of esmolol aimed at reducing the heart rate by 20% after the initial resuscitation process in hyperkinetic septic shock patients on (1) cardiac index and (2) systemic and regional hemodynamics as well as inflammatory patterns.MethodsNine consecutive stabilized tachycardic hyperkinetic septic shock patients treated with norepinephrine for a minimum of 6 h were included. Esmolol was infused during 6 h in order to decrease the heart rate by 20%. The following data were recorded at hours H0 (before esmolol administration), H1–H6 (esmolol administration) and 1 h after esmolol cessation (H7): systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure, heart rate, PICCO transpulmonary thermodilution, sublingual and musculo-cutaneous microcirculation, indocyanine green clearance and echocardiographic parameters, diuresis, lactate, and arterial and venous blood gases.ResultsEsmolol was infused 9 (6.4–11.6) hours after norepinephrine introduction. Esmolol was ceased early in 3 out of 9 patients due to a marked increase in norepinephrine requirement associated with a picture of persistent cardiac failure at the lowest esmolol dose. For the global group, during esmolol infusion, norepinephrine infusion increased from 0.49 (0.34–0.83) to 0.78 (0.3–1.11) µg/min/kg. The use of esmolol was associated with a significant decrease in heart rate from 115 (110–125) to 100 (92–103) beats/min and a decrease in cardiac index from 4.2 (3.1–4.4) to 2.9 (2.5–3.7) l/min/m−2. Indexed stroke volume remained unchanged. Cardiac function index and global ejection fraction also markedly decreased. Using echocardiography, systolic, diastolic as well as left and right ventricular function parameters worsened. After esmolol cessation, all parameters returned to baseline values. Lactate and microcirculatory parameters did not change while the majority of pro-inflammatory proteins decreased in all patients.ConclusionIn the very early phase of septic shock, heart rate reduction using fast esmolol titration is associated with an increased risk of hypotension and decreased cardiac index despite maintained adequate tissue perfusion (NCT02068287).

Branham sign in dogs undergoing interventional patent ductus arteriosus occlusion or surgical ligation: a retrospective study.

Background:The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical ductal closure, a direct comparison of the Branham sign elicited by these two techniques has not been made.Aim:Since closure with an Amplatz canine ductal occluder (ACDO) occurs over 10 minutes and surgical ligation (SL) is more rapid, we hypothesized that the Branham sign following occlusion of a PDA with an ACDO would be less severe than following SL.Methods:Clinical records of dogs diagnosed with left-to-right shunting PDA between 2008 and 2018 were retrospectively reviewed. Of 139 dogs undergoing PDA occlusion, only 41 dogs (ACDO n = 32, SL n = 9) were included after applying exclusion criteria. Heart rate (HR) and blood pressure (BP) from occlusion time (T0) until 30 minutes post occlusion (T30) were recorded. Signalment and anesthetic protocol were also recorded. The influence of age and weight on the hemodynamic variations was assessed. Hemodynamic variables and calculations were compared between and within groups using a repeated measures general linear model, and post hoc tests were applied if significance was identified.Results:A mild Branham sign was present in both groups, and hemodynamic changes were not significantly different between groups. In both groups, there was a significant decrease in HR (11 bpm, 5.3–16.3; p < 0.001) (10.4%, 5.4–15.5; p < 0.001) and increase in diastolic BP (9.5 mmHg, 3–16; p = 0.002) (23.5%, 7.1–39.9; p = 0.002), but systolic BP did not change significantly (p = 0.824). Age and weight did not influence Branham sign.Conclusion:The Branham sign in dogs is mild in both groups, lasts for at least 30 minutes, and is independent of the method of PDA closure.

Neonatal Arrhythmia

Arrhythmias are seldom observed in the newborn period and rarely lead to serious consequences. Because they may be a continuation of fetal arrhythmias, newborn arrhythmias are different from those occurring at later ages. Here we describe a case of a newborn presented with tachycardia at birth. A female baby of 1950 grams born by emergency cesarean section for fetal distress at 36 weeks of gestation. Fetal tachycardia of 251 bpm was detected prenatally. Electrocardiography showed supraventricular tachycardia (SVT). Hematological and biochemical tests done were within normal limits. Echocardiography revealed normal anatomy with severe tachycardia, dilated chambers with moderate to severe TR with moderately reduced ventricle function. For persisting SVT intravenous adenosine was administered with no significant decrease in heart rate, then continuous intravenous amiodarone infusion was started resulting in a transient decrease in heart rate, however again increased, hence baby was started on intravenous digoxin which responded well. Repeated echocardiography showed normal cardiac chambers and function. Baby was discharged on maintenance oral digoxin and was gradually weaned and stopped after 12 months of age. Neonatal arrhythmias is not an uncommon condition in newborns, however it should be early recognized and evaluated for a better outcome of the baby. Although the frequency of arrhythmias in the newborn period is not high, SVT are the most frequently observed arrhythmias in this period.

Portable Biosensors for Psychophysiological Stress Monitoring of a Helicopter Crew.

This study aims to analyze the psychophysiological stress response of a helicopter crew using portable biosensors, and to analyze the psychophysiological stress response differences of experienced and non-experienced crew members. We analyzed 27 participants (33.89 ± 5.93 years) divided into two different flight maneuvers: a crane rescue maneuver: 15 participants (three control and 12 military) and a low-altitude maneuver: 12 participants (five control and seven military). Anxiety, rating of perceived exertion, subjective perception of stress, heart rate, blood oxygen saturation, skin temperature, blood lactate, cortical arousal, autonomic modulation, leg and hand strength, leg flexibility, spirometry, urine, and short-term memory were analyzed before and after both helicopter flight maneuvers. The maneuvers produced a significant increase in stress and effort perception, state of anxiety, and sympathetic modulation, as well as a significant decrease in heart rate, blood oxygen saturation, leg and inspiratory muscle strength, and urine proteins. The use of biosensors showed how a crane rescue and low-altitude helicopter maneuvers produced an anticipatory anxiety response, showing an increased sympathetic autonomic modulation prior to the maneuvers, which was maintained during the maneuvers in both experienced and non-experienced participants. The crane rescue maneuver produced a higher maximal heart rate and decreased pulmonary capacity and strength than the low-altitude maneuver. The psychophysiological stress response was higher in the experienced than in non-experienced participants, but both presented an anticipatory stress response before the maneuver.

Pain catastrophizing in athletes correlates with pain and cardiovascular changes during a painful cold pressor test.

Athletes are often exposed to pain due to injury and competition. There is preliminary evidence that cardiovascular measures could be an objective measure of pain, but the cardiovascular response can be influenced by psychological factors such as catastrophizing. The purpose of our study was to use a painful cold pressor test to measure the relationship between catastrophizing, pain, and cardiovascular variables in athletes. Pre-post test. We completed all measures in a laboratory setting. Thirty-six male rugby athletes participated in the study. We measured catastrophizing with the Pain Catastrophizing Scale and pain with a Numeric Pain Rating Scale. Cardiovascular measures included heart rate, systolic, and diastolic blood pressure, and heart rate variability. During the cold pressor test, participants experienced a significant increase in pain (0 to 4.1±2.2), systolic blood pressure (126.7±16.5mm Hg to 149.7±23.4mm Hg), diastolic blood pressure (76.9±8.3mm Hg to 91.9±11.5mm Hg) and heart rate variability (from 0.0164ms±0.0121 to 0.0400ms±0.0323) (all p<.001). In addition, there was a significant decrease in heart rate after the cold pressor test (p=0.04). There was a significant correlation between athlete's pain catastrophizing to both pain intensity and change in heart rate during the cold pressor test (p=.017 and p=.003 respectively). A significant linear regression indicated pain and catastrophizing explained 29% of the variance of the change in heart rate (p=.003). Athletes who have catastrophizing thoughts are more likely to experience higher levels of pain and a greater cardiovascular response during a painful stimulus. The change in cardiovascular variables may be a good alternative for an objective measure of pain in athletes in the future.

Heart rate variability biofeedback intero-nociceptive emotion exposure therapy for adverse childhood experiences

Background: Psychiatric patients with adverse childhood experiences (ACE) tend to have dysfunctions in the interoceptive part of their emotional experience. The integration of interoceptive emotional activity in the insular and cingulate cortices is linked to the regulation of sympathovagal balance. This makes heart rate variability (HRV) an ideal measure for providing feedback on emotion regulation in real-time. Methods: A sample of one hundred (n=100) outpatients was evaluated. Participants underwent eight 30-minutes ACE exposure sessions during which patients were guided to experience bodily sensations related to ACE while their HRV was monitored using a commercial biofeedback device. Results: Comparing the results of the first to last therapeutic session, a significant decrease in heart rate and an increase in HRV at the onset of the session were observed. Conclusions: This study suggests a physiological impact of therapeutic interventions on autonomic balance and underlines the interest in HRV biofeedback as clinical practice.

Yoga could reduce the burden and symptoms of atrial fibrillation as well as medication related side effects and the complications with cardiac ablation

Abstract Background Atrial fibrillation (AF) is a common cardiac arrhythmia that affects around three million people worldwide. Thromboembolic stroke, myocardial ischemia and congestive heart failure with significant financial burden are bad outcomes of AF. It is associated with significant morbidity and is also an independent risk factor for mortality. The treatment of AF and its associated complications increases healthcare resource utilization and contributes to increasing costs of healthcare, particularly costs associated with recurrent hospitalization. Methods 538 patients of atrial fibrillation are enrolled in our multicentric study from 2012 to 2017 that brought to light the therapeutic impact a noninvasive, medication-free intervention has on a costly disease.The unique approach of this study involved patients serving as their own controls; for the first 12 weeks, patients continued standard AF medical or catheter ablation therapy, followed by 16 weeks of 30-min alternate day yoga sessions (Savasana / Sun Salution Yoga Posture, Ujjayi Breath and Anulom –Vilom Pranayam). Patients were also encouraged to practice yoga at home on a daily basis.We divided into two group Yoga and Non Yoga and compared the data after 16 weeks of training. Results Yoga training reduced symptomatic AF episodes (14.8±4 vs. 8.2±3.2, p&amp;lt;0.005), symptomatic non-AF episodes (12.8±2.8 vs. 9.2±2.2; p&amp;lt;0.004), asymptomatic AF episodes (2.4±0.4 vs. 1.3±0.20; p&amp;lt;0.005), and depression and anxiety (p&amp;lt;0.005) used Goldberg anxiety score 2.5 fold improved as compared to non yoga group while improving, QoL parameters including physical functioning, vitality, social functioning, and mental health as assessed using the SF-36 (p=0.017, p&amp;lt;0.001, p&amp;lt;0.001, p=0.019, and p&amp;lt;0.003, respectively). There were significant decreases in heart rate and systolic (11±3 mmhg) and diastolic (6±2 mmhg) blood pressure after yoga training (p&amp;lt;0.002). This may directly result in decreased hospitalization (38% in yoga vs 16% in non yoga group) and healthcare costs reduction in yoga group. Yoga is also an intervention free from medication-related side effects or the complications observed with cardiac ablation. Conclusions The primary outcome was a composite of the reductions in symptomatic AF, symptomatic non-AF, and asymptomatic AF episodes as recorded by a diary and correlated with a non-looping event monitor with low cost. Strikingly, the results validate the ability of yoga practice to reduce patient-reported AF symptoms. It also demonstrated a statistically significant impact on quality of life (QoL), mental health, physical functioning, depression, and anxiety with avoid of side effects of medication or ablation. Funding Acknowledgement Type of funding source: None

Comparison of the Anesthetic Effects of Isoflurane and Sevoflurane Inhalation on the Cardiovascular System of the Common Buzzard (Buteo buteo).

The aim of this study was to compare the effects of isoflurane (ISO) and sevoflurane (SEVO) inhalation anesthesia on the cardiovascular system of the common buzzard (Buteo buteo). Fourteen common buzzards of unknown sex and age, weighing 700-900 g each, were used for the study. The buzzards were randomly divided into an ISO group and a SEVO group, each comprising 7 buzzards. The buzzards were then anesthetized by masked induction with either ISO or SEVO. After induction, all buzzards were intubated with a 2.5-mm-diameter uncuffed endotracheal tube. Anesthesia was maintained with 3% ISO or 4% SEVO in a 3 L/min flow of 100% oxygen. Before induction, immediately after induction, and at intervals of 5, 10, 15, 20, 25, and 30 min after the patients were induced, the heart rate, respiratory rate, and body temperature of the buzzards were recorded. In addition, before and during anesthesia, serum electrolytes (sodium, ionized calcium, and potassium), blood gas measurements (arterial pH, arterial partial pressure of carbon dioxide, arterial partial pressure of oxygen, bicarbonate concentration, and oxyhemoglobin saturation), and hematocrit values were evaluated in the blood samples taken from both the ISO and SEVO groups. A statistically significant decrease in body temperature was observed in both groups. A significant decrease in heart rate was observed in the ISO group. The increases in partial pressure of carbon dioxide and bicarbonate concentration were statistically significant in both groups. The effects of ISO and SEVO anesthesia on the cardiovascular and respiratory system in the buzzards were similar based on the results of this study.

Cardioprotection by triiodothyronine following caloric restriction via long noncoding RNAs

Severe caloric-restriction compromises thyroid hormone (TH) status, apparently to save energy and proteins for enduring stress stimulus. However, a persistent decrease in TH levels may compromise heart function. We hypothesized that supplementation of low dose active TH or targeting hypoxia-inducible factor-1-alpha, HIF-1α (a strong activator of deiodinase enzyme that degrades peripheral active THs) will prevent deterioration of cardiac performance. Adult mice were subjected to acute fasting based on institutional animal protocols with ad libitum access to water. The following groups were studied: Control mice with free access to food; severe caloric restriction fasting only group; Fasting with Triiodo-l-Thyronine (T3); Fasting with HIF-1α inhibitor (BAY). Cardiac hemodynamic and electrophysiological studies were performed and role of long noncoding RNAs were explored. Following severe caloric-restriction, we found that body weights, and heart weights to a partial extent, were decreased. Low-dose T3 treatment attenuated left ventricular hemodynamic impairment in indices of cardiac contractility and relaxation. In electrophysiology studies, fasting mice developed atrial tachyarrhythmias upon induction. This reverted to control levels following T3 treatment. There was a significant increase in atrioventricular conduction time and significant decrease in heart rate following fasting. Both these changes were attenuated following T3 treatment. Furthermore, BAY partially improved hemodynamics. Compared to the severe caloric-restriction group, both T3 and BAY reduced MALAT1 and GAS5 long noncoding RNA expression. These new findings indicate that T3 and BAY protect from cardiac decompensation secondary to acute severe caloric-restriction partly mediated by long noncoding RNAs.

Comparative study between magnesium sulphate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery: a prospective randomized study

BackgroundFunctional endoscopic sinus surgery (FESS) has been proposed as a selected treatment used in patients with chronic sinusitis that have not responded to medical therapy. Due to the nature of the location of endoscopic sinus surgery, even a small amount of bleeding can reduce the operative visibility. The aim of the work was to compare between dexmedetomidine and magnesium sulphate regarding their efficacy as a hypotensive agent in FESS in adult patients to obtain a bloodless surgical field.Patients and methodsSixty patients were randomly assigned into two groups, (D group) for dexmedetomidine (n = 30) and (M group) for magnesium sulphate (n = 30). In (D group), patients received 1 μg/kg dexmedetomidine in 100 ml saline solution as the loading dose 10 min before induction and 0.5–1 μg/kg/h infusion via syringe pump during surgery. In (M group), patients received 40 mg/kg magnesium sulphate in 100 ml saline solution over 10 min as the intravenous loading dose 10 min before induction, with a subsequent 10–15 mg/kg/h infusion. If there is an increase in the arterial blood pressure greater than the targeted MAP (55–65 mmHg), nitroglycerine infusion was started by 0.5 μg/kg/min. The surgeon estimated the quality of the surgical field and recorded it. The total blood loss was measured. In recovery, time to reach Aldrete score ≥ 9 was recorded to fulfill the discharge criteria. Pain score was assessed by the NRS numerical rating score. The time needed to first analgesia requirement was recorded. Sedation score was recorded using Ramsay sedation score.ResultsThere was no statistically significant difference between both groups regarding MAP except at 30 min postoperatively as there was a statistically significant decrease in the MAP among the dexmedetomidine (D group) (p = 0.039). Nitroglycerine was required in eight cases in the magnesium sulphate (M group) to reach the targeted MAP which was statistically significant compared to the (D group). Patients in the (D group) had a statistically significant decrease in heart rate than in the (M group) during and after the operation (p = 0.35). The quality of the surgical field was significantly better among the (D group) (p < 0.05), and accordingly, the surgeon satisfaction was significantly higher in the (D group) (p = 0.001). Time to reach Aldrete score ≥ 9 and time for first analgesic requirement postoperatively were significantly longer in the (D group) (p = 0.023, p = 0.001 respectively). Regarding the Ramsay sedation score (RSS), it was higher in the (D group) which was statistically significant (p ≤ 0.001).ConclusionDexmedetomidine was more effective than magnesium sulphate to achieve controlled hypotension in patients undergoing FESS. Compared with magnesium, dexmedetomidine offers the advantage of better clarity of the field, surgical satisfaction, less bleeding, and prolonged postoperative analgesia.

Hematological and Running Performance Modification of Trained Athletes after Reverse vs. Block Training Periodization.

The aim of the present study was to analyze the effect of block (BP) and a reverse training periodization (RP) in the hematological and running performance of amateur trained athletes. Modifications in hematological, aerobic, and anaerobic running performance and countermovement jump before and after twelve weeks of BP vs. RP training programs were analyzed in 16 trained athletes (eight males: 40.0 ± 6.2 years; 179.2 ± 12.8 cm; 73.8 ± 12.2 kg; and eight females: 34.2 ± 4.1 years; 163.4 ± 9.6 cm; 57.0 ± 11.0 kg). A significant decrease in heart rate (HR) at ventilatory threshold (VT1) (p = 0.031; ES = 1.40) was observed in RP without changes in BP. In addition, RP increased significantly VO2max (p = 0.004; ES = 0.47), speed at VO2max (p = 0.001; ES = 1.07), HR at VT2 (p < 0.001; ES = 1.32) and VT1 (p = 0.046; ES = 0.57), while BP improved VO2max (p = 0.004; ES = 0.51), speed at VO2max (p = 0.016; ES = 0.92), and HR at VT2 (p = 0.023; ES = 0.78). In addition, only RP increased anaerobic performance in a running-based anaerobic sprint test (RAST) (mean sprint: p = 0.009; ES = 0.40, best sprint: p = 0.019; ES = 0.30 and total time: p = 0.009; ES = 0.40). Moreover, both types of training periodization proposed in this study maintained hematological values and efficiently improved jump performance (p = 0.044; ES = 0.6) in RP and p = 0.001; ES = 0.75 in BP). Therefore, twelve weeks of either RP or BP is an effective strategy to increase jump and aerobic running performance maintaining hematological values, but only RP increases anaerobic running performance.

The Mechanism of Relaxation by Viewing a Japanese Garden: A Pilot Study.

To explore people's visual attention and psychological and physiological responses to viewing a Japanese garden (an asymmetrically designed garden) and an herb garden (a symmetrically designed garden). There are few studies of eye movements when observing different style gardens, and how they are connected to the interpretation of the space, and physiological and psychological responses. Thirty subjects were recruited and their physiological and psychological responses to viewing the garden types were assessed using a heart-rate monitor and questionnaire. Eye movements while viewing projected slide images of the gardens were tracking using an eye-tracking monitor. A significant decrease in heart rate was observed when subjects were viewing the Japanese garden as opposed to viewing the herb garden. Mood was significantly improved in both gardens, but eye-gaze patterns differed. The Japanese garden elicited far more comments about expectations for the coming season; unlike the herb garden, it also induced memories of viewing other landscapes. The physiological and psychological responses to viewing gardens differs based on the quality of landscape design and the prior experience of viewers.

Heart rate variability biofeedback intero-nociceptive emotion exposure therapy for adverse childhood experiences

Background: Psychiatric patients with adverse childhood experiences (ACE) tend to be dysfunctional in the interoceptive part of their emotional experience. The integration of interoceptive emotional activity in the insular and cingulate cortices is linked to the regulation of sympathovagal balance. This makes heart rate variability (HRV) an ideal measure for providing feedback on emotion regulation in real time. Methods: A sample of one hundred (n=100) outpatients was evaluated. Participants underwent eight 30-minutes ACE exposure sessions during which patients were guided to experience bodily sensations related to ACE while their HRV was monitored using a commercial biofeedback device. Results: Comparing the results of first to last therapeutic session, a significant decrease in heart rate and an increase in HRV at the onset of the session were observed. Conclusions: This study suggests physiological impact of therapeutic interventions on the autonomic balance and underlines the interest of HRV biofeedback as a clinical practice.

Acute Administration of Gut Microbial Metabolites Reduces Blood Pressure and Cardiac Contractility

Metabolites produced by the gut microbiota can affect host physiology; one class of these metabolites are short chain fatty acids (SCFAs). Prior work by our laboratory has shown that intravenous administration of SCFAs causes acute hypotension (Pluznick, Protzko et al. 2013) and that treating vessels with SCFAs ex vivo results in vasorelaxation (Natarajan, Hori et al. 2016). To expand upon these findings, we performed IP injections of acetate in mice that were implanted with DSI telemetry transmitters to monitor mean arterial pressure (MAP) and heart rate (HR) in real time. Sodium acetate (acetate is the most abundant SCFA in the circulation) was given at a 1g/kg dose via IP, which elevates plasma acetate by 3–4 fold over baseline (Shubitowski, Poll et al. 2019). Upon sodium acetate IP injection, we observed a rapid and reproducible drop in MAP (−49.2 +/− 10.7 mmHg maximum drop, n=10 males + females, p&lt;0.05) when compared to an IP injection of saline. Surprisingly, in addition to a significant depression of MAP, mice injected with acetate also showed a significant depression in HR (−257.6 +/− 55.8 bpm maximum drop, p&lt;0.05). IP injections of propionate and butyrate, two other SCFA microbial metabolites, had similar depressive effects on MAP and HR, but lactate (control) had no effect. Had SCFAs been solely acting on the vasculature, we would have expected the baroreflex to increase HR. To determine if acetate was having a direct cardiac effect, we used isolated perfused Langendorff hearts from mice. During acetate infusion, Langendorff hearts showed a significant decrease in HR, suggesting a direct mechanism of action (353.8 +/− 39.5 bpm baseline vs 274.6 +/− 21.3 bpm acetate n=5, p&lt;0.05), however the HR drop was on a much slower time scale than seen in vivo. To further probe the effects of acetate on cardiac contractility, pressure volume loops were performed on anesthetized mice and acetate was administered by IP. Inferior vena cava occlusion after acetate IP showed a significant decrease in Preload Recruitable Stroke Work (PRSW, 73.06 +/− 20.98 vs. 49.06 +/− 22.11 mmHg*μl baseline vs acetate, n=7 males + females, p&lt;0.05) and end‐systolic elastance (Ees, 3.493 +/−1.139 vs. 1.519 +/− 0.5781 mmHg/μl baseline vs. acetate, n=7 males + females, p&lt;0.05), two parameters of load‐independent cardiac contractility. Finally, pre‐treatment of conscious mice with cardioselective β antagonist metoprolol blocked the acetate mediated drop in HR in mice implanted with telemetry devices, but the drop in MAP remained intact. We hypothesize that acetate acts independently on the peripheral vasculature and the cardiac muscle, with direct and indirect effects on cardiac function. Both components are likely contributing to the MAP and HR effects seen in whole animals. Together these data demonstrate a previously unknown and potentially detrimental effect of short chain fatty acids on cardiac function.Support or Funding InformationF31HL144061, R01HL128512, R01DK107726

Long-Term Outcome of LVAD in Duchenne Population with End Stage Cardiomyopathy

The aim of this study was to report the effect of long-term use of VAD in patients affected by Duchenne Muscular Distrophy and end stage cardiomyopathy. We collected data of DMD patients with end-stage cardiomyopathy implanted with LVAD in our center (group 1) and the ones in regular follow-up not eligible for LVAD implantation (group 2). Each patient of group 1 underwent extensive pre-operative assessment, in-hospital treatment and was enrolled in a dedicated DMD HF (heart failure) clinic during the post-discharge period. Patients of group 2 were followed in a dedicated DMD HF clinic or as inpatient in case of need of inotropic support. During long-term follow-up all data were recorded including echocardiography, ECG examination, laboratory blood tests, and respiratory function. Survival was represented by Kaplan Meier analysis and compared by log rank. A total of 8 DMD patients (group 1) were implanted with LVAD and treated at our center during the period from 2011 until 2018 (mean age at implantation was 16.9 ± 2.9 years)¸ whilst 4 patients (group 2) were not eligible for LVAD implantation. At the time of the last follow-up, 4 out of 8 patients were alive and 2 out of 8 patients did not have post-operative complications. The principal causes of 3 deaths at the median follow-up of 22 months were sepsis, tracheal bleeding, and cerebral hemorrhage. After 1 year from implantation we noticed a significant decrease in heart rate (p=0.002), in LV volumes and diameters (LVEDD p=0.03, LVESD p=0.02, EDV p=0.01 and ESV p=0.02) and significant increase in ejection fraction (p=0.0036). However, relative wall thickness did not change over time, showing an eccentric remodeling pattern before and after LVADs. Analysis on short and long-term follow-up showed significant improvement of survival in DMD patients treated with LVAD compared to the group that was not implanted (log rank&lt0.001), with a 5-year increase in life expectancy. Our data showed that cardiac atrophy is persistent in Duchenne cardiomyopathy despite the improvement of EF due to a significant ventricular unloading coupled with chronic therapy. LVAD improved outcomes in patients with LVAD when compared to those without. An integration of outpatient DMD HF clinic and patient-centered palliative care will most likely increase the quality of life and delivery of care for this population.

SEDATIVE, CARDIORESPIRATORY, AND THERMOREGULATORY EFFECTS OF ALFAXALONE ON BUDGERIGARS (MELOPSITTACUS UNDULATUS).

Alfaxalone is a neurosteroid anesthetic agent that has been extensively used in both human and veterinary medicine for more than 50 yr. Previous studies involving avian species demonstrated various dose ranges and multiple routes of administration. The aim of this study was to evaluate the short-term sedative, cardiorespiratory, and thermoregulatory effects of an intramuscular injection of alfaxalone on budgerigars (Melopsittacus undulatus). A crossover study was performed with a sample size of 10 male budgerigars, previously determined to be healthy based on physical examination. Alfaxalone was administered intramuscularly at two doses: 15 and 20 mg/kg. The lower dose resulted in mild to moderate sedation for 29 ± 5 min, whereas the higher dose resulted in moderate to profound sedation for 29 ± 7 min. A statistically significant decrease in heart rate was observed 2 min after administration of alfaxalone at 15 mg/kg; however, this finding was noted to be transient. A statistically significant decrease in respiratory rate was observed at 6 and 10 min after injection in both groups. Cloacal temperature measurement with a digital thermometer and eye temperature calculated from thermographic images demonstrated a decrease in body temperature over time but was not found to be statistically significant. Intramuscular use of alfaxalone proved to provide short-term sedation in budgerigars, with statistically significant but clinically mild cardiorespiratory effects. Due to a significant decrease in body temperature, active warming is recommended when using alfaxalone in budgerigars.