Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac au...Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac autonomic modulation in adolescents withDMDby analyzing heart rate variability(HRV)indices in patients with and without betablockers.Methods:A cross-sectional study was conducted with 90 participants divided into three groups:(1)participants with DMD receiving beta-blocker therapy(DMDB,n=30),(2)participants with DMD without beta-blocker therapy(GMDM,n=30),and(3)age-and sex-matched typically developing participants(GDT,n=30).HRV was assessed using validated beat-to-beat heart rate monitoring(RS800CX,Polar)under controlled conditions.Linear and non-linear HRV indices(including Detrended Fluctuation Analysis and Symbolic Dynamics)were analysed using Kubios HRV software.Results:DMD patients exhibited autonomic impairment,characterized by decreased HRV,increased sympathetic dominance,and reduced parasympathetic modulation.Betablocker therapy was associated with significantly higher Mean Beat-to-beat interval(RR)and lower Mean Heart Rate(HR)compared to the non-beta-blocker DMD group,with values approaching those observed in typically developing participants.Non-linear indices suggested thatDMDpatients receiving beta-blockers demonstrated increased HRV complexity and fractal properties compared to those not receiving beta-blockers,although differences remained between the DMD and control groups.Conclusions:Autonomic dysfunction in DMD is characterized by reduced HRV and altered sympathovagal balance.In our results,beta-blocker therapy was associated with improved HRV and enhanced autonomic control.These findings highlight the potential cardioprotective role of betablockers in DMD management and emphasize the need for further research into optimizing autonomic function in DMD.展开更多
BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High...BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.展开更多
BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient populatio...BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient population.AIM To assess the impact of autonomic nerve-oriented anatomical laparoscopic surgery on recovery and postoperative risks in patients with colorectal cancer.METHODS Data from 116 patients diagnosed with colorectal cancer,treated between January 2016 and May 2024,were randomly divided into 2 groups(n=58 each)according to surgical approach:Control(radical vessel-oriented laparoscopic surgery);and Observation(autonomic nerve-oriented anatomical surgery).Perioperative in-dicators,and postoperative risk for urinary dysfunction and sexual function were compared between the 2 groups.RESULTS Compared with the control group,the observation group experienced less in-traoperative blood loss(P<0.05)and exhibited superior perioperative indicators(P<0.05).At 2 weeks and 3 months postoperatively,the proportion of patients with urinary dysfunction in the observation group was lower than that in the control group(P<0.05).Four months postoperatively,there were significant differences in male erectile dysfunction,female dyspareunia,and sexual pleasure grading between the 2 groups(P<0.05).CONCLUSION The autonomic nerve-oriented anatomical approach to laparoscopic surgery for colorectal cancer accelerates postoperative recovery,with decreased intraope-rative blood loss,lower impact on urinary and sexual functions,and enhances surgical safety.展开更多
Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehig...Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehighlights the pivotal role of autonomic nervous system(ANS)dysfunction in itsprogression and prognosis.The ANS,comprising sympathetic and parasympatheticbranches,exerts significant control over cardiac function,including heartrate,contractility,and vascular tone.In CHF,sympathetic overactivation coupledwith parasympathetic withdrawal contributes to adverse cardiac remodeling,arrhythmogenesis,and further deterioration of cardiac performance.This minireviewsummarizes current knowledge on the role of autonomic dysfunction inCHF and heart transplantation.It focuses on how sympathetic nervous systemimbalance contributes to CHF progression and explores the impact of autonomicdysregulation on post-transplant outcomes.By synthesizing existing evidence,thereview highlights ANS modulation as a key therapeutic target for improvingcardiac function and patient prognosis in both clinical settings.展开更多
Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activi...Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activity and mood associated with backpacks in mountaineering and hiking, research is also needed from a psychological perspective. In this study, the effects of adjusting the backpack shoulder stabilizer were preliminarily tested in terms of subjective fatigue and changes in autonomic nervous activity after hiking. Methods: The experimental 15 healthy participants hiked the mountain under two conditions: 1) without adjusting the stabilizer, a feature of the backpack (NAH condition), and 2) with the stabilizer adjusted (AH condition). First, all participants hiked the mountain in the NAH condition, and after a 30-minute break, they began the hike in the AH condition after confirming that a) their heart rate had recovered and b) they were in good physical condition. Results: HR was significantly lower after each hiking session than during the session. RMSSD was significantly lower pre-AH and post-AH than the NAH condition, but there was no significant difference between the NAH condition and either post-NAH or post-AH. Additionally, RMSSD was significantly lower in the AH condition than pre-AH or post-AH. The shoulders and back were significantly more burdened in the NAH condition than in the AH condition. The pleasure level was significantly higher in the AH condition than in the NAH condition. Conclusion: The results showed that also adjusting the position of the waist belt when adjusting the shoulder stabilizer, which is mainly used for the neck and shoulders, has a significant positive effect on the subjective burden on the upper body and parasympathetic nervous system activity after hiking.展开更多
Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular compli...Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.展开更多
This study sought to conduct a bibliometric analysis of acupuncture studies focusing on heart rate variability(HRV)and to investigate the correlation between various acupoints and their effects on HRV by utilizing ass...This study sought to conduct a bibliometric analysis of acupuncture studies focusing on heart rate variability(HRV)and to investigate the correlation between various acupoints and their effects on HRV by utilizing association rule mining and network analysis.A total of 536 publications on the topic of acupuncture studies based on HRV.The disease keyword analysis revealed that HRV-related acupuncture studies were mainly related to pain,inflammation,emotional disorders,gastrointestinal function,and hypertension.A separate analysis was conducted on acupuncture prescriptions,and Neiguan(PC6)and Zusanli(ST36)were the most frequently used acupoints.The core acupoints for HRV regulation were identified as PC6,ST36,Shenmen(HT7),Hegu(LI4),Sanyinjiao(SP6),Jianshi(PC5),Taichong(LR3),Quchi(LI11),Guanyuan(CV4),Baihui(GV20),and Taixi(KI3).Additionally,the research encompassed 46 reports on acupuncture animal experiments conducted on HRV,with ST36 being the most frequently utilized acupoint.The research presented in this study offers valuable insights into the global research trend and hotspots in acupuncture-based HRV studies,as well as identifying frequently used combinations of acupoints.The findings may be helpful for further research in this field and provide valuable information about the potential use of acupuncture for improving HRV in both humans and animals.展开更多
BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus diseas...BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.展开更多
The secretory activities of meibomian glands are regulated by the autonomic nervous system, The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pat...The secretory activities of meibomian glands are regulated by the autonomic nervous system, The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pathogenesis of dry eye. In view of this, we established a dry eye rat model by removing the bilateral ovaries. We used neuropeptide Y and vasoactive intestinal polypeptide as markers of autonomic neurotransmitters. Our results showed that the concentration of estradiol in serum significantly decreased, the density of neuropeptide Y immunoreactivity in nerve fibers significantly increased, the density of vasoactive intestinal polypeptide immunoreactivity in nerve fibers significantly decreased, and the ratio of vasoactive intestinal polypeptide/neuropeptide Y positive staining significantly decreased. These results suggest that a decrease in ovary activity may lead to autonomic nervous system dysfunction, thereby affecting the secretory activity of the meibomian gland, which participates in sexual hormone imbalance-induced dry eye.展开更多
Kapalbhati is well known for improving cardiovascular health.But there are some reports of heart attacks while practising kapalbhati.We hypothesize that ill-effect of kapalbhati could be because of autonomic dysfuncti...Kapalbhati is well known for improving cardiovascular health.But there are some reports of heart attacks while practising kapalbhati.We hypothesize that ill-effect of kapalbhati could be because of autonomic dysfunction to heart.In the present study,we aim to understand the acute effect of kapalbhati yoga on heart rate dynamics using heart rate variability(HRV)analysis.Resting heart rate(HR)varies widely in different individuals and during various physiological stresses,particularly,exercise it can go up to three-fold.These changes in heart rate are known as heart rate variability(HRV).Variability in heart rate reflects the control of autonomic system on the heart and which can be determined during brief periods of electrocardiographic(ECG)monitoring.HRV measures the effect of any physical exercise on the heart rate using time-and frequency-domain methods.Frequency-domain method involves power spectral analyses of the beat-to-beat intervals(R-R intervals)variability data.When total power vs.frequency,fast fourier transform analysis of R-R intervals data is done,it shows three well-defined peaks/rhythms in every individual,which contain different physiological information.Thus,the total spectral power of R-R intervals data can be divided into three components or bands viz.,the very low frequency(VLF)band,the low-frequency(LF)band and the high frequency(HF)band.VLF represent very long time-period physiological phenomenon like thermoregulation,circadian rhythms etc.and thus are not seen in short-term recordings like in this work.LF band power represents long period physiological rhythms in the frequency range of 0.05-0.15 Hz and LF band power increases as a consequence of sympathetic activation.HF band represent physiological rhythms in the frequency range of 0.15-0.5 Hz and they are synchronous with the respiration rate,and arise due to the intrathoracic pressure changes and mechanical vibrations caused by the breathing activity.In this work,twenty healthy male volunteers were trained in kapalbhati yoga and their ECG waveforms(2 min.)were obtained while doing kapalbhati(breathing at 1 Hz frequency for 2 min.)and were compared with the baseline(just 2 min.before the start)and post-kapalbhati(immediately 2 min.after completing the practice)HRV data.Our results showed a significant decrease in the time-domain measures i.e.,NN50,pNN50 and the mean heart rate interval during-kapalbhati when compared statistically to the respective before practice or“pre”-kapalbhati(p<0.05,student’s paired t-test)values.Frequency-domain indices showed that during-kapalbhati there is a significant increase(~48%)in the LF band power which suggests sympathetic activation and a significant increase(~88%)in the low frequency to the high frequency power ratio(LF/HF ratio)which indicates sympathetic system predominance.A significant decrease(~63%)in the HF component was also noted during-kapalbhati as compared to the“pre-kapalbhati”values which shows decrease in parasympathetic tone.Thus,these results suggest that during-kapalbhati there is drastic increase of sympathetic tone whereas parasympathetic activity is reduced.We propose these changes in autonomic system control on heart are responsible for the myocardial ischemic attacks induced during kapalbhati in some individuals.展开更多
Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and invol...Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.展开更多
Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of thi...Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescription of prostacyclin analogues,thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na^+,K^+-ATPase(phosphodiesterase inhibitor),ALA,dihomo-γ-linolenic acid(DGLA),ω-3 polyunsaturated fatty acids(ω-3 PUFAs),and the simultaneous prescription of ALA,ω-3 PUFAs and DGLA,but the future investigations are needed.Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological,in the foreground midodrine and fludrocortisone acetate,treatment methods are necessary.展开更多
Cardiac autonomic neuropathy(CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate...Cardiac autonomic neuropathy(CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction anddilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability(the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.展开更多
Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests use...Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.展开更多
BACKGROUND： Transplantation of Akt-over-expressing mesenchymal stem ceils （Akt-MSCs） has been shown to repair infarcted myocardium and improve cardiac function. However, little is known about the therapeutic effect...BACKGROUND： Transplantation of Akt-over-expressing mesenchymal stem ceils （Akt-MSCs） has been shown to repair infarcted myocardium and improve cardiac function. However, little is known about the therapeutic effects of Akt-MSCs on cardiac autonomic neuropathy in chronic heart failure （CHF）. OBJECTIVE： The present study used adriamycin-induced CHF rat models to observe the effect of Akt-MSCs on cardiac autonomic nervous regeneration and the factors mediating this effect. DESIGN, TIME AND SETTING： A randomized, controlled animal experiment was performed at the Central Laboratory of Basic Medical College, China Medical University, between September 2008 and April 2009. MATERIALS： Rabbit anti-choline acetyltransferase （CHAT）, growth associated protein-43 （GAP-43） synaptophysin （SYN） polyclonal antibodies and the secondary antibody （goat anti-rabbit IgG） were purchased from Boster, China. Cat-A-Kit assay system was provided by Amersham, USA. METHODS： （1） Adult rat MSCs were isolated and cultured for the preparation of Akt-MSCs. （2） Forty male Wistar rats were intramyocardially administered adriamycin at 2 mg/kg over 3 days for a total of five times and once a week for additional five times thereafter to establish CHF models. At 2 weeks after final adriamycin treatment, 34 successful CHF rat models were randomized to three groups： Akt-MSCs （n = 11）, simple MSCs （s-MSCs, n =11）, and control （n = 12）. Each group was intravenously administered Akt-MSCs （2x106 cells in 100 IJL PBS）, s-MSCs （2×10^6 cells in 100 μL PBS） or equal volume of phosphate buffered saline, once a day for a total of three times. MAIN OUTCOME MEASURES： At 4 weeks after final adriamycin treatment, myocardial norepinephrine （NE） content was detected using a Cat-A-Kit assay system. Myocardial CHAT, SYN and GAP-43 were performed by immunohistochemistry and Western blot analysis. Prior to, 2 and 4 weeks after adriamycin treatment, echocardiographic examination was performed and left ventricular ejection fraction （LVEF） was determined. RESULTS： Myocardial NE content, as well as SYN-positive and GAP-43-positive nerve fiber density and expression, and LVEF, was the greatest in the Akt-MSCs group, followed by the s-MSCs group, and lastly the control group （P 〈 0.05 or P 〈 0.01）. ChAT expression was similar between Akt-MSCs and s-MSCs groups, but it was higher compared with the control group （P 〈 0.05）. NE contents were negatively correlated to LVEF （r = -0.64, P = 0.015）. CONCLUSION： Transplantation of MSCs, in particular Akt-MSCs, promotes cardiac nervous regeneration in failing heart, which might be mediated by GAP-43.展开更多
The influence of b-cell function on cardiovascular autonomic neuropathy(CAN), an important diabetesrelated complication, is still unclear. In this study, we aimed to investigate the association between residual b-cell...The influence of b-cell function on cardiovascular autonomic neuropathy(CAN), an important diabetesrelated complication, is still unclear. In this study, we aimed to investigate the association between residual b-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN? group(diabetic patients with CAN, n = 20) and a CAN-group(diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured.Homeostasis model assessment-beta cells(HOMA-B) and HOMA-insulin resistance(IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN-group, the CAN? group had significantly lower fasting plasma insulin(6.60 ± 4.39 vs 10.45 ± 7.82 l/L, P = 0.029), fasting C-peptide(0.51 ± 0.20 vs0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B(21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio(r = 0.24, P = 0.043) and the 30:15 test(r = 0.26,P = 0.023). Further analysis showed that fasting C-peptide(OR: 0.041, 95% CI 0.003–0.501, P = 0.012) and HOMAB(OR: 0.965, 95% CI 0.934–0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values \ 0.67 nmol/L were more likely to have CAN than those with C-peptide levels C0.67 nmol/L(OR:6.00, 95% CI 1.815–19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased b-cell function was closely associated with CAN in this population.展开更多
The function of the heart is to contract and pump oxygenated blood to the body and deoxygenated blood to the lungs.To achieve this goal,a normal human heart must beat regularly and continuously for one's entire li...The function of the heart is to contract and pump oxygenated blood to the body and deoxygenated blood to the lungs.To achieve this goal,a normal human heart must beat regularly and continuously for one's entire life.Heartbeats originate from the rhythmic pacing discharge from the sinoatrial(SA) node within the heart itself.In the absence of extrinsic neural or hormonal influences,the SA node pacing rate would be about 100 beats per minute.Heart rate and cardiac output,however,must vary in response to the needs of the body's cells for oxygen and nutrients under varying conditions.In order to respond rapidly to the changing requirements of the body's tissues,the heart rate and contractility are regulated by the nervous system,hormones,and other factors.Here we review how the cardiovascular system is controlled and influenced by not only a unique intrinsic system,but is also heavily influenced by the autonomic nervous system as well as the endocrine system.展开更多
The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation（PANP） was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male p...The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation（PANP） was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation（PANP） from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients（18.37%） presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients（21.82%） in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed（P〉0.05）. It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.展开更多
Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common p...Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common presentation of syncope, and its diagnostic criteria include:(1) absence of any other evident etiology for syncope or presyncope,(2) positive response to head-up tilt test with evident vasovagal reaction (hypotension and/or bradycardia), and (3) no concomitant chronic or acute disease [1, 2]. The onset of VVS peaks initially in childhood and adolescence, and accounts for 60%–70% of all syncopal cases. Clinicians pay great attention to syncope among children and adolescents, due to its high prevalence and its impact on patients’ quality of life. Affected individuals often experience mental stress, economic burdens, and accidental bodily injuries related to syncope [2]. While the pathogenesis of VVS is not fully understood, autonomic nervous dysfunction has been identified as a contributing mechanism. The examination of autonomic nervous function can provide important information about patients with syncope.展开更多
The current randomized controlled trial was performed at the China Rehabilitation Science Institute, China to test the hypothesis that musical auditory stimulation has positive effects on the autonomic nervous system ...The current randomized controlled trial was performed at the China Rehabilitation Science Institute, China to test the hypothesis that musical auditory stimulation has positive effects on the autonomic nervous system of patients with disorder of consciousness.Although past studies have recommended that patients with disorder of consciousness listen to patient-preferred music, this practice is not universally accepted by researchers.Twenty patients with severe disorder of consciousness listened to either therapist-selected(n = 10, 6 males and 4 females;43.33 ± 18.76 years old) or patient-preferred(n = 10, 5 males and 5 females, 48.83 ± 18.79 years old) musical therapy, 30 minutes/day, 5 times/week for 6 weeks.The results showed no obvious differences in heart rate variability-related parameters including heart rate, standard deviation of normal-to-normal R-R intervals, and the root-mean-square of successive heartbeat interval differences of successive heartbeat intervals between the two groups of patients.However, percentage of differences exceeding 50 ms between adjacent normal number of intervals, low-frequency power/high-frequency power, high-frequency power norm, low-frequency power norm, and total power were higher in patients receiving therapist-selected music than in patients receiving their own preferred music.In contrast, this relationship was reversed for the high-frequency power and very-low-frequency band.These results suggest that compared with preferred musical stimulation, therapist-selected musical stimulation resulted in higher interactive activity of the autonomic nervous system.Therefore, therapist-selected musical stimulation should be used to arouse the autonomic nervous system of patients with disorder of consciousness.This study was approved by the Institutional Ethics Committee of China Rehabilitation Research Center, China(approval No.2018-022-1) on March 12, 2018 and registered with the Chinese Clinical Trial Registry(registration number Chi CTR1800017809) on August 15, 2018.展开更多
文摘Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac autonomic modulation in adolescents withDMDby analyzing heart rate variability(HRV)indices in patients with and without betablockers.Methods:A cross-sectional study was conducted with 90 participants divided into three groups:(1)participants with DMD receiving beta-blocker therapy(DMDB,n=30),(2)participants with DMD without beta-blocker therapy(GMDM,n=30),and(3)age-and sex-matched typically developing participants(GDT,n=30).HRV was assessed using validated beat-to-beat heart rate monitoring(RS800CX,Polar)under controlled conditions.Linear and non-linear HRV indices(including Detrended Fluctuation Analysis and Symbolic Dynamics)were analysed using Kubios HRV software.Results:DMD patients exhibited autonomic impairment,characterized by decreased HRV,increased sympathetic dominance,and reduced parasympathetic modulation.Betablocker therapy was associated with significantly higher Mean Beat-to-beat interval(RR)and lower Mean Heart Rate(HR)compared to the non-beta-blocker DMD group,with values approaching those observed in typically developing participants.Non-linear indices suggested thatDMDpatients receiving beta-blockers demonstrated increased HRV complexity and fractal properties compared to those not receiving beta-blockers,although differences remained between the DMD and control groups.Conclusions:Autonomic dysfunction in DMD is characterized by reduced HRV and altered sympathovagal balance.In our results,beta-blocker therapy was associated with improved HRV and enhanced autonomic control.These findings highlight the potential cardioprotective role of betablockers in DMD management and emphasize the need for further research into optimizing autonomic function in DMD.
文摘BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.
文摘BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient population.AIM To assess the impact of autonomic nerve-oriented anatomical laparoscopic surgery on recovery and postoperative risks in patients with colorectal cancer.METHODS Data from 116 patients diagnosed with colorectal cancer,treated between January 2016 and May 2024,were randomly divided into 2 groups(n=58 each)according to surgical approach:Control(radical vessel-oriented laparoscopic surgery);and Observation(autonomic nerve-oriented anatomical surgery).Perioperative in-dicators,and postoperative risk for urinary dysfunction and sexual function were compared between the 2 groups.RESULTS Compared with the control group,the observation group experienced less in-traoperative blood loss(P<0.05)and exhibited superior perioperative indicators(P<0.05).At 2 weeks and 3 months postoperatively,the proportion of patients with urinary dysfunction in the observation group was lower than that in the control group(P<0.05).Four months postoperatively,there were significant differences in male erectile dysfunction,female dyspareunia,and sexual pleasure grading between the 2 groups(P<0.05).CONCLUSION The autonomic nerve-oriented anatomical approach to laparoscopic surgery for colorectal cancer accelerates postoperative recovery,with decreased intraope-rative blood loss,lower impact on urinary and sexual functions,and enhances surgical safety.
基金Supported by National Key Research and Development Program of China,No.2022YFC3500704Youth Talent Support Project of China Association of Acupuncture-Moxibustion,No.2024-2026ZGZJXH-QNRC005。
文摘Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehighlights the pivotal role of autonomic nervous system(ANS)dysfunction in itsprogression and prognosis.The ANS,comprising sympathetic and parasympatheticbranches,exerts significant control over cardiac function,including heartrate,contractility,and vascular tone.In CHF,sympathetic overactivation coupledwith parasympathetic withdrawal contributes to adverse cardiac remodeling,arrhythmogenesis,and further deterioration of cardiac performance.This minireviewsummarizes current knowledge on the role of autonomic dysfunction inCHF and heart transplantation.It focuses on how sympathetic nervous systemimbalance contributes to CHF progression and explores the impact of autonomicdysregulation on post-transplant outcomes.By synthesizing existing evidence,thereview highlights ANS modulation as a key therapeutic target for improvingcardiac function and patient prognosis in both clinical settings.
文摘Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activity and mood associated with backpacks in mountaineering and hiking, research is also needed from a psychological perspective. In this study, the effects of adjusting the backpack shoulder stabilizer were preliminarily tested in terms of subjective fatigue and changes in autonomic nervous activity after hiking. Methods: The experimental 15 healthy participants hiked the mountain under two conditions: 1) without adjusting the stabilizer, a feature of the backpack (NAH condition), and 2) with the stabilizer adjusted (AH condition). First, all participants hiked the mountain in the NAH condition, and after a 30-minute break, they began the hike in the AH condition after confirming that a) their heart rate had recovered and b) they were in good physical condition. Results: HR was significantly lower after each hiking session than during the session. RMSSD was significantly lower pre-AH and post-AH than the NAH condition, but there was no significant difference between the NAH condition and either post-NAH or post-AH. Additionally, RMSSD was significantly lower in the AH condition than pre-AH or post-AH. The shoulders and back were significantly more burdened in the NAH condition than in the AH condition. The pleasure level was significantly higher in the AH condition than in the NAH condition. Conclusion: The results showed that also adjusting the position of the waist belt when adjusting the shoulder stabilizer, which is mainly used for the neck and shoulders, has a significant positive effect on the subjective burden on the upper body and parasympathetic nervous system activity after hiking.
文摘Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.
基金supported by the Natural Science Foundation of Sichuan Province(2023NSFSC1799)the Science and Technology Development Fund of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine(21ZS05,23YY07)Chengdu University of Traditional Chinese Medicine Xinglin Scholar Postdoctoral Program BSH2023010.
文摘This study sought to conduct a bibliometric analysis of acupuncture studies focusing on heart rate variability(HRV)and to investigate the correlation between various acupoints and their effects on HRV by utilizing association rule mining and network analysis.A total of 536 publications on the topic of acupuncture studies based on HRV.The disease keyword analysis revealed that HRV-related acupuncture studies were mainly related to pain,inflammation,emotional disorders,gastrointestinal function,and hypertension.A separate analysis was conducted on acupuncture prescriptions,and Neiguan(PC6)and Zusanli(ST36)were the most frequently used acupoints.The core acupoints for HRV regulation were identified as PC6,ST36,Shenmen(HT7),Hegu(LI4),Sanyinjiao(SP6),Jianshi(PC5),Taichong(LR3),Quchi(LI11),Guanyuan(CV4),Baihui(GV20),and Taixi(KI3).Additionally,the research encompassed 46 reports on acupuncture animal experiments conducted on HRV,with ST36 being the most frequently utilized acupoint.The research presented in this study offers valuable insights into the global research trend and hotspots in acupuncture-based HRV studies,as well as identifying frequently used combinations of acupoints.The findings may be helpful for further research in this field and provide valuable information about the potential use of acupuncture for improving HRV in both humans and animals.
文摘BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.
基金supported by the Key Technology Research & Development Program of Hebei Province,No.10276105D-3the Key Project of Hebei Province Health Department of Medical Science,No.20120154the Key Technology Research & Development Program of Hebei Province Handan City,No.1023108101-2
文摘The secretory activities of meibomian glands are regulated by the autonomic nervous system, The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pathogenesis of dry eye. In view of this, we established a dry eye rat model by removing the bilateral ovaries. We used neuropeptide Y and vasoactive intestinal polypeptide as markers of autonomic neurotransmitters. Our results showed that the concentration of estradiol in serum significantly decreased, the density of neuropeptide Y immunoreactivity in nerve fibers significantly increased, the density of vasoactive intestinal polypeptide immunoreactivity in nerve fibers significantly decreased, and the ratio of vasoactive intestinal polypeptide/neuropeptide Y positive staining significantly decreased. These results suggest that a decrease in ovary activity may lead to autonomic nervous system dysfunction, thereby affecting the secretory activity of the meibomian gland, which participates in sexual hormone imbalance-induced dry eye.
文摘Kapalbhati is well known for improving cardiovascular health.But there are some reports of heart attacks while practising kapalbhati.We hypothesize that ill-effect of kapalbhati could be because of autonomic dysfunction to heart.In the present study,we aim to understand the acute effect of kapalbhati yoga on heart rate dynamics using heart rate variability(HRV)analysis.Resting heart rate(HR)varies widely in different individuals and during various physiological stresses,particularly,exercise it can go up to three-fold.These changes in heart rate are known as heart rate variability(HRV).Variability in heart rate reflects the control of autonomic system on the heart and which can be determined during brief periods of electrocardiographic(ECG)monitoring.HRV measures the effect of any physical exercise on the heart rate using time-and frequency-domain methods.Frequency-domain method involves power spectral analyses of the beat-to-beat intervals(R-R intervals)variability data.When total power vs.frequency,fast fourier transform analysis of R-R intervals data is done,it shows three well-defined peaks/rhythms in every individual,which contain different physiological information.Thus,the total spectral power of R-R intervals data can be divided into three components or bands viz.,the very low frequency(VLF)band,the low-frequency(LF)band and the high frequency(HF)band.VLF represent very long time-period physiological phenomenon like thermoregulation,circadian rhythms etc.and thus are not seen in short-term recordings like in this work.LF band power represents long period physiological rhythms in the frequency range of 0.05-0.15 Hz and LF band power increases as a consequence of sympathetic activation.HF band represent physiological rhythms in the frequency range of 0.15-0.5 Hz and they are synchronous with the respiration rate,and arise due to the intrathoracic pressure changes and mechanical vibrations caused by the breathing activity.In this work,twenty healthy male volunteers were trained in kapalbhati yoga and their ECG waveforms(2 min.)were obtained while doing kapalbhati(breathing at 1 Hz frequency for 2 min.)and were compared with the baseline(just 2 min.before the start)and post-kapalbhati(immediately 2 min.after completing the practice)HRV data.Our results showed a significant decrease in the time-domain measures i.e.,NN50,pNN50 and the mean heart rate interval during-kapalbhati when compared statistically to the respective before practice or“pre”-kapalbhati(p<0.05,student’s paired t-test)values.Frequency-domain indices showed that during-kapalbhati there is a significant increase(~48%)in the LF band power which suggests sympathetic activation and a significant increase(~88%)in the low frequency to the high frequency power ratio(LF/HF ratio)which indicates sympathetic system predominance.A significant decrease(~63%)in the HF component was also noted during-kapalbhati as compared to the“pre-kapalbhati”values which shows decrease in parasympathetic tone.Thus,these results suggest that during-kapalbhati there is drastic increase of sympathetic tone whereas parasympathetic activity is reduced.We propose these changes in autonomic system control on heart are responsible for the myocardial ischemic attacks induced during kapalbhati in some individuals.
文摘Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.
文摘Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescription of prostacyclin analogues,thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na^+,K^+-ATPase(phosphodiesterase inhibitor),ALA,dihomo-γ-linolenic acid(DGLA),ω-3 polyunsaturated fatty acids(ω-3 PUFAs),and the simultaneous prescription of ALA,ω-3 PUFAs and DGLA,but the future investigations are needed.Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological,in the foreground midodrine and fludrocortisone acetate,treatment methods are necessary.
文摘Cardiac autonomic neuropathy(CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction anddilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability(the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.
基金supported partly by grants from the National Institutes of Health,USA(NS081740 and NS082184)
文摘Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.
基金Scientific Research Program of Higher Education Institute in Liaoning Province, No. 2008S248
文摘BACKGROUND： Transplantation of Akt-over-expressing mesenchymal stem ceils （Akt-MSCs） has been shown to repair infarcted myocardium and improve cardiac function. However, little is known about the therapeutic effects of Akt-MSCs on cardiac autonomic neuropathy in chronic heart failure （CHF）. OBJECTIVE： The present study used adriamycin-induced CHF rat models to observe the effect of Akt-MSCs on cardiac autonomic nervous regeneration and the factors mediating this effect. DESIGN, TIME AND SETTING： A randomized, controlled animal experiment was performed at the Central Laboratory of Basic Medical College, China Medical University, between September 2008 and April 2009. MATERIALS： Rabbit anti-choline acetyltransferase （CHAT）, growth associated protein-43 （GAP-43） synaptophysin （SYN） polyclonal antibodies and the secondary antibody （goat anti-rabbit IgG） were purchased from Boster, China. Cat-A-Kit assay system was provided by Amersham, USA. METHODS： （1） Adult rat MSCs were isolated and cultured for the preparation of Akt-MSCs. （2） Forty male Wistar rats were intramyocardially administered adriamycin at 2 mg/kg over 3 days for a total of five times and once a week for additional five times thereafter to establish CHF models. At 2 weeks after final adriamycin treatment, 34 successful CHF rat models were randomized to three groups： Akt-MSCs （n = 11）, simple MSCs （s-MSCs, n =11）, and control （n = 12）. Each group was intravenously administered Akt-MSCs （2x106 cells in 100 IJL PBS）, s-MSCs （2×10^6 cells in 100 μL PBS） or equal volume of phosphate buffered saline, once a day for a total of three times. MAIN OUTCOME MEASURES： At 4 weeks after final adriamycin treatment, myocardial norepinephrine （NE） content was detected using a Cat-A-Kit assay system. Myocardial CHAT, SYN and GAP-43 were performed by immunohistochemistry and Western blot analysis. Prior to, 2 and 4 weeks after adriamycin treatment, echocardiographic examination was performed and left ventricular ejection fraction （LVEF） was determined. RESULTS： Myocardial NE content, as well as SYN-positive and GAP-43-positive nerve fiber density and expression, and LVEF, was the greatest in the Akt-MSCs group, followed by the s-MSCs group, and lastly the control group （P 〈 0.05 or P 〈 0.01）. ChAT expression was similar between Akt-MSCs and s-MSCs groups, but it was higher compared with the control group （P 〈 0.05）. NE contents were negatively correlated to LVEF （r = -0.64, P = 0.015）. CONCLUSION： Transplantation of MSCs, in particular Akt-MSCs, promotes cardiac nervous regeneration in failing heart, which might be mediated by GAP-43.
基金supported by the Medical Scientific Research Foundation of Guangdong Province of China(A2018286)the Key Projects of Clinical Disciplines of Hospitals Affiliated to Ministry of Health from Ministry of Health of China(A1781)
文摘The influence of b-cell function on cardiovascular autonomic neuropathy(CAN), an important diabetesrelated complication, is still unclear. In this study, we aimed to investigate the association between residual b-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN? group(diabetic patients with CAN, n = 20) and a CAN-group(diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured.Homeostasis model assessment-beta cells(HOMA-B) and HOMA-insulin resistance(IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN-group, the CAN? group had significantly lower fasting plasma insulin(6.60 ± 4.39 vs 10.45 ± 7.82 l/L, P = 0.029), fasting C-peptide(0.51 ± 0.20 vs0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B(21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio(r = 0.24, P = 0.043) and the 30:15 test(r = 0.26,P = 0.023). Further analysis showed that fasting C-peptide(OR: 0.041, 95% CI 0.003–0.501, P = 0.012) and HOMAB(OR: 0.965, 95% CI 0.934–0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values \ 0.67 nmol/L were more likely to have CAN than those with C-peptide levels C0.67 nmol/L(OR:6.00, 95% CI 1.815–19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased b-cell function was closely associated with CAN in this population.
文摘The function of the heart is to contract and pump oxygenated blood to the body and deoxygenated blood to the lungs.To achieve this goal,a normal human heart must beat regularly and continuously for one's entire life.Heartbeats originate from the rhythmic pacing discharge from the sinoatrial(SA) node within the heart itself.In the absence of extrinsic neural or hormonal influences,the SA node pacing rate would be about 100 beats per minute.Heart rate and cardiac output,however,must vary in response to the needs of the body's cells for oxygen and nutrients under varying conditions.In order to respond rapidly to the changing requirements of the body's tissues,the heart rate and contractility are regulated by the nervous system,hormones,and other factors.Here we review how the cardiovascular system is controlled and influenced by not only a unique intrinsic system,but is also heavily influenced by the autonomic nervous system as well as the endocrine system.
文摘The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation（PANP） was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation（PANP） from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients（18.37%） presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients（21.82%） in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed（P〉0.05）. It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.
基金supported by the Science and Technology Program of Beijing Municipality, China (Z171100001017253)Peking University Clinical Scientist Program, China (BMU2019LCKXJ001)
文摘Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common presentation of syncope, and its diagnostic criteria include:(1) absence of any other evident etiology for syncope or presyncope,(2) positive response to head-up tilt test with evident vasovagal reaction (hypotension and/or bradycardia), and (3) no concomitant chronic or acute disease [1, 2]. The onset of VVS peaks initially in childhood and adolescence, and accounts for 60%–70% of all syncopal cases. Clinicians pay great attention to syncope among children and adolescents, due to its high prevalence and its impact on patients’ quality of life. Affected individuals often experience mental stress, economic burdens, and accidental bodily injuries related to syncope [2]. While the pathogenesis of VVS is not fully understood, autonomic nervous dysfunction has been identified as a contributing mechanism. The examination of autonomic nervous function can provide important information about patients with syncope.
基金supported by the Beijing Science and Technology Project Foundation of China, No.Z181100001718066(to HTL)。
文摘The current randomized controlled trial was performed at the China Rehabilitation Science Institute, China to test the hypothesis that musical auditory stimulation has positive effects on the autonomic nervous system of patients with disorder of consciousness.Although past studies have recommended that patients with disorder of consciousness listen to patient-preferred music, this practice is not universally accepted by researchers.Twenty patients with severe disorder of consciousness listened to either therapist-selected(n = 10, 6 males and 4 females;43.33 ± 18.76 years old) or patient-preferred(n = 10, 5 males and 5 females, 48.83 ± 18.79 years old) musical therapy, 30 minutes/day, 5 times/week for 6 weeks.The results showed no obvious differences in heart rate variability-related parameters including heart rate, standard deviation of normal-to-normal R-R intervals, and the root-mean-square of successive heartbeat interval differences of successive heartbeat intervals between the two groups of patients.However, percentage of differences exceeding 50 ms between adjacent normal number of intervals, low-frequency power/high-frequency power, high-frequency power norm, low-frequency power norm, and total power were higher in patients receiving therapist-selected music than in patients receiving their own preferred music.In contrast, this relationship was reversed for the high-frequency power and very-low-frequency band.These results suggest that compared with preferred musical stimulation, therapist-selected musical stimulation resulted in higher interactive activity of the autonomic nervous system.Therefore, therapist-selected musical stimulation should be used to arouse the autonomic nervous system of patients with disorder of consciousness.This study was approved by the Institutional Ethics Committee of China Rehabilitation Research Center, China(approval No.2018-022-1) on March 12, 2018 and registered with the Chinese Clinical Trial Registry(registration number Chi CTR1800017809) on August 15, 2018.
