Stimulation Of Sympathetic Nervous System Research Articles

POPDC1 Variants Cause Atrioventricular Node Dysfunction and Arrhythmogenic Changes in Cardiac Electrophysiology and Intracellular Calcium Handling in Zebrafish.

Popeye domain-containing (POPDC) proteins selectively bind cAMP and mediate cellular responses to sympathetic nervous system (SNS) stimulation. The first discovered human genetic variant (POPDC1S201F) is associated with atrioventricular (AV) block, which is exacerbated by increased SNS activity. Zebrafish carrying the homologous mutation (popdc1S191F) display a similar phenotype to humans. To investigate the impact of POPDC1 dysfunction on cardiac electrophysiology and intracellular calcium handling, homozygous popdc1S191F and popdc1 knock-out (popdc1KO) zebrafish larvae and adult isolated popdc1S191F hearts were studied by functional fluorescent analysis. It was found that in popdc1S191F and popdc1KO larvae, heart rate (HR), AV delay, action potential (AP) and calcium transient (CaT) upstroke speed, and AP duration were less than in wild-type larvae, whereas CaT duration was greater. SNS stress by β-adrenergic receptor stimulation with isoproterenol increased HR, lengthened AV delay, slowed AP and CaT upstroke speed, and shortened AP and CaT duration, yet did not result in arrhythmias. In adult popdc1S191F zebrafish hearts, there was a higher incidence of AV block, slower AP upstroke speed, and longer AP duration compared to wild-type hearts, with no differences in CaT. SNS stress increased AV delay and led to further AV block in popdc1S191F hearts while decreasing AP and CaT duration. Overall, we have revealed that arrhythmogenic effects of POPDC1 dysfunction on cardiac electrophysiology and intracellular calcium handling in zebrafish are varied, but already present in early development, and that AV node dysfunction may underlie SNS-induced arrhythmogenesis associated with popdc1 mutation in adults.

Correlation between blood pressure response to sub maximal exercise and left ventricular hypertrophy

There is currently no consensus on the definition of normal BP (blood pressure) increase during physical activity and thus of the exaggerated BP response to exercise. A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully explained. Endothelial dysfunction and increased afterload contribute to development of HRE. From neurohormonal aspects. Studies showed that excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE [1]. However, evidences for efficacy and outcomes of treatment of HRE to submaximal exertion in individuals without hypertension or low grade hypertension is scarce and therefore warrants further studies. Presents small cohort of patients a total of 38 women and 46 men, aged 52±8 years, without evidence of cardiovascular disease, with a mean resting BP of 142±7/75±7mmHg had their BP measured at rest and during submaximal treadmill exercise. LV mass was measured using trans thoracic echocardiography. For the majority of the subjects on the initial evaluation we discovered echocardiographic evidence of concentric hypertrophy. Among the resting and exercise BP indices, sub maximal SBP was the strongest correlate of LV mass (r=0.40, P<0.04). In multivariate analysis, maximal SBP was independently as-sociated with LV mass an concentric LV hypertrophy, after adjustment for lean body mass and gender. Subaximal exercise SBP is a modest but still independent predictor of LV remodeling (grade and type of LV geometry) in population with prehypertension, I and II grade hypertension. These results raise the possibility that the SBP response to sub maximal exercise is an early marker of developing LV hypertrophy.

Effect of oral melatonin and oral clonidine premedication on attenuation of hemodynamic response to direct laryngoscopy and tracheal intubation: A randomized controlled trial

Background and aimsDirect laryngoscopy and endotracheal intubation act as powerful noxious stimuli causing stimulation of sympathetic nervous system. Hence the present study intended to evaluate and compare the role of oral melatonin and clonidine as premedication in attenuation of this hemodynamic response. MethodsA Prospective, randomized, double blinded, placebo-controlled study. A total of 120 participants, ASAI/II, belonging to age group 18–60 years, were selected in study, equally divided into three groups: Group M (Melatonin 6 mg), Group C (Clonidine 0.2 mg), and Group P (Placebo). The drugs were given 60 min prior to induction of general anesthesia. Vital parameters like HR, SBP, DBP, MAP, and RPP (rate pressure product) were recorded before study drug administration (baseline), 30 min after drug administration, before induction, before intubation, immediately after intubation (0 min); 1, 2, 3, 5, and 10 min after intubation. P value < 0.05 was considered significant. ResultsA total of 115 participants were included in the study, out of which 35 were in Group M, 40 in Group C, and 40 in Group P. 21(18.3 %) were males and 94(81.7 %) were females. The mean values were much lower in Group M and Group C as compared to Group P terms of HR, SBP, DBP, and RPP at the following timepoints: before intubation, 0,1,2,3,5,10 min after intubation (p < 0.05). ConclusionBoth oral melatonin and clonidine are excellent drugs as premedication for attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation. Also, there is much lesser need for intraoperative rescue propofol doses and antihypertensives.

Targeting adrenergic receptors to mitigate invariant natural killer T cells-induced acute liver injury

Invariant Natural Killer T (iNKT) cell activation by α-galactosylceramide (αGC) potentiates cytotoxic immune responses against tumors. However, αGC-induced liver injury is a limiting factor for iNKT-based immunotherapy. Although adrenergic receptor stimulation is an important immunosuppressive signal that curbs tissue damage induced by inflammation, its effect on the antitumor activity of invariant Natural Killer T (iNKT) cells remains unclear. We use mouse models and pharmacological tools to show that the stimulation of the sympathetic nervous system (SNS) inhibits αGC-induced liver injury without impairing iNKT cells' antitumoral functions. Mechanistically, SNS stimulation prevents the collateral effect of TNF-α production by iNKT cells and neutrophil accumulation in hepatic parenchyma. Our results suggest that the modulation of the adrenergic signaling can be a complementary approach to αGC-based immunotherapy to mitigate iNKT-induced liver injury without compromising its antitumoral activity.

The role of postprandial thermogenesis in the development of impaired glucose tolerance and type II diabetes.

Accounting for 5%-15% of total daily energy expenditure, postprandial thermogenesis (PPT) refers to an acute increase in resting metabolic rate (RMR) in the hours after eating. This is largely explained by the energy costs of processing the macronutrients of a meal. Most individuals spend the majority of the day in the postprandial state, thus over one's lifetime even minor differences in PPT may possess true clinical significance. In contrast to RMR, research indicates that PPT may be reduced in the development of both prediabetes and type II diabetes (T2D). The present analysis of existing literature has found that this impairment may be exaggerated in hyperinsulinemic-euglycemic clamp studies compared with food and beverage consumption studies. Nonetheless, it is estimated that daily PPT following carbohydrate consumption alone is approximately 150 kJ lower among individuals with T2D. This estimate fails to consider protein intake, which is notably more thermogenic than carbohydrate intake (20%-30% vs. 5%-8%, respectively). Putatively, dysglycemic individuals may lack the insulin sensitivity required to divert glucose toward storage-a more energy-taxing pathway. Accordingly, the majority of findings has associated an impaired PPT with a reduced "obligatory" energy output (i.e., the energy costs associated with nutrient processing). More recently, it has been reported that "facultative" thermogenesis [e.g., the energy costs associated with sympathetic nervous system (SNS) stimulation] may also contribute to any impairment in PPT among individuals with prediabetes and T2D. Further longitudinal research is required to truly ascertain whether meaningful changes in PPT manifest in the prediabetic state, before the development of T2D.

Beta-Adrenergic stimulation is necessary but not sufficient to promote CIH-induced Multiple Myeloma progression

Multiple myeloma (MM), a terminal cancer of bone marrow plasma cells, affects about 35,000 people yearly, and kills 13,000. The KaLwRij mouse model spontaneously develops pre-malignant myeloma disease (MGUS) and is receptive to myeloma development. In the C57BL/6 mouse model, chronic intermittent hypoxia allows lethal engraftment of malignant myeloma cells. Our central hypothesis is that myeloma susceptibility in both models is modulated by the sympathetic nervous system and beta-adrenergic receptor activation. 8 - week old C57BL/6 female mice were exposed to either propranolol, isoproterenol, or saline for 6 weeks. At week 2, mice were injected with either 5TGM1/GFP+ (MM) cells or saline. Heart rate and heart rate variability were collected using MouseOx and LabChart Pro to monitor expected drug effects. All animals were monitored for terminal paralysis. Bone marrow and spleen cells were harvested for qPCR analysis to quantify 5TGM1 cell proliferation. C57BL/6 mice did not have decreased survival when treated with isoproterenol, but propranolol was protective against CIH-induced MM susceptibility. Propranolol did not increase survival in KalwRij mice. In order for Multiple Myeloma to progress in the CIH mouse model, β2-adrenergic receptor activation is required but is not sufficient. This experiment can be used to understand the role of sympathetic nervous system stimulation and its contribution to MM engraftment and growth. Supported by NIH 1R56HL152365. This is the full abstract presented at the American Physiology Summit 2023 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.

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review.

POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.

Video-assisted thoracoscopic sympathectomy for Harlequin syndrome.

Harlequin syndrome is an exceedingly rare condition, characterized by unilateral facial flushing and hyperhidrosis. Postulated to be dysregulated sympathetic nervous system stimulation of the dermal vasculature and blood vessels of the face. There is no clear unifying pathological cause. Due to its heterogeneity and rarity, very little is known about the treatment of it. Hereafter, we describe our experience in successfully curing right-sided Harlequin syndrome through video-assisted thoracoscopic sympathectomy.

Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort.

ObjectivesPatients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders.MethodsWe examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase.ResultsWe found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR −3.20 ± 1.30 ms, p = 0.026; RMSSD: −3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (−0.04 ± 0.17 μS, p = 0.019) and EDR (−0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001).ConclusionOur data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.

A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotracheal intubation than PLMA insertion. The elevation in theseResults: hemodynamic parameters signicantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic response produced when PLMA was used forConclusion: securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.

Difference of Anxiety Subscale and Depression Score in Methamphetamine Abuse Prior and after Abstinence Over the Course of Three Weeks in Rehabilitation Center of Medan Plus

BACKGROUND: Clinical effect of amphetamine is related to the release of central monoamine in such a long period of time which leads to enhanced stimulation of sympathetic nervous system. Abstinence is defined as a period of restraint in which no substance is used. Anxiety and depression are most common psychiatry problem related to methamphetamine usage that has to be addressed in rehabilitation effort of methamphetamine abuse. AIM: This study is to investigate the difference of anxiety subscale and depression (hospital anxiety and depression scale [HADS]) in methamphetamine abuse prior and after abstinence over the course of 3 weeks in rehabilitation center of Medan Plus. METHODS: This quasi-experimental study was conducted with pre- and post-test design. Sample used in this research was generated through consecutive sampling, part of non-probability sampling, in which 30 subjects that are individuals with methamphetamine abuse were recruited in Rehabilitation Centre of Medan Plus, North Sumatera. Measurement was conducted to assist the effect of 3 weeks abstinence on HADS core. In the other hand, assessment smoking and substance involvement screening test was also used to investigate the length of substance usage. RESULTS: Our study found a significant difference between anxiety and depression symptoms score prior and after 3 weeks abstinence in methamphetamine user (p &lt; 0.001). CONCLUSION: Following abstinence, several clinical symptoms were seen to be resolved or decreased within the first couple of weeks, including symptoms of anxiety and depression.

Role of Black Salt to Reduce in Hypertension, Reality and Evidence Based Studies

Salt in diet is very important to make our life healthy and energetic. Quantity and quality of salt with appropriate ratio or balance in electrolytes which are responsible for volume of body, blood velocity, for functions of receptors and enzymes, to prevent inflammation, proliferation and to make balance in muscles contraction and nerve conduction through to avoid high stimulation of sympathetic nervous system. Hence, scanning and focus with monitoring and supply of healthy salt in limits may prevent volume overload, renal dysfunction &amp; left ventricular hypertrophy, to prevent cardiac functions, to avoid the weaken gut immunity and also to prevent cerebral oedema, cerebral aneurysm and hypertension cause stroke. Control of salt with intake of low quantity and high quality with more frequency of intervals during 24 hours in required amount of salt in balanced electrolytes may help to avoid high salt sensitivity. Balanced salt intake is also important to avoid volume expansion and obesity with reduction of insulin resistance leads to prevent hypertension and diabetes which are leading risk factors for cardio-renal syndrome, cardiovascular morbidity and mortality. Our data suggested a 2.5-fold higher risk for high blood pressure in sea or white salt users versus black salt or Himalayan rock salt which showed more potassium and magnesium with low sodium ions as compared to sea salt.

“Hemodynamic Changes Between Endotracheal Intubation And Laryngeal Mask Airway Insertion”

Introduction: Haemodynamic stability is an important aspect to the anaesthesiologist for the benefit of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. Airway management is a crucial skill for the clinical anesthesiologist. Objective: To evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material and Methods: This was prospective observational study conducted in Dept. Of Anesthesiology, 250 Bedded Shaheed Shaikh Abu Naser Specialized Hospital, Khulna, Bangladesh from July to December 2020. This was a prospective observational study on 52 patients of ASA I-II status divided into 2 groups of 26 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no significant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classification. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically significant. P&lt;0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: In conclusion the demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is significantly greater than that caused by LMA insertion.

Sex features of cutaneous microvasculature in healthy working-age people

Aim. To study sex characteristics of cutaneous microvascular structure and function in a cohort of healthy working-age people without cardiovascular diseases.Material and methods. The study included 35 healthy men (42±4 years) and 34 women (41 ±5 years). The cardiovascular system was assessed in all patients. The microcirculatory bed of the skin was investigated by the following non-invasive methods: 1) computerized video capillaroscopy; 2) laser Doppler flowmetry; 3) photoplethysmography.Results. According to computerized video capillaroscopy in men, compared with women, there was a smaller number of both functioning capillaries (78 vs 86 capillaries/mm2, respectively (p&lt;0,05)) and their total number (100 vs 120 capillaries/mm2, respectively (p&lt;0,001)). Against the background of a decrease in capillary density in men, there was a higher skin interstitial hydration — 113 vs 96 gm (p&lt;0,005) in men than in women. At the level of precapillary arterioles, where humoral tone regulation prevails. Laser Doppler flowmetry revealed lower pulse amplitude in men than in women — 0,87 vs 1,02 pf, respectively (p&lt;0,05), which indicates a lower arterial blood inflow to exchange microvessels. Against this background, the constrictor response of precapillary arterioles to a sympathetic nervous system stimulation in men is higher than in women — 45% vs 40%, respectively (p&lt;0,05). At the level of large arterioles, where neural tone regulation prevails, photoplethysmography revealed lower augmentation index standardized at a heart rate in men (-4,6 vs 1,7%, respectively, p&lt;0,05), which indicates lower rigidity of muscular vessels in men.Conclusion. In working-age healthy people, sex differences are noted at all cutaneous microvascular levels, which must be taken into account when planning studies.

Correlations between sympathetic nervous system activity and smoking, as well as unattended blood pressure in essential hypertension

Abstract Background/Introduction It is a well-known fact that the sympathetic nervous system is involved with the pathophysiology of hypertension. Smoking, which is one of the most significant risk factors for cardiovascular morbidity and mortality, also contributes to the development of hypertension mainly through the stimulation of the sympathetic nervous system. Moreover, measurement of unattended blood pressure (BP) may provide additional information compared to conventionally attended BP. Purpose The aim of this study was to demonstrate the impact of smoking on sympathetic nervous system stimulation, and on BP measurement variations with and without medical supervision. Methods We studied patients with essential hypertension, who were separated into two groups, depending on their smoking habits (Group I: non-smokers, Group II: smokers). In all participants, sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted with the same device, on the same day of MSNA recording, in random order. Then, we compared the two BP measurement values of each patient to assess which of the two was higher. Results Ninety-two consecutive patients (58±11 years, 50 males) were evaluated. Smokers (n=19) did not differ as regards 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index when compared to non-smokers (n=73). However, higher levels of MSNA were recorded to smokers (73.16±13.42 vs. 61.04±18.10 bursts per 100 heartbeats, p&amp;lt;0.01). Furthermore, higher percentage of smokers recorded to have unattended BP values higher than attended (73.7% vs. 47.9% of them respectively, p=0.045). In particular, in smokers unattended BP was higher than attended by 10.07±6.7 mmHg, while in non-smokers unattended BP was lower than attended by 6.6±7.14 mmHg. No correlation was found between the MSNA and the differences observed in the two values resulting from the two different measurements of BP, maybe due to the small size of the sample. Conclusions Cigarette smoking is accompanied with higher sympathetic nervous system activation. Moreover, smokers exhibit higher unattended blood pressure values than normal measurements. The emerging hypothesis is that the stimulation of the sympathetic system causes this difference in measurements. A larger sample of patients is needed to fully determine the clinical significance of the above observation. Funding Acknowledgement Type of funding sources: None.

Sleep quality and associated factors among patients with chronic illness at South Wollo Zone Public Hospitals, Northeast Ethiopia

Background: Pathological and nighttime sleep deprivations have substantial adverse effects on regulation of weight, sugar and blood pressure because of endothelial dysfunction, sympathetic nervous system stimulation, regulation and activation of systemic inflammation. Thus, this study was aimed to assess quality of sleep among patients with chronic illness and its associated factors at South Wollo Zone Public Hospitals, Northeast Ethiopia. Methods and Materials: The study was conducted at South Wollo Zone Public Hospitals, Northeast Ethiopia from February 15 2019 till April 15 2019. Institutional based cross sectional study design was employed. All patients with chronic illness who are on follow up in South Wollo Zone Public Hospitals were sources of population. Sample size was calculated by using EPI info version 7 and the total sample size was 344. The study employed stratified random sampling technique and study participants were selected by systematic sampling. After taking ethical approval from College of Medicine and Health Sciences Ethical Approval Committee, permission from selected Hospitals and informed verbal consent from patients, the data were collected by a tool which has 3 parts: Sociodemographic data, Pittsburgh Sleep Quality Index and factors affecting sleep quality. Data were entered in to Epi data version 4.1 and exported to Statistical Package for Service Product 25 for analysis. Different data presentation tools and binary logistic regression were enrolled by considering 95% confidence level and p value of 0.05. Result: Among the total study participants, near to one third (31.7%) of them got sleep after 30 minutes. More than one fourth of them slept for less than 7 hours. Less than half of the study participants had habitual sleep efficiency of more than 85% however 296(86%) of them did not face day time dysfunction Conclusion and recommendations: more than one third of patients with chronic illness had poor sleep quality. One third of study participants had sleep duration of less than the recommendations(less than 7 hours). Age, educational status, residence, and perception of prognosis of disease were factors that have associations with poor sleep quality among patients with chronic illness. Health care providers who are doing in chronic illness follow up clinic should be initiated to assess and screen those patients with poor sleep quality.

English

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P &lt; 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol

Identification of PACAP-Expressing Neurons in the Hypothalamic Origins of Sympathetic Outflow Tracts Terminating in Brown Adipose Tissue of Mice

Abstract Adaptive thermogenesis in brown adipose tissue is stimulated by the sympathetic nervous system (SNS) in response to cold stress. Using retrograde viral transneuronal tract tracers, previous studies have identified that the paraventricular nucleus (PVN), ventromedial hypothalamus (VMH), and median preoptic nucleus (MnPO) contain neurons that are part of sympathetic outflow tracts to brown adipose tissue, presumptively involved in SNS stimulation of interscapular brown adipose tissue (iBAT). Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) is a peptide hormone known to regulate energy homeostasis, acting in both the central (CNS) and peripheral nervous system (PNS). Mice lacking PACAP have impaired adrenergic-induced thermogenesis and a cold-sensitive phenotype. In the CNS, PACAP is highly expressed in the VMH, MnPO, and PVN of the hypothalamus. Injection of PACAP into the VMN increased core body temperature and sympathetic nerve activity to brown adipose tissue. While these studies show exogenous PACAP can activate sympathetic outflow tracts to brown adipose tissue, they do not confirm that endogenously expressed PACAP induces sympathetic nerve activity as an adaptive mechanism to cold stress, or if sympathetic outflow tracts originating in the hypothalamus express PACAP. We hypothesize that PACAP is expressed in neurons of sympathetic outflow tracts originating in the hypothalamus. To test this hypothesis, PACAP-eGFP transgenic mice were injected with the retrograde neural tracer, pseudorabies virus tagged with β-galactosidase (β-gal, PRV-BaBlu), in iBAT where postganglionic nerves innervate the tissue. Five-days post-infection, animals were culled, brains removed and cryosectioned. Neurons positive for green fluorescent protein (eGFP) and/or β-gal immunoreactivity (ir) were identified by immunohistochemistry in serial coronal and sagittal brain cryo-sections. Co-occurrence of eGFP-ir and β-gal-ir, inferred PACAP expressing neurons present in sympathetic outflow tracts (ImageJ). Co-occurrence was identified in several structures in the hypothalamus and thalamus. In conclusion, this study presents neuroanatomical evidence for populations of PACAPinergic neurons in the hypothalamus that are part of sympathetic outflow tracts to brown adipose tissue, providing further evidence of a central role for PACAP in regulating energy homeostasis.

Influence of a Patent Foramen Ovale on Heart Rate‐Core Temperature Relationship at Rest and During Exercise in Young, Healthy Men

During both passive and active heat stress, there is a relationship between increases in core temperature (Tcore) and the heart rate (HR) response. As Tcore rises, HR increases as a result of sympathetic nervous system stimulation and due to the direct effects of temperature on the sinoatrial node. Young, healthy men with a patent foramen ovale (PFO+) have a higher Tcore at rest and during exercise so they may have altered thermoregulatory (Tcore) and cardiovascular (HR) coupling compared to those without a PFO (PFO-). We aimed to test two hypotheses: 1) That there is a relationship between inter-individual values for HR and Tcore at rest and during exercise and 2) The presence of a PFO alters the HR-Tcore inter-individual relationship at rest and during exercise. Thirty male subjects free of cardiometabolic and respiratory diseases (ages 19-36) participated in the study (15 PFO+/15 PFO-) and performed a graded exercise protocol that included cycling at exercise intensities of 50% (154 ± 22 W) and 90% (277 ± 40 W) of VO2max. HR and Tcore (esophageal probe) were measured at rest and continuously during the exercise test. Linear regression analyses were performed to determine the relationships between Tcore and HR at rest and at 50% and 90% of VO2max as a main group and in both PFO- and PFO+ subgroups. Absolute workload was not different at 50% and 90% VO2max between PFO+ and PFO- groups (p > 0.05). A positive relationship between Tcore and HR was seen at rest (r = 0.45, p < 0.05), 50% (r = 0.50, p < 0.05), and 90% (r = 0.44, p < 0.05) VO2max for combined group data. PFO+ subjects had higher resting HR (66 ± 8 vs 58 ± 9 bpm, p < 0.05) and Tcore (36.67 ± 0.23 vs 36.41 ± 0.28°C, p < 0.05) vs PFO- subjects; no group differences were seen during exercise (p > 0.05 for both intensities). A positive relationship existed between individual values for resting Tcore and HR in PFO+ (r = 0.66, p < 0.05) but not in PFO- subjects. In PFO+ subjects, there was no relationship between the two variables during exercise. In PFO- subjects, there was a positive relationship between Tcore and HR at 50% (r = 0.65, p < 0.05) and 90% (r = 0.54, p < 0.05) VO2max. Our data are consistent with the idea that there are differences in thermoregulatory and/or cardiovascular coupling between PFO+ and PFO- subjects at rest and during exercise. A possible explanation is that PFO+ subjects may have higher levels of inflammatory markers (interleukins, TNFα, etc), leading to elevated core temperatures at rest, thus contributing to the greater variability in the HR-Tcore responses during exercise.

Assessment of effect of propofol and ketamine in electroconvulsive therapy anesthesia

Background: Ketamine is in clinical use since 1970. It is a unique intravenous (IV) anesthetic that produces a wide spectrum of pharmacological effects including sedation, catalepsy, somatic analgesia, bronchodilation, and sympathetic nervous system stimulation. Materials and Methods: The present study was conducted in the Department of Anesthesiology of MGM Medical College, Navi Mumbai. 100 patients who were scheduled for ECT treatment were enrolled. The study population was randomly assigned to receive one of three anesthetic agents (Ketamine, Propofol, or Ketofol). After premedication with intravenous atropine sulfate (0.25 mg), propofol (10 mg/ml), ketamine (10 mg/ml), or ketofol was administered slowly (20 mg/10 s) until the patient no longer responded to his/her name being called loudly and showed loss of the eyelash reflex. Results: We found that both ketamine and Ketofol have an increased mean seizure duration compared to propofol.Conclusion:We found that both Ketamine and Ketofol have an increased mean seizure duration compared to propofol.