Heart Rate Time Research Articles

Whole-body networks: a holistic approach for studying aging.

Aging is a multi-organ disease, yet the traditional approach has been to study each organ in isolation. Such organ-specific studies have provided invaluable information regarding its pathomechanisms. However, an overall picture of the whole-body network (WBN) during aging is still incomplete. In this study, we analyzed the functional magnetic resonance imaging blood-oxygen level-dependent, respiratory rate and heart rate time series of a young and an elderly group during eyes-open resting-state. We constructed WBNs by exploring the time-lagged coupling between the different organs. First, we showed that our analytical pipeline could identify regional differences in the networks of both cohorts, allowing us to proceed with the remaining analyses. The comparison of the WBNs revealed a complex relationship where some connections were stronger and some weaker in the elderly. Finally, the interconnectivity and segregation of the WBNs were negatively correlated with the short-term memory and verbal learning of the young participants. This study: i) validated our methodology, ii) identified differences in the WBNs of the two groups and iii) showed correlations of WBNs with behavioral measures. In conclusion, the concept of WBN shows great potential for the understanding of aging and age-related diseases.

Exploring the Effects of Sleep Deprivation on Physical Performance: An EEG Study in the Context of High-Intensity Endurance

BackgroundWhile the effects of sleep deprivation on cognitive function are well-documented, its impact on high-intensity endurance performance and underlying neural mechanisms remains underexplored, especially in the context of search and rescue operations where both physical and mental performance are essential. This study examines the neurophysiological basis of sleep deprivation on high-intensity endurance using electroencephalography (EEG). In this crossover study, twenty firefighters were subjected to both sleep deprivation (SD) and normal sleep conditions, with each participant performing endurance treadmill exercise the following morning after each condition. EEG signals were recorded before and after high-intensity endurance exercise, and power spectrum analysis and functional connectivity analysis were performed on sleep related frequency bands rhythm: δ (0.5–4 Hz) and θ (4–8 Hz). The EEG power spectral and functional connectivity were measured by repeated measure analysis of variance.ResultsThe SD condition had an average sleep duration of 3.78 ± 0.69 h, while the duration for normal sleep was 7.63 ± 0.52 h. After high-intensity endurance exercise, the SD condition had a higher maximum heart rate (p < 0.05) and shorter exercise time (p < 0.05) than normal sleep. Compared with before exercise, the δ band in the left parietal lobe P7 channel increased significantly (p < 0.01), and the θ band in the central Cz channel and the left and right parietal lobe P7 and P8 channel increased significantly (p < 0.01 & p < 0 0.05) in SD and normal sleep conditions after exercise. After exercise, compared with normal sleep, the δ band power in occipital O1 and Oz channels and parietal P7 and TP7 channels in SD significantly decreased (p < 0.05 & p < 0.01); the power of the θ band decreased significantly in the occipital O1 channel, central CZ channel and the left and right parietal P7 and P8 channel (p < 0.05 & p < 0.01). Whole connectivity showed a significant increase (p = 0.001) in the δ band for the SD condition at post-exhaustion. Local connectivity analysis identified a localized network in the δ band with reduced (p < 0.001) post-exhaustion in the SD condition displaying inter-hemispheric differences in certain connections (FP1-CP4, T7-C4, T7-TP8, and O1-FT8) and intra-hemispheric (C3-CPz and Pz-P4) variations.ConclusionsSleep deprivation significantly reduced maximum endurance performance, indicating decreased neural activity in the central and parietal brain regions. Alterations in δ and θ frequency band power, along with disrupted connectivity, may highlight the neurophysiological basis underlying this decline.

Heart Rate Variability Does Not Predict Recurrence of Apnoea of Prematurity After Ceasing Caffeine Therapy: A Prospective Cohort Study.

We evaluated whether sample entropy of heart rate time series could serve as a biomarker for guiding caffeine cessation in preterm infants treated for apnoea of prematurity (AOP). We also assessed associations of sample entropy with weeks of gestation, clinical morbidity, AOP frequency and caffeine reinitiation. We conducted a prospective single-centre study at the University Children's Hospital Basel, Switzerland, from July 2019 to June 2020. We included 61 hospitalised preterm infants born before 32 weeks of gestation. Heart rate was derived from the clinical standard monitoring system at caffeine cessation, 3 days later, and at discharge. Sample entropy was calculated from 90-min recordings using custom-written analytical software. We obtained valid data from 44/61 infants (72%) with a mean of 28.4 weeks of gestation (range: 24.0-31.7). Twenty-eight (64%) were male. Sample entropy at caffeine cessation was positively associated with weeks of gestation (R2 = 0.15, p = 0.01) and negatively with bronchopulmonary dysplasia (R2 = 0.18, p = 0.01). It did not predict AOP frequency or caffeine reinitiation. Sample entropy at caffeine cessation is associated with maturation at birth and bronchopulmonary dysplasia but does not predict AOP within 3 days of cessation. Further studies should assess longitudinal measurements to predict respiratory control in preterm infants. clinicaltrials.gov: NCT04303494.

Cerebral, Splanchnic, and Renal Transit Time Measurement and Blood Volume Estimation Using Contrast-Enhanced Ultrasonography.

We aimed to measure cerebral, splanchnic, and renal transit times and the associated blood volumes using contrast ultrasound. In healthy individuals, regional transit times were calculated from time-intensity curves generated as ultrasound contrast passed through the associated inflow and outflow vessels. These included the internal carotid artery and internal jugular vein (brain), the superior mesenteric artery and portal vein (intestines), and the renal artery and renal vein (kidney). An organ's blood volume relative to the stroke volume delivered to that organ with each cardiac cycle was calculated from the product of heart rate and transit time of contrast passage through the associated vascular bed. The fraction of systemic stroke volume received by each organ was calculated from the respective velocity-time integral and inflow vessel cross-sectional area and used to estimate absolute organ blood volume. The cohort consisted of 16 participants (age: 42 ± 13 years; 5 female) without known cerebrovascular, gastrointestinal, or renal disease. Cerebral, splanchnic, and renal transit times were obtained for 15, 14, and 8 individuals, respectively. Anatomic variability of the renal vessels confounded the acquisition of renal transit times. For all organs, transit times were reproducible and the associated blood volumes were generally comparable to reference values. Cerebral, gastrointestinal, and renal transit times/blood volumes can be reasonably acquired from contrast ultrasound, although the latter is less reliably available. Assessment of the impact on regional blood volumes of pharmacologic or other interventions is a next step toward clinical application of this technique.

Impact of structured exercise interventions on health outcomes in drug rehabilitation patients: a comparative study of open and closed exercises

Background This study investigates the effects of open and closed exercise interventions on the physical and mental health of individuals undergoing substance use disorder (SUD). We examined changes in tendency of recurrence of use, vital capacity (VC), resting heart rate (RHR), sleep quality, and choice reaction time. Methods Conducted over six months at the drug rehabilitation center, 95 participants were randomly assigned to closed exercise, open exercise, or control group. Outcome measures were taken at baseline, three months, and six months. Results Both exercise groups showed significant improvements in reduction of return-to-use risk and VC compared to baseline. Open exercise groups showed earlier significant improvements in risk of return to use at three months. No significant changes were observed in RHR. Both exercise groups showed significant improvements in sleep quality, with the open exercise group also showing significant improvements in choice reaction time. At six months, both exercise groups showed significant improvements over the control group in tendency of recurrence of use, VC, and sleep quality, with no significant differences between the exercise groups. Conclusions Both exercise interventions led to significant improvements in reducing the risk of return to substance use, VC, sleep quality, and choice reaction time, with the open exercise group showing the most pronounced effects in choice reaction time.

Abstract 4136938: Autonomous Personalized Dynamic ECG Analysis Predicts 1-hour Incidence of Sudden Cardiac Arrest

Background: Sudden cardiac arrest (SCA) is a leading cause of death in the USA. Defibrillators prevent SCA by delivering shocks for sustained ventricular tachyarrhythmias (VT). However, current clinical methods for predicting SCA are limited. We have shown that distinct nonlinear fluctuation patterns “hidden” within normal-appearing ECG waveforms have unique prognostic value. Hypothesis: Autonomous personalized dynamic ECG analysis predicts the 1-hour incidence of SCA. Methods: In an established pressure-overload model that exhibits key features of human VT and SCA (e.g., cardiac restitution properties), 30% of 37 freely ambulating animals had spontaneous SCA in 4 weeks. The exposures included a rolling 1-hour window of time, frequency and nonlinear domain measures of heart rate and QT time series during sinus rhythm, and EntropyX QT , a higher-dimensional machine learning-based nonlinear measure of cardiac repolarization dynamics. Results: In multivariate analyses, the major independent predictors of 1-hour incidence of SCA were (1) high EntropyX QT ; (2) high parasympathetic tone, as indexed by the high-frequency component of the heart rate power spectral density; and (3) the degree of coupling between RR and QT intervals. The baseline values of EntropyX QT and parasympathetic tone increased by 3.6-fold and 46.5-fold, respectively, during the hour preceding SCA. The adjusted ROC curve area was &gt; 89%. Conclusion: Continuous autonomous analysis of cardiac repolarization and autonomic dynamics strongly and independently predicts the subacute incidence of SCA. Incorporation of these measures into current strategies of SCA risk stratification has potential to save many lives and warrants further evaluation.

The metabolic and circadian signatures of gestational diabetes in the postpartum period characterised using multiple wearable devices.

Gestational diabetes mellitus (GDM) affects 14% of all pregnancies worldwide and is associated with cardiometabolic risk. We aimed to exploit high-resolution wearable device time-series data to create a fine-grained physiological characterisation of the postpartum GDM state in free-living conditions, including clinical variables, daily glucose dynamics, food and drink consumption, physical activity, sleep patterns and heart rate. In a prospective observational study, we employed continuous glucose monitors (CGMs), a smartphone food diary, triaxial accelerometers and heart rate and heart rate variability monitors over a 2 week period to compare women who had GDM in the previous pregnancy (GDM group) and women who had a pregnancy with normal glucose metabolism (non-GDM group) at 1-2 months after delivery (baseline) and 6 months later (follow-up). We integrated CGM data with ingestion events recorded with the smartphone app MyFoodRepo to quantify the rapidity of returning to preprandial glucose levels after meal consumption. We inferred the properties of the underlying 24 h rhythm in the baseline glucose. Aggregating the baseline and follow-up data in a linear mixed model, we quantified the relationships between glycaemic variables and wearable device-derived markers of circadian timing. Compared with the non-GDM group (n=15), the GDM group (n=22, including five with prediabetes defined based on fasting plasma glucose [5.6-6.9 mmol/l (100-125 mg/dl)] and/or HbA1c [39-47 mmol/mol (5.7-6.4%)]) had a higher BMI, HbA1c and mean amplitude of glycaemic excursion at baseline (all p≤0.05). Integrating CGM data and ingestion events showed that the GDM group had a slower postprandial glucose decrease (p=0.01) despite having a lower proportion of carbohydrate intake, similar mean glucose levels and a reduced amplitude of the underlying glucose 24 h rhythm (p=0.005). Differences in CGM-derived variables persisted when the five women with prediabetes were removed from the comparison. Longitudinal analysis from baseline to follow-up showed a significant increase in fasting plasma glucose across both groups. The CGM-derived metrics showed no differences from baseline to follow-up. Late circadian timing (i.e. sleep midpoint, eating midpoint and peak time of heart rate) was correlated with higher fasting plasma glucose and reduced amplitudes of the underlying glucose 24 h rhythm (all p≤0.05). We reveal GDM-related postpartum differences in glucose variability and 24 h rhythms, even among women clinically considered to be normoglycaemic. Our results provide a rationale for future interventions aimed at improving glucose variability and encouraging earlier daily behavioural patterns to mitigate the long-term cardiometabolic risk of GDM. ClinicalTrials.gov no. NCT04642534.

Variability of Loa loa microfilarial counts in successive blood smears and its potential implication in drug-related serious adverse events

BackgroundThe standard method to diagnose Loa loa infection and quantify microfilarial density (MFD) is the microscopic examination of calibrated thick blood smears (TBSs). In 1950, it was noticed that successive L. loa MFD samples from a single capillary puncture could exhibit up to 20% variation. Although loiasis treatment allocation is based on MFD to prevent serious adverse events (SAEs), data on this variability are scarce. There are also no guidelines supporting the collection and analysis of one or two TBSs.MethodsWe assessed the variability of two successive L. loa MFD samples (MFD1 and MFD2), collected from 255 patients. We analyzed the influence of sex, age, weight, heart rate, arterial pressure, body temperature, and sampling time on MFD variability, as well the impact of MFD variability on MFD thresholds relevant to loiasis treatment protocols.ResultsThe MFD2 was found to have increased in 63% (1145/1826) of TBS pairs and to have decreased in 37% (681/1826) of TBS pairs. The MFD2 were on average 28% higher than the MFD1. These variations drove a total of 333 (17.4%) changes in MFD classes according to loiasis treatment protocol, including 210 (11.3%) class increases. TBSs generated from blood samples from subjects with lower MFD (1–1000 mf/ml) or lower mean arterial pressure (MAP; 55–80 mmHg), or from blood samples collected at an earlier hour time-point (10:00–10:59 a.m.) were more subject to MFD2 variability in a multivariate analysis. The MFD relative change was not constant over time for a given person.ConclusionsWe observed a trend towards an increase in MFD2 with an important variability between samples that may impact loiasis treatment allocation. We suggest that systematically sampling at least two successive TBSs might allow better MFD assessments to prevent post-treatment SAEs. Further studies are needed to verify this variability in larger samples as well as confirm the potential explanatory variables identified.Graphical

Circadian rhythm in atrial fibrillation detected by implantable loop recorder: a post-hoc analysis of a randomized clinical trial

Abstract Introduction Previous studies suggest the existence of circadian, weekly, and seasonal rhythms in the occurrence of atrial fibrillation (AF), which may be utilized to improve the yield of screening. The heterogeneity of AF natural history also necessitates better phenotyping to overcome the challenges of identifying candidates for screening and treatment. Purpose To explore the potential circadian rhythm in AF occurrence in persons without known arrhythmia but at high risk of AF and stroke. Methods Post-hoc analysis of the LOOP study (Atrial Fibrillation Detected by Continuous Electrocardiogram Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals), which randomized 6004 AF naïve participants (≥70 years old with additional stroke risk factors) 1:3 to receive implantable loop recorder screening or usual care. All loop recorder data was extracted to obtain the date and time of AF episode onset, AF duration, mean and max heart rate (HR) during AF, and symptom annotations. New-onset AF episodes lasting ≥6 minutes were adjudicated, and all subsequent episodes were included in the analysis. Results A total of 41,713 AF episodes (median duration 18 (8-64) minutes) were identified among 430 participants (Table 1). The median number of episodes for each participant with AF was 21 (4-82) and the median AF burden was 0.17% (0.04%-0.83%) of time from debut to end of monitoring. The most and least frequent days of AF onset were Sunday (15.3%) and Friday (13.6%), respectively, while AF occurred slightly more often during spring (26%) than in other seasons. The median time of onset was 09:57:15 AM (05:15:30 AM – 03:33:00 PM). The most frequent time of onset was at 09:00 AM (rounded to the nearest hour), which was two times more likely than at 09:00 PM, and 22% of all episodes occurred between 08:00 and 11:00 AM (Figure 1). A total of 25,329 (61%) episodes occurred between midnight and noon (AM). Nocturnal episodes, defined as episodes with onset between 10:00 PM and 07:00 AM, occurred in 368 (86%) AF participants and constituted a median of 40% of all episodes and 37% (14%-63%) of each participant’s episodes. The median duration of nocturnal episodes was 28 (10-104) minutes compared to 14 (8-44) minutes for daytime episodes. The averaged heart rate during AF was 81 (71-96) beats per minute (BPM), while 330 (77%) participants had AF episodes with heart rates equal to or above 100 BPM, and the duration of these episodes was 50 (15-201) minutes compared to 30 (21-85) minutes for slower episodes (below 100 BPM). Conclusion A circadian pattern was observed for screening-detected AF. AF onset occurred predominantly between 08:00 and 11:00 AM, representing more than one in five episodes. Nocturnal AF occurred in most participants with AF and accounted for almost half of all episodes, while these episodes also lasted longer than daytime episodes. This may warrant future studies investigating the timing of AF screening.

Enhancing Sports Injury Risk Assessment in Soccer Through Machine Learning and Training Load Analysis.

Sports injuries pose significant challenges in athlete welfare and team dynamics, particularly in high-intensity sports like soccer. This study used machine learning algorithms to assess non-contact injury risk in professional male soccer players from physiological and mechanical load variables. Twenty-five professional male soccer players with a first-time, non-contact muscle injury were included in this study. Recordings of external load (speed, distance, and acceleration/deceleration data) and internal load (heart rate) were obtained during all training sessions and official matches over a 4-year period. Machine learning model training and evaluation features were calculated for each of nine different metrics for a 28-day period prior to the injury and an equal-length baseline epoch. The acute surge in the values of each workload metric was quantified by the deviation of maximum values from the average, while the variations of cumulative workload over the last four weeks preceding injury were also calculated. Seven features were selected by the model as prominent estimators of injury incidence. Three of the features concerned acute load deviations (number of sprints, training load score-incorporating heart rate and muscle load- and time of heart rate at the 90-100% of maximum). The four cumulative load features were (total distance, high speed and sprint running distance and training load score). The accuracy of the muscle injury risk assessment model was 0.78, with a sensitivity of 0.73 and specificity of 0.85. Our model achieved high performance in injury risk detection using a limited number of training load variables. The inclusion, for the first time, of heart rate related variables in an injury risk assessment model highlights the importance of physiological overload as a contributor to muscle injuries in soccer. By identifying the important parameters, coaches may prevent muscle injuries by controlling surges of training load during training and competition.

Heart rate reactivity, recovery, and endurance of the incremental shuttle walk test in patients prone to heart failure.

Few randomized trials assessed the changes over time in the chronotropic heart rate (HR) reactivity (CHR), HR recovery (HRR) and exercise endurance (EE) in response to the incremental shuttle walk test (ISWT). We addressed this issue by analysing the open HOMAGE (Heart OMics in Aging) trial. In HOMAGE, 527 patients prone to heart failure were randomized to usual treatment with or without spironolactone (25-50mg/day). The current sub-study included 113 controls and 114 patients assigned spironolactone (~70% on beta-blockers), who all completed the ISWT at baseline and at Months 1 and 9. Within-group changes over time (follow-up minus baseline) and between-group differences at each time point (spironolactone minus control) were analysed by repeated measures ANOVA, unadjusted or adjusted for sex, age and body mass index, and additionally for baseline for testing 1 and 9month data. Irrespective of randomization, the resting HR and CHR did not change from baseline to follow-up, with the exception of a small decrease in the HR immediately post-exercise (-3.11b.p.m.) in controls at Month 9. In within-group analyses, HR decline over the 5min post-exercise followed a slightly lower course at the 1month visit in controls and at the 9month visits in both groups, but not at the 1month visit in the spironolactone group. Compared with baseline, EE increased by two to three shuttles at Months 1 and 9 in the spironolactone group but remained unchanged in the control group. In the between-group analyses, irrespective of adjustment, there were no HR differences at any time point from rest up to 5min post-exercise or in EE. Subgroup analyses by sex or categorized by the medians of age, left ventricular ejection fraction or glomerular filtration rate were confirmatory. Combining baseline and Months 1 and 9 data in both treatment groups, the resting HR, CHR and HRR at 1 and 5min averaged 61.5, 20.0, 9.07 and 13.8b.p.m. and EE 48.3 shuttles. Spironolactone on top of usual treatment compared with usual treatment alone did not change resting HR, CHR, HRR and EE in response to ISWT. Beta-blockade might have concealed the effects of spironolactone. The current findings demonstrate that the ISWT, already used in a wide variety of pathological conditions, is a practical instrument to measure symptom-limited exercise capacity in patients prone to developing heart failure because of coronary heart disease.

Integrating Dynamic Time Warping and K-means clustering for enhanced cardiovascular fitness assessment

The appropriate measurement of cardiovascular ’Performance Enhancement’ is critical for improving physical fitness and overall health. Traditional methods, effective as they are, often rely on complex, cumbersome equipment, limiting their practical use for real-time, dynamic exercise evaluation. Thus, understanding the intricate relationship between physiological responses and exercise ‘Performance Enhancement’ using wearable technology is essential for tailoring effective fitness regimes. This study involved 52 participants, utilizing Garmin Vivosmart 5 wearables to analyze heart rate time series during the YMCA Three-Minute Step Test, assessing fitness levels and characterizing personalized heartbeat dynamics. The study employed Dynamic Time Warping (DTW) for clustering these time series into high and low VO2max groups. Additionally, heart rate dynamics were examined using K-means clustering to identify distinct patterns during exercise—namely ‘Efficient Adaptation’, ‘Balance Under Pressure’, ‘Active Strain’, and ‘Efficiency Improvement’ clusters. This analysis demonstrated that non-trained individuals showed higher ‘Active Strain’ and ‘Efficiency Improvement’ dynamics and lower ‘Efficient Adaptation’ dynamics, indicating the exercise’s varied effectiveness based on training level. This method provides a novel approach for identifying individual fitness levels and the efficacy of specific exercises, enabling personalized physical activity planning.

Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome

IntroductionChronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS. MethodsClinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored. ResultsThirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study. ConclusionsThe present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.

Evaluation of fecal calprotectin levels in neonatal calves with diarrhea

This study aimed to determine the levels of fecal calprotectin in calves that had diarrhea in the neonatal period. The study was carried out on a total of 52 calves, 42 with diarrhea (diarrhea group) brought to the Animal Hospital of the Faculty of Veterinary Medicine, Balikesir University, for diagnosis and treatment, and 10 healthy (control group). The diarrhea-afflicted calves ranged in age from 3 to 30 days and included a variety of races and sexes. For blood gases, hematological, and biochemical analyses, ten milliliters of blood were collected from each calf’s jugular vein. To determine the levels of calprotectin, stool samples were gathered and stored in sterile containers. The heart rate and capillary refill time (CRT) of the calves with diarrhea were significantly (P&lt;0.05) higher than the control group. The calves who had diarrhea also had increased potassium (K) and creatinine levels in addition to metabolic acidosis and hyponatremia. Furthermore, the serum albumin and oxygen saturation values of the diarrheal calves were found to be significantly lower than those of the control group. Fecal calprotectin levels were found to be significantly higher in the calves with diarrhea compared to the control group. When fecal calprotectin levels were examined in terms of etiological factors, no statistical difference was detected between the groups. Consequently, it was determined that fecal calprotectin levels in calves with diarrhea could be a potential biomarker for enteritis.

The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery

Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Results Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.

Templer's death anxiety scale on the relationship between white coat hypertension and anxiety: A cross-sectional study.

The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R2 of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.

Practical application of a heuristic model for swim coaches to optimize training

Swim coaches routinely monitor the performance and performance determining variables of their athletes to optimize training programs in an individual-specific manner with the ultimate aim to swim faster and win races. To interpret the collected data, they require a suitable, and practically useful, conceptual framework, which can be found in the power balance of swimming. For coaches a heuristic model for training and performance optimization based on the power balance has been proposed. We build on this model and illustrate how it can be employed in the training practice using data of an exemplary sub-elite swimmer (700 FINA points), which was collected continuously during two training sessions. Variables that are used in daily swim training practice, such as heart rate (HR), stroke count (SC), stroke rate (SR), and lap time (LT), were measured. By combining external load variables (e.g. LT) and internal load variables (e.g. HR) with technical variables (e.g. SR), the degree to which the swimmer complies with the training program can be determined. The measured values of these variables are presented using a traffic light feedback system indicating the degree of compliance. The traffic light system enables coaches to adjust the program if deemed necessary. It is thus shown how the model and commonly measured variables can assist swim coaches in the design and evaluation of training sessions in their pursuit of personal performance improvement leading to greater athletic success.

A 2.3-5.7 μW Tri-Modal Self-Adaptive Photoplethysmography Sensor Interface IC for Heart Rate, SpO2, and Pulse Transit Time Co-Monitoring.

This paper presents a tri-modal self-adaptive photoplethysmography (PPG) sensor interface IC for concurrently monitoring heart rate, SpO2, and pulse transit time, which is a critical intermediate parameter to derive blood pressure. By implementing a highly-reconfigurable analog front-end (AFE) architecture, flexible signal chain timing control, and flexible dual-LED drivers, this sensor interface provides wide operating space to support various PPG-sensing use cases. A heart-beat-locked-loop (HBLL) scheme is further extended to achieve time-multiplexed dual-input pulse transit time extraction based on two PPG sensors placed at fingertip and chest. A self-adaptive calibration scheme is proposed to automatically match the chip's operating point with the current use case, guaranteeing a sufficient signal-to-noise ratio for the user while consuming minimum system power. This paper proposes a DC offset cancellation (DCOC) approach comprised by a logarithmic transimpedance amplifier and an 8-bit SAR ADC, achieving a measured 38 nA residue error and 8.84 μA maximum input current. Fabricated in a 65nm CMOS process, the proposed tri-modal PPG sensor interface consumes 2.3-5.7 μW AFE power and 1.52 mm2 die area with 102dB (SpO2 mode), 110-116 dB (HR & PTT mode) dynamic range. A SpO2 test case and a HR & PTT test case are both demonstrated in the paper, achieving 18.9 μW and 43.7 μW system power, respectively.

Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis

BackgroundNasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes.MethodsFour electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17.ResultsOut of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects.ConclusionIn summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.

Clinical effects of epidurally administered lidocaine with or without dexmedetomidine in sheep

The study was designed as a randomized, prospective, blinded, clinical trial to compare the clinical effects of epidural lidocaine hydrochloride 2% (L2%) alone and in combination with dexmedetomidine (DL2%) in sheep. A total of 19 adult sheep, 14 females & 5 males were assigned to one of the two lumbosacral epidural treatments: L2% (4 mg kg –1) and DL2% (2.5 µg kg –1 + 4 mg kg –1) in a randomized order. The total volume of the drug combination was kept constant. Onset, analgesia, motor blockade, sedation and behaviour were determined before treatment, after effect of treatment and at recovery. Duration of epidural anesthesia and motor blockade were recorded. Heart rate, blood pressure, respiratory rate, rectal temperature and capillary refill time were recorded prior to treatments and every 15 minutes following epidural anesthesia for 60 minutes. Epidural anesthesia was produced with both the treatments effectively and was easily performed in all the studied animals. Both the treatments provided complete analgesia however no significant difference (p = 0.35) was recorded in onset time to analgesia. Duration of epidural anesthesia was significantly greater (p < 0.0001) with DL2% (239.56 ± 19.48 min) than L2% (69.30 ± 3.03 min). Significant extension (p < 0.0001) of motor blockade was recorded with DL2% (251.89 ± 22.18 min) than with L2% (88.30 ± 2.36 min) alone. The median analgesic scores were significantly higher in DL2% in comparison to the L2% alone. Rescue analgesia had to be given in 20% of L2% and 33.3% of DL2%.