Significant Differences In Heart Rate Research Articles

The effect of position on feeding performance in infants with cleft lip and palate: Quasiexperimental study.

This single-group, quasiexperimental study was conducted to determine the effect of feeding position on the physiological parameters and feeding performance of term-born infants with cleft lip and palate (CLP) in the preoperative period. The study sample consisted of 45 infants aged 0-6 months with CLP followed up preoperatively in our outpatient clinic between January 2021 and 2022. Infants who were being fed with a specialty bottle for babies with CLP and whose families consented to participate in the study were included. After 2 h of fasting, the infants were fed in the elevated supine (ESU) position for the first meal, then in the elevated side-lying (ESL) position for the second meal after another 2 h of fasting. The infants' heart rate and oxygen saturation values before, during, and after each feed and indicators of feeding performance were compared between the positions. There was no significant difference between the positions in terms of heart rate and oxygen saturation before, during, or after feeding (p > .05). There was no statistically significant difference in measures of feeding performance according to the infants' feeding position (p > .05). According to the findings obtained in this study, infants with CLP showed no statistically significant differences in heart rate, oxygen saturation, or feeding performance when fed in the ESLand ESU positions. However, despite the lack of statistical significance, both physiological values and feeding performance tended to be better when the infants were fed in the ESL position, nurses can practice ESL position according to the infant's opposite direction of the side of the cleft lip or palate.

The analgesic effect of ultrasound-guided cervical erector spinae block in arthroscopic shoulder surgery: a randomized controlled clinical trial

BackgroundErector spinae plane block (ESPB) is a novel fascial plane block technique that can provide effective perioperative analgesia for thoracic, abdominal and lumbar surgeries. However, the effect of cervical ESPB on postoperative analgesia after arthroscopic shoulder surgery is unknown. The aim of this study is to investigate the analgesic effect and safety of ultrasound-guided cervical ESPB in arthroscopic shoulder surgery.MethodsSeventy patients undergoing arthroscopy shoulder surgery were randomly assigned to one of two groups: ESPB group (n = 35) or control group (n = 35). Patients in the ESPB group received an ultrasound-guided ESPB at the C7 level with 30 mL of 0.25% ropivacaine 30 min before induction of general anesthesia, whereas patients in the control group received no block. The primary outcome measures were the static visual analogue scale (VAS) pain scores at 4, 12, and 24 h after surgery. Secondary outcomes included heart rate (HR) and mean arterial pressure (MAP) before anesthesia (t1), 5 min after anesthesia (t2), 10 min after skin incision (t3), and 10 min after extubation (t4); intraoperative remifentanil consumption; the Bruggrmann comfort scale (BCS) score, quality of recovery-15 (QoR-15) scale score and the number of patients who required rescue analgesia 24 h after surgery; and adverse events.ResultsThe static VAS scores at 4, 12 and 24 h after surgery were significantly lower in the ESPB group than those in the control group (2.17 ± 0.71 vs. 3.14 ± 1.19, 1.77 ± 0.77 vs. 2.63 ± 0.84, 0.74 ± 0.66 vs. 1.14 ± 0.88, all P < 0.05). There were no significant differences in HR or MAP at any time point during the perioperative period between the two groups (all P > 0.05). The intraoperative consumption of remifentanil was significantly less in the ESPB group compared to the control group (P < 0.05). The scores of BCS and QoR-15 scale were higher in the ESPB group 24 h after surgery than those in the control group (P < 0.05). Compared to the control group, fewer patients in the ESPB group required rescue analgesia 24 h after surgery (P < 0.05). No serious complications occurred in either group.ConclusionsUltrasound-guided cervical ESPB can provide effective postoperative analgesia following arthroscopic shoulder surgery, resulting in a better postoperative recovery with fewer complications.Trial registrationChictr.org.cn identifier ChiCTR2300070731 (Date of registry: 21/04/2023, prospectively registered).

The Role of TOMM40 in Cardiovascular Mortality and Conduction Disorders: An Observational Study.

Aims: TOMM40 single nucleotide polymorphism (SNP) rs2075650 consists of allelic variation c.275-31A > G and it has been linked to Alzheimer disease, apolipoprotein and cholesterol levels and other risk factors. However, data on its role in cardiovascular disorders are lacking. The first aim of the study is to evaluate mortality according to TOMM40 genotype in a cohort of selected patients affected by advanced atherosclerosis. Second aim was to investigate the relationship between Xg and AA alleles and the presence of conduction disorders and implantation of defibrillator (ICD) or pacemaker (PM) in our cohort. Materials and Methods: We enrolled 276 patients (mean age 70.16 ± 7.96 years) affected by hemodynamic significant carotid stenosis and/or ischemia of the lower limbs of II or III stadium Fontaine. We divided the population into two groups according to the genotype (Xg and AA carriers). We evaluated several electrocardiographic and echocardiographic parameters, including heart rate, rhythm, presence of right and left bundle branch block (LBBB and RBBB), PR interval, QRS duration and morphology, QTc interval, and left ventricular ejection fraction (LVEF). We clinically followed these patients for 82.53 ± 30.02 months and we evaluated the incidence of cardiovascular events, number of deaths and PM/ICD implantations. Results: We did not find a difference in total mortality between Xg and AA carriers (16.3 % vs. 19.4%; p = 0.62). However, we found a higher mortality for fatal cardiovascular events in Xg carriers (8.2% vs. 4.4%; HR = 4.53, 95% CI 1.179-17.367; p = 0.04) with respect to AA carriers. We noted a higher percentage of LBBB in Xg carriers (10.2% vs. 3.1%, p = 0.027), which was statistically significant. Presence of right bundle branch block (RBBB) was also higher in Xg (10.2% vs. 4.4%, p = 0.10), but without reaching statistically significant difference compared to AA patients. We did not observe significant differences in heart rate, presence of sinus rhythm, number of device implantations, PR and QTc intervals, QRS duration and LVEF between the two groups. At the time of enrolment, we observed a tendency for device implant in Xg carriers at a younger age compared to AA carriers (58.50 ± 0.71 y vs. 72.14 ± 11.11 y, p = 0.10). During the follow-up, we noted no statistical difference for new device implantations in Xg respect to AA carriers (8.2% vs. 3.5%; HR = 2.384, 95% CI 0.718-7.922; p = 0.156). The tendency to implant Xg at a younger age compared to AA patients was confirmed during follow-up, but without reaching a significant difference(69.50 ± 2.89 y vs. 75.63 ± 8.35 y, p = 0.074). Finally, we pointed out that Xg carriers underwent device implantation 7.27 ± 4.43 years before AA (65.83 ± 6.11 years vs. 73.10 ± 10.39 years) and that difference reached a statistically significant difference (p = 0.049) when we considered all patients, from enrollment to follow-up. Conclusions: In our study we observed that TOMM40 Xg patients affected by advanced atherosclerosis have a higher incidence of developing fatal cardiovascular events, higher incidence of LBBB and an earlier age of PM or ICD implantations, as compared to AA carriers. Further studies will be needed to evaluate the genomic contribution of TOMM40 SNPs to cardiovascular deaths and cardiac conduction diseases.

Acute cardiovascular and muscular response to rowing ergometer exercise in artificial gravity – a pilot trial

Prolonged immobilization and spaceflight cause cardiovascular and musculoskeletal deconditioning. Combining artificial gravity through short-arm centrifugation with rowing exercise may serve as a countermeasure. We aimed to compare the tolerability, muscle force production, cardiovascular response, and power output of rowing on a short-arm centrifuge and under terrestrial gravity. Twelve rowing athletes (4 women, aged 27.2 ± 7.4 years, height 179 ± 0.1 cm, mass 73.7 ± 9.4 kg) participated in two rowing sessions, spaced at least six weeks apart. One session used a short-arm centrifuge with +0.5 Gz, while the other inclined the rowing ergometer by 26.6° to mimic centrifugal loading. Participants started self-paced rowing at 30 W, increasing by 15 W every three minutes until exhaustion. We measured rowing performance, heart rate, blood pressure, ground reaction forces, leg muscle activation, and blood lactate concentration. Rowing on the centrifuge was well-tolerated without adverse events. No significant differences in heart rate, blood pressure, or blood lactate concentration were observed between conditions. Inclined rowing under artificial gravity resulted in lower power output (−33%, p < 0.001) compared to natural gravity, but produced higher mean and peak ground reaction forces (p < 0.0001) and increased leg muscle activation. Muscle activation and ground reaction forces varied with rotational direction. Rowing in artificial gravity shows promise as a strategy against cardiovascular and muscular deconditioning during long-term spaceflight, but further investigation is required to understand its long-term effects.

Effect of remifentanil in clinical anesthesia and postoperative analgesia

Purpose: To investigate the effect of remifentanil in clinical anesthesia and postoperative intravenous analgesia. Methods: A retrospective analysis was conducted on the medical records of 100 patients who received remifentanil for anesthesia and postoperative intravenous analgesia at Zibo Center Hospital, Zibo, China from February 2020 to February 2023. The patients were divided into study and control groups comprising 50 patients in each group. The study group received remifentanil intravenously (8 g/kg) while the control group received fentanyl (3 - 4 μg/kg). Heart rate (HR), mean arterial pressure (MAP), and Bispectral Index (BIS) were monitored 5 min before anesthesia (T1), 10 min after (T2), 40 min after (T3), and 5 min before the end of surgery (T4). The levels of blood glucose (Glu), angiotensin II (Ang II), and cortisol (Cor) were measured at T1, T2, T3, and T4. Analgesic and sedative effects were evaluated 3, 12 and 24 h after surgery using the visual analog scale (VAS) and Ramsay sedation score. Results: At T1, T2, T3, and T4, there were no significant differences in HR, MAP, and BIS between the two groups (p &gt; 0.05), while the levels of Glu, Ang II, and Cor in study group were significantly lower (p &lt; 0.05). At 3, 12 and 24 h after surgery, VAS score in the study group was significantly lower, while Ramsay's analgesia score was significantly higher (p &lt; 0.05). Total effectiveness was significantly higher in the study group (p &lt; 0.05). Recovery time for orientation, spontaneous breathing, awakening, stay in the recovery room, and incidence of adverse reactions were significantly lower in study group (p &lt; 0.05). Conclusion: The use of remifentanil for postoperative intravenous analgesia significantly lowers stress response, sedation and improves recovery time. It is, therefore, effective, and produces lower adverse effects than fentanyl. Large-scale investigation to determine the impact of confounding factors on the outcome of fentanyl/remifentanil combination is required.

Increasing HCCS function in vivo mediates restoring heme integrity, limiting superoxide overproduction, and conferring reconditioning mitochondrial function in the acute postischemic heart

Background: A serious consequence of acute myocardial ischemia-reperfusion injury (I/R) is heme impairment which causes mitochondrial dysfunction, which contributes to cell death. Such acute I/R-induced mitochondrial dysfunction is characterized by impaired respiration and overproducing superoxide. The cascading ROS propagates heme damage in the array of mitochondrial electron transport chain, adding insult to myocardial injury. Mitochondrial holocytochrome c synthetase (HCCS) catalyzes attaching heme to apocytochrome c or apocytochrome c1 by forming thioether bonds. We reasoned that overexpression of HCCS would ameliorate I/R injury by stabilization of heme moieties in key mitochondrial enzymes. Methods: A mouse model with overexpression of HCCS in the myocytes (HCCS-tg) was generated and echocardiography was used to evaluate cardiac function. The HCCS-tg mouse was subjected to 30-min of coronary ligation and 24-h of reperfusion. Mitochondria were isolated from the myocardium of the risk region and assessed by OCR. The profile of heme from the cardiac mitochondria was assessed by differential UV/VIS spectral analysis. EPR spin-trapping and ubiquinol (Q2H2)-mediated cytochrome c reduction were used to assay superoxide generation by CxI (complex I) and CxIII (complex III) in mitochondria. Results: We detected gaining HCCS function in vivo (one-fold increase) marginally increases the fractional shortening of the mouse heart. There is no significant difference in heart rate and LVIDs/LVIDd between wild type control and HCCS-tg. Increasing function of HCCS in the myocytes further enhances mitochondrial function of HCCS-tg via increasing state-3 OCR, decreasing state-4 OCR, and alleviating superoxide generation by CxI (NADH-linked) and CxIII (Q2H2-linked). Increased HCCS function significantly decreases the infarct size assessed by IF/AAR and IF/LV when the mouse hearts were subjected to acute I/R injury. Overexpressing HCCS in myocytes further protected the heme integrity and the associated activity of electron transport chain in the mitochondria from acute I/R injury. Acute I/R also mediates downregulation of Cox10 and Cox15 required for mitochondrial a-type heme (heme a) biosynthesis and integrity of Cx4 (complex IV) activity, while increasing HCCS function in vivo preserves the integrity of heme a and protects the levels of Cox10, Cox15, and Cx4 activity after acute I/R injury. Conclusion: Acute I/R mediates mitochondrial heme impairment and associated mitochondrial dysfunction via impairing HCCS function and the thioether bonds of c-type heme, whereas overexpression of HCCS in the myocytes mediates protecting integrity of heme from I/R injury, limiting overproducing superoxide, and conferring reconditioning mitochondrial function in the post-ischemic heart. None. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Characterization of cardiac fibrosis in older lean vs. obese male ZSF1 rats

The ZSF1 rat is a novel strain produced by crossing a ZDF (Zucker diabetic fatty) female and SHHF (Spontaneously Hypertensive Heart Failure) male rat. Offspring of this hybrid have two phenotypes: healthy lean or obese prone to diabetes and heart failure. The metabolic syndrome and hypertension displayed by the obese ZSF1 rat mimics that seen in individuals who are predisposed to heart failure with preserved ejection fraction (HFpEF). Historically, HFpEF is a diffcult disease to accurately model with rodents and the ZSF1 rat is a promising model for the spontaneous progression to HFpEF. In recent studies, the oldest age at which ZSF1 rats were studied was 32 weeks and these obese rats displayed diastolic dysfunction, cardiac fibrosis, and hypertrophy. Since the prevalence of HFpEF increases with advanced age, the aim of the current study is to evaluate the extent of fibrosis in older ZSF1 rats (40-42 weeks) and determine whether this age group is more appropriate for the study of fibrotic cardiac remodeling related to HFpEF. We hypothesize that left ventricular (LV) fibrosis and collagen gene expression will be increased in obese compared to lean counterparts. Furthermore, we expect that the extent of fibrosis in this age group will exceed that reported in 32-week-old rats; thus, providing an improved model for the study of fibrotic heart disease. Lean and obese male ZSF1 rats (n=8/group) were aged to 40-42 weeks. Rats were anesthetized with a ketamine/xylazine cocktail and cardiac function was evaluated by invasive hemodynamics. The heart was removed, and the LV was trimmed and weighed. A mid-myocardial section from the LV was fixed and embedded in paraffn for histology. Remaining LV tissue was frozen for extraction of RNA and protein for biochemical analysis. LV collagen was assessed by Sirius red stain and collagen I ( Col1a1) and III ( Col3a1) gene expression were assessed by RTqPCR. With no significant difference in heart rate, obese ZSF1 rats had higher LV developed pressure compared to lean (191.1 vs. 122.0 mmHg, p&lt;0.05) and increased maximum and minimum dP/dT (p&lt;0.05). Obese ZSF1 rats exhibited cardiac hypertrophy as measured by LV weight normalized to tibial length (30.21 vs. 23.61 mg/mm, p&lt;0.05, n=7/group) and increased fibrosis (Sirius red) compared to lean counterparts. Furthermore, the fibrosis in obese ZSF1 rats was concentrated in the endocardial and perivascular regions, and qualitatively more than previously published in the 32-week-old ZSF1. Preliminarily, obese ZSF1 rats exhibit a 3.5-fold increase in Col1a1 (p=0.02) and a 19-fold increase in C ol3a1 (p=0.06) gene expression compared to lean (n=3/group). Interestingly, not only is this a larger increase than that reported in 32-week-old old ZSF1s, but the relative increase in Col3a1 vs. Col1a1 is larger. Taken together, these data suggest a progression of cardiac fibrosis beyond what has been reported in the 32-week-old ZSF1 rats. Use of aged ZSF1 rats may be valuable for the study of fibrogenic mediators in HFpEF for the elucidation of therapeutic agents to reduce or reverse cardiac fibrosis. Future studies will include female rats to evaluate sex-specific progression of fibrosis. North Carolina Biotechnology Center Flash Grant (JH) and ECU REDE startup program (AG). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Facilitating ambulatory heart rate variability analysis using accelerometry-based classifications of body position and self-reported sleep

Objective. This study aimed to examine differences in heart rate variability (HRV) across accelerometer-derived position, self-reported sleep, and different summary measures (sleep, 24 h HRV) in free-living settings using open-source methodology. Approach. HRV is a biomarker of autonomic activity. As it is strongly affected by factors such as physical behaviour, stress, and sleep, ambulatory HRV analysis is challenging. Beat-to-beat heart rate (HR) and accelerometry data were collected using single-lead electrocardiography and trunk- and thigh-worn accelerometers among 160 adults participating in the SCREENS trial. HR files were processed and analysed in the RHRV R package. Start time and duration spent in physical behaviours were extracted, and time and frequency analysis for each episode was performed. Differences in HRV estimates across activities were compared using linear mixed models adjusted for age and sex with subject ID as random effect. Next, repeated-measures Bland–Altman analysis was used to compare 24 h RMSSD estimates to HRV during self-reported sleep. Sensitivity analyses evaluated the accuracy of the methodology, and the approach of employing accelerometer-determined episodes to examine activity-independent HRV was described. Main results. HRV was estimated for 31 289 episodes in 160 individuals (53.1% female) at a mean age of 41.4 years. Significant differences in HR and most markers of HRV were found across positions [Mean differences RMSSD: Sitting (Reference) − Standing (−2.63 ms) or Lying (4.53 ms)]. Moreover, ambulatory HRV differed significantly across sleep status, and poor agreement between 24 h estimates compared to sleep HRV was detected. Sensitivity analyses confirmed that removing the first and last 30 s of accelerometry-determined HR episodes was an accurate strategy to account for orthostatic effects. Significance. Ambulatory HRV differed significantly across accelerometry-assigned positions and sleep. The proposed approach for free-living HRV analysis may be an effective strategy to remove confounding by physical activity when the aim is to monitor general autonomic stress.

Full spectrum cannabidiol-rich extract reduced propofol dosage required for anesthetic induction in dogs-a pilot study.

Cannabinoids show great therapeutic potential, but their effect on anesthesia still remains unclear. Use of chronic recreational Cannabis in humans undergoing anesthetic procedures tends to require a higher dose when compared to non-users. On the other hand, studies on rodents and dogs have shown that cannabinoid agonists may potentiate certain anesthetics. This contrast of effects possibly occurs due to different time lengths of administration of different phytocannabinoids at different doses, and their distinct effects on the Endocannabinoid System, which is also affected by anesthetics such as propofol and isoflurane. Twenty-seven healthy male dogs, client-owned, ranging from 1 to 7 years, and from 5 to 35 kg were selected, mean weight 15.03±7.39 kg, with owners volunteering their animals to participate in the research performed in the Federal University of Santa Catarina (UFSC). Dogs were randomized into 3 groups. The Control Group (CON, n = 9), receiving only Extra Virgin Olive Oil, the same oil-base used in the treatment groups. Group 2 (G2, n = 9) received 2 mg/kg of total phytocannabinoids, and Group 3 (G3, n = 9) received 6 mg/kg of total phytocannabinoids. All groups received their treatments transmucosally, 75 min before their induction with propofol. Heart and respiratory rate, blood pressure, temperature and sedation were evaluated prior to, and at 30, 60, and 75 min after administration of the fsCBD-rich extract or Placebo extract. Preanesthetic medication protocol was also included across all treatment groups, 15 min before induction. Parametric data was analyzed with one-way ANOVA, followed by Student-Newman-Keuls (SNK) if significant statistical differences were found. Non-parametric data was analyzed using Friedman's test, followed by Dunn test for comparisons between all timepoints in the same group. Kruskal-Wallis followed by Dunn was utilized for between groups comparisons. Propofol dose necessary for induction was analyzed through One-way ANOVA followed by Tukey's Multiple Comparisons Test, using Instat by Graphpad, and differences were considered statistically significant when p < 0.05. Our analysis assessed if statistical significance was present between time points in the same group, and between groups in the same time points. In our study, 6 mg/kg of total phytocannabinoids were able to reduce the dose of propofol necessary for induction by 23% when compared to the control group. The fsCBD-rich extract did not produce significant sedation within or between groups, although statistically significant differences in heart rate and systolic blood pressure were found. Our findings indicate that phytocannabinoids could be an adjunct option in anesthesia, although further research is necessary to better confirm this data. Additionally, further research is needed to determine the best dosage, delivery method, time for administration, ideal molecular profile for desired effects, safety, drug-drug interactions, and transurgical effects.

Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children.

Many behavior management techniques are employed to reduce the anxiety associated with dental procedures in children. One of the most commonly used methods comprises audiovisual distraction using virtual reality (VR) eyeglasses. In this study, an innovative device, a periorbital eye massager (PEM), is compared with VR to evaluate dental anxiety in children. in this study, 22 children were divided into two groups, that is, group I consisting of PEM and group II consisting of VR. The participants were instructed to wear the device and then subjected to dental restorative procedures. After completion of the procedure, anxiety was measured using a validated questionnaire by the children and by using the modified behavior pain scale by the second investigator. Also, physiological parameters like heart rate and oxygen saturation were evaluated before and after a dental procedure. The results were statistically insignificant for group I and group II when a validated questionnaire and modified behavior pain scale were used to measure the dental anxiety of children. Also, the data also shows no significant difference in heart rate and oxygen saturation between the two groups. The innovative PEM can also be used as an effective behavior management tool in managing dental anxiety in children, as there was no statistically significant difference between PEM and VR. As a pediatric dentist, the methods for administering a patient present a novel challenge because behavior management varies from patient to patient. As a result, the prospects for augmenting various techniques of behavior therapy for pediatric patients are limitless. Gala UP, Kalaskar R. Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children. Int J Clin Pediatr Dent 2024;17(1):48-53.

Delaying Suspension Syndrome Onset in Aerially Suspended Victims Through Leg Raising.

Suspension syndrome (SS) develops when venous blood pools in extremities of passively suspended individuals, resulting in presyncopal symptoms and potential unconsciousness or death independent of additional injuries. We investigated use of leg raising to delay onset of SS, as it can decrease venous pooling and increase cardiac return and systemic perfusion. Participants were suspended in rock climbing harnesses at an indoor climbing wall in a legs-dangling control position or a legs-raised interventional position to compare physiological outcomes between groups. Participants were suspended for a maximum of 45 min. Onset of 2 or more symptoms of SS, such as vertigo, lightheadedness, or nausea, halted suspension immediately. We recorded each participant's heart rate, blood pressure, oxygen saturation, lower leg oxygen saturation, pain rating, and presyncope scores presuspension, midsuspension, and postsuspension, as well as total time suspended. There were 24 participants. There was a significant difference in total time suspended between groups (43.05±6.7 min vs 33.35±9.02 min, p=0.007). There was a significant difference in heart rate between groups overall (p=0.012), and between groups, specifically at the midsuspension time interval (80±11 bpm vs 100±17 bpm, p=0.003). Pain rating was significantly different between groups (p=0.05). Differences in blood pressure, oxygen saturation, lower leg oxygen saturation, and presyncope scores were not significant. Leg raising lengthened the time individuals tolerated passive suspension and delayed symptom onset.

The effect of motor imagery and action observation on autonomic functions in patients with chronic stroke

ABSTRACT Objectives This study aimed to investigate the effects of motor imagery (MI), action observation (AO), and action execution (AE) interventions on the autonomic nervous system (ANS) in individuals with chronic stroke. Methods This was a single-center, randomized, case-control study. Thirty-six patients were randomly assigned to MI (n = 10), AO (n = 15), and the AE group (n = 11). Heart rate (HR)-based measurements (HR, heart rate variability (HRV)) and blood pressure were evaluated before the practice of each group. In the MI group, participants were instructed to imagine themselves walking at their own comfortable pace for 5 minutes. Meanwhile, in the AO group, participants were shown a video of a person walking for 5 minutes. Finally, in the AE group, participants were instructed to actually walk for 5 minutes. Then, all measurements were taken again. Results A statistically significant difference was found in HR and mean RR interval within the AE group (p < 0.05). There was a statistically significant difference in the Root Mean Square of Successive Differences Between Normal Heartbeats (RMSSD) (ms) within the AO group (p < 0.05). There was a significant difference in HR and mean RR intervals (ms) between groups (p < 0.05). According to post-hoc analyses, HR was statistically significantly higher in the AE group compared to the other groups, and the mean RR interval was statistically significantly lower (p < 0.05). Conclusions In conclusion, in patients with chronic stroke, AE and AO may affect ANS by increasing sympathetic activation. It is recommended for future studies to evaluate whether patients actually engage in imagery during the MI task.

The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study

IntroductionDue to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants.MethodsA double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants’ faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0.ResultsEighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05–91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35–96.85), (91.5 ± 1.24, 95% CI:91.12–91.87), and (93.60 ± 1.27, 95% CI:93.85–94.50).ConclusionThis study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.

Effect of Various Hydration Strategies on Work Intensity and Selected Physiological Indices in Young Male Athletes during Prolonged Physical Exercise at High Ambient Temperatures.

Background: In high temperatures, adequate hydration is vital for sustained physical exercise. This study explores the effect of three hydration strategies on physiological indices and work intensity. Methods: The research involved 12 healthy males who engaged in three test series, each separated by a one-week interval. During the trials, participants underwent a 120 min cycling session in a thermal climate chamber (temperature: 31 ± 2 °C, humidity: 60 ± 3%, air movement: <1 m/s). Measurements of rectal temperature (Tre) and heart rate (HR), and assessment of subjective workload perception, and thermal comfort were made both before and during the exercise. The computation of the physical strain index (PSI) relied on Tre and HR values. Three hydration strategies (isotonic drink, water, and no hydration) were administered before, during, and after the exercise. Results: Regardless of the hydration strategy, the participants' mean body mass decreased as a result of the exercise. Statistically significant differences in HR were observed between the no-hydration and water groups (p < 0.036). The mean PSI values significantly varied between hydration strategies, with the no hydration group exhibiting a higher PSI compared to the isotonic drink or water groups (p < 0.001). Conclusions: All hydration strategies contribute to thermoregulatory processes and mitigate the rise in internal body temperature during sustained physical exercise in elevated ambient temperatures.

Effects of isoflurane anaesthesia depth and duration on renal function measured with [99mTc]Tc-mercaptoacetyltriglycine SPECT in mice

BackgroundThe influence of anaesthetic depth and the potential influence of different anaesthetic beds and thus different handling procedures were investigated in 86 severe combined immunodeficient (SCID) mice using semi-stationary dynamic single photon emission computed tomography (SPECT) for kidney scintigraphy. Therefore, isoflurane concentrations were adjusted using respiratory rate for low (80–90 breath/min) and deep anaesthesia (40–45 breath/min). At low anaesthesia, we additionally tested the influence of single bed versus 3-mouse bed hotel; the hotel mice were anaesthetized consecutively at ~ 30, 20, and 10 min before tracer injections for positions 1, 2, and 3, respectively. Intravenous [99mTc]Tc-MAG3 injection of ~ 28 MBq was performed after SPECT start. Time-activity curves were used to calculate time-to-peak (Tmax), T50 (50% clearance) and T25 (75% clearance).ResultsLow and deep anaesthesia corresponded to median isoflurane concentrations of 1.3% and 1.5%, respectively, with no significant differences in heart rate (p = 0.74). Low anaesthesia resulted in shorter aortic blood clearance half-life (p = 0.091) and increased relative renal tracer influx rate (p = 0.018). A tendency toward earlier Tmax occurred under low anaesthesia (p = 0.063) with no differences in T50 (p = 0.40) and T25 (p = 0.24). Variance increased with deep anaesthesia. Compared to single mouse scans, hotel mice in position 1 showed a delayed Tmax, T50, and T25 (p < 0.05 each). Furthermore, hotel mice in position 1 showed delayed Tmax versus position 3, and delayed T50 and T25 versus position 2 and 3 (p < 0.05 each). No difference occurred between single bed and positions 2 (p = 1.0) and 3 (p = 1.0).ConclusionsDeep anaesthesia and prolonged low anaesthesia should be avoided during renal scintigraphy because they result in prolonged blood clearance half-life, delayed renal influx and/or later Tmax. Vice versa, low anaesthesia with high respiratory rates of 80–90 rpm and short duration (≤ 20 min) should be preferred to obtain representative data with low variance.

Liraglutide does not increase heart rate of diabetic patients during acute myocardial infarction.

Glucagon-like peptide 1 receptor agonists have been shown to reduce all-cause and cardiovascular mortality in patients with Type 2 diabetes mellitus (T2DM). The probable increase in heart rate hinders its early usage in acute myocardial infarction patients. In our study, we aimed to find out whether the use of liraglutide in patients with acute myocardial infarction as early as at the time of hospitalization would increase the heart rate. This was an observational retrospective study. From December 2020 to August 2021, 200 patients with acute myocardial infarction were included in our study and divided into three groups: T2DM + liraglutide group (n = 46), T2DM + non-liraglutide group (n = 42), and non-T2DM group (n = 112). The primary outcomes were the differences in heart rate. Secondary outcomes were differences in systolic and diastolic blood pressure. There were no significant differences in heart rate among the three groups at admission, the day before the first shot of liraglutide, and before discharge. There was also no significant difference in heart rate between diabetic patients with acute myocardial infarction and those on liraglutide during the hospital stay. And there were no differences of beta-blocker dosages among the three groups. Liraglutide did not affect the blood pressure during acute myocardial infarction. Liraglutide did not increase the heart rate in diabetic patients during acute myocardial infarction and did not lead to an increase in the dose of beta-blockers in the patients. It also had no effect on blood pressure and showed better efficacy in lowering glucose levels without additional hypoglycemic events.

Does Lake Louise questionnaire interpret high-altitude headache as acute mountain sickness? Experience in the western Himalayas.

High-altitude headache (HAH) and headache in acute mountain sickness (AMS) are common among lowlanders ascending to the high altitude and are often confused with one another. A pilot study was undertaken to analyze HAH and AMS cases in Indian lowlanders ascending to Leh city (3500 m) in western Himalayas. A total number of 1228 Indian lowlanders, who ascended (fresh and re-inductees) by air and acclimatized, participated in this pilot study. The intensity of headache was assessed by the Visual Analogue Score. The parameters of HAH as per the International Classification of Headache Disorders-3 and 2018 Revised Lake Louise Questionnaire (LLQ) were used to differentiate HAH and AMS. Out of 1228 cases, 78 (6.4%) cases had headache, of which 24 (1.95%) cases were HAH only, 40 (3.25%) cases AMS only and 14 (1.14%) cases were defined as both HAH and AMS. There was a significant difference in heart rate [F (2,51) = (4.756), P =0.01] between these groups. It also showed a difference in the correlation between the parameters within the groups. The Odd's Ratio of AMS in fresh and re-inductees was found to be 4.5 and for HAH it was 4.33. The findings of this study suggest that LLQ has a tendency of overestimating AMS by including HAH cases. Furthermore differential parameters exhibit differences when AMS and HAH are considered separately. Re-inductees showed a lower incidence of HAH and AMS.

Do you mind the role of spinal sensory block duration in a crucial endocrine disorder of diabetes mellitus? A prospective observational study.

Diabetes mellitus, per se, is a global health concern, which is often accompanied by complications such as diabetic neuropathy. This prospective observational study purposed to assess the durations of spinal sensory block and motor blocks in individuals with and without diabetes mellitus who had undergone spinal anesthesia. This study incorporated 80 cases, which were evenly divided into spinal sensory block without diabetes mellitus and spinal sensory block with diabetes mellitus. Various parameters were recorded at different time points, including heart rate, mean arterial blood pressure, SpO2, and spinal block characteristics. Notable measures included maximum spinal sensory block onset time, time to reach the 10th thoracic vertebra (T10), maximal spinal sensory block, time for Bromage scores, and block regression while controlling for age-related variations. Patients in the diabetic group exhibited extended block durations, with significant differences in heart rate noted at specific time points. Regarding the spinal block characteristics, the "maximum onset of SSB" and the "time to reach the T10" were more prolonged in the SSBwDM without significance. Maximum sensory spinal sensory block did not differ. However, some cases in the SSBwDM displayed blocks extending up to the T6. The times to achieve Bromage motor block scores 1-3 were shorter in SSBwDM and lost significance regarding age. Notably, the regression time was longer in SSBwDM, which held significance for both parameters. Diabetic cases commonly encounter prolonged block durations post-subarachnoid intervention, potentially linked to nerve sensitivity, age-related changes, and glycemic control. As such, attenuated local doses for diabetic neuropathic cases may enhance early mobilization, attenuate thromboembolic events, and expedite gastrointestinal recovery.

Comparative Evaluation of Two Different Doses of Dexmedetomidine for Intra Operative Moderate Sedation During Spinal Anesthesia

Background: Intravenous (IV) sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. Sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of sedation and hemodynamic stability.&#x0D; Objective: To compare efficacy of dexmedetomidine for intraoperative sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia.&#x0D; Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and sedation using observer’s assessment of alertness/sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test. &#x0D; Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p&gt;0.05). According to sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep.&#x0D; Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.

Safety and effectiveness of remdesivir for the treatment of COVID-19 patients with end-stage renal disease: A retrospective cohort study

BackgroundRemdesivir has been used to treat severe coronavirus 2019 (COVID-19); however, its safety and effectiveness in patients remain unclear. This study aimed to investigate the safety and effectiveness of remdesivir in patients with COVID-19 with end-stage renal disease (ESRD). MethodsThis retrospective study used the Chang Gung Research Database (CGRD) and extracted data from 21,621 adult patients with COVID-19 diagnosed between April 2021 and September 2022. The patients were divided into groups based on their remdesivir use and the presence of ESRD. The adverse effects of remdesivir and their outcomes were analyzed after propensity score matching. ResultsTo compare the adverse effects of remdesivir, propensity scores were used for one-to-one matching between patients with and without ESRD treated with remdesivir (N=110). There were no statistically significant differences in heart rates, blood glucose levels, variations in hemoglobin levels before and after remdesivir use, or liver function between the two groups after remdesivir use. A comparison was made between patients with ESRD using remdesivir and those not using remdesivir after propensity score matching (N=44). Although a shorter length of stay (LOS), lower intensive care unit (ICU) admission rate, and lower intubation rate were noted in the ESRD group treated with remdesivir, the difference was not statistically significant. ConclusionRemdesivir is safe for use in patients with COVID-19 and ESRD; no increased adverse effects were noted compared with patients without ESRD. However, the effectiveness of remdesivir use in patients with COVID-19 and ESRD remains uncertain.