A comprehensive review of heart rate variability as an indicator in the regulation of the autonomic nervous system by acupuncture:a bibliometric analysis

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.

COVID-19-induced gastrointestinal autonomic dysfunction:A systematic review

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.

Cardiovascular autonomic neuropathy in diabetes:Pathophysiology,clinical assessment and implications

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.

Research progress of acupuncture analgesia based on autonomic nerve regulation pathway

The autonomic nervous system(ANS)includes the sympathetic,parasympathetic,and enteric nervous systems,and its senior regulatory center includes the brainstem,cingulate gyrus,and hypothalamus.Acupuncture can affect visceral,vascular,and glandular functions via the autonomic nervous regulatory pathway.In this paper,the relationship between pain and autonomic nervous function,the application of acupuncture guided by the autonomic nervous system,and the basis and clinical research on acupuncture analgesia are reviewed.

Abnormal Systemic and Ocular Responses to the Valsalva Manoeuvre in Primary Open-Angle Glaucoma:A Case for Autonomic Failure?

Objective This study aimed to examine the association of primary open-angle glaucoma(POAG)with autonomic dysfunction by assessing the differences in systemic and ocular responses to an autonomic provocation test,the Valsalva manoeuvre(VM),between POAG patients and normal subjects.Methods Forty POAG and forty control subjects were subjected to the VM.Systemic and ocular parameters were measured at baseline,phase 2,and phase 4 of the VM(VM2 and VM4),where VM2 and VM4 are sympathetic and parasympathetic nervous activation states,respectively.Heart rate variability was used to assess the autonomic nervous activity,among which the high-frequency component(HF)and the low-frequency(LF)/HF ratio were used as indices of parasympathetic and sympathetic activation,respectively.Results POAG patients demonstrated higher sympathetic activation(LF/HF ratio median:2.17 vs.1.53,P=0.000)than controls at baseline and exhibited attenuated sympathetic and parasympathetic responses(a smaller change in LF/HF and HF values)during the VM than controls.During VM,the intraocular pressure(IOP),mean blood pressure(MAP),mean ocular perfusion pressure(MOPP),and the Schlemm’s canal area(SCAR)increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups(all P<0.05).However,when we compared the changes above,the fluctuations in IOP,MAP,and MOPP were more pronounced in POAG than in controls(all P<0.05),while the changes in amplitudes of SCAR were smaller in POAG(P<0.05).Furthermore,from VM2 to VM4,the choroid thickness(ChT)in the POAG group was significantly decreased,while it was unchanged in normal subjects(P=0.258).A regression analysis showed a significant correlation of the baseline LF/HF with IOP change values(ΔIOP)from baseline to VM2 in POAG(R^(2)=0.147,P=0.014).Conclusion Patients with POAG showed more pronounced fluctuations in IOP,MAP,MOPP and ChT during the VM than controls.These reactions could be associated with autonomic dysfunction in POAG.

Exercise Intolerance and Excessive Chronotropic Response Due to Possible Autonomic Dysfunction Post COVID-19 Infection

Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.

Characteristics of Sleep and Autonomic Activity in Active Older Adults Based on Metabolic Age: A Comparative Case Study

Background: The balance of autonomic nervous system activity and its relationship with body composition, sleep quality, and activities of daily living among older people is still unclear. Purpose: This comparative case study examined the characteristics of body composition, sleep quality, and autonomic nerve activity in active older adults with a younger body age-calculated from age trends in body composition and basal metabolic rate. Methods: We selected two cases with a metabolic age younger than their actual age. They had good sleep quality, no sarcopenia, strong muscle and grip strength, and balanced autonomic nervous system activity. They were compared with two other age- and gender-matched cases, who had poor sleep quality, unbalanced autonomic nervous system activity, and had a physical age closer to their actual age. Results: Older adults with more muscle mass and higher basal metabolism were younger than their actual age, had a better sleep status, and had a good balance of autonomic nervous activity during exercise stimulation. They also had lower percentages of body and visceral fat and higher percentages of body water. Conclusion: Two cases had a metabolic age younger than their actual age were found to be much younger than their actual age. However, the older adults with normal muscle mass and basal metabolic rate had poor sleep status and no sympathetic hyperactivity during exercise simulation.

Effects of Laparoscopic Pelvic Autonomic Nerve-Preserving Radical Resection of Rectal Cancer on Urinary and Sexual Function

Objective:To investigate and analyze the effect of laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer on urinary and sexual function.Methods:Cases of laparoscopic radical resection of rectal cancer in our hospital from April 2018 to April 2023 were selected,and 60 patients who met the requirements were included as research subjects.The patients were divided into an experimental group and a reference group by a double-blind mechanism,with 30 cases in each group.The experimental group underwent laparoscopic pelvic autonomic radical resection,while the reference group underwent ordinary radical resection.The voiding function,urodynamics,sexual function,and blood indexes of the patients of both groups were compared.Results:The total incidence of voiding dysfunction in the experimental group was significantly lower than in the reference group(P<0.05).Urodynamics such as abdominal leak point pressure(ALPP),maximum urethral pressure(MUP),maximum urethral closure pressure(MUCP),and functional urethral length(FUL)in the experimental group were significantly better than those in the reference group(P<0.05).The incidences of erectile dysfunction and ejaculatory dysfunction in the experimental group were significantly lower than those in the reference group(P<0.05).Before the surgery,there were no significant differences in the blood indexes such as C-reactive protein(CRP),cortisol(Cor),and pre-albumin(PA)between the two groups(P>0.05);after the operation,the blood indexes of the patients in the experimental group were significantly better than those in the reference group(P<0.05).Conclusion:Laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer has lesser effects on urinary and sexual functions.

Activities of autonomic neurotransmitters in meibomian gland tissues are associated with menopausal dry eye

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.

Acute Effect of Kapalbhati Yoga on Cardiac Autonomic Control Using Heart Rate Variability Analysis in Healthy Male Individuals

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.

Cardiac autonomic neuropathy in patients with diabetes mellitus

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.

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

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.

Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment

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.

Cardiac autonomic nerve fiber regeneration in chronic heart failure Do Akt gene-transduced mesenchymal stem cells promote repair?

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.

Anatomical Basis and Clinical Research of Pelvic Autonomic Nerve Preservation with Laparoscopic Radical Resection for Rectal Cancer

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.

Autonomic and endocrine control of cardiovascular function

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.

Assessment of the cardiovascular and gastrointestinal autonomic complications of diabetes

The global prevalence of diabetes mellitus is increasing; arguably as a consequence of changes in diet, lifestyle and the trend towards urbanization. Unsurprisingly, the incidence of both micro and macrovascular complications of diabetes mirrors this increasing prevalence. Amongst the complications with the highest symptom burden, yet frequently under-diagnosed and sub-optimally treated, is diabetic autonomic neuropathy, itself potentially resulting in cardiovascular autonomic neuropathy and gastrointestinal(GI) tract dysmotility. The aims of this review are fourfold. Firstly to provide an overview of the pathophysiological processes that cause diabetic autonomic neuropathy. Secondly, to discuss both the established and emerging cardiometric methods for evaluating autonomic nervous system function in vivo. Thirdly, to examine the tools for assessing pan-GI and segmental motility and finally, we will provide the reader with a summary of putative non-invasive biomarkers that provide a pathophysiological link between lowgrade neuro inflammation and diabetes, which may allow earlier diagnosis and intervention, which in future may improve patient outcomes.

Autonomic nervous system network and liver regeneration

To date, various signal transducers, cytokines, growth factors, and hormones have been reported to play an important role in homeostasis of various organs. Various cells and organs are involved in the hepatic regeneration process, which proceeds as a result of the coordination of many factors. While these factors are well known to be involved in the liver regeneration after the liver injury, however, as the details of such mechanisms have not been sufficiently elucidated, the practical applicability of hepatic regeneration based on the action of these and cytokines growth factors is still unclear. In terms of the involvement of the autonomic nervous system in hepatic regeneration, cell proliferation resulting from direct signal transduction to the liver has also been reported and recent studies focusing on the inter-organ communication via neural network opened a novel aspect of this field for therapeutic applicability. Therefore, the appropriate understanding of the relationship between autonomic neural network and liver regeneration through various organs including brain, afferent nerve, efferent nerve, etc. is essential. This mini-review explains the principle of neural system involved in the inter-organ communication and its contribution on the liver regeneration upon the liver injury reviewing recent progress in this field.

Positive effects of music therapist's selected auditory stimulation on the autonomic nervous system of patients with disorder of consciousness: a randomized controlled trial

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.

Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease

AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34),who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center "Bezanijska Kosa"with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability(HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in7.9% of controls(P < 0.001). Parameters of short-term analysis of RR variability, which are the indicators ofvagal activity, had lower values in patients with GERD than in the control group. Long-term HRV analysis of time-domain parameters indicated lower values in patients with reflux disease when compared to the control group. Power spectral analysis of long-term HRV revealed lower low- and high-frequency values.Detailed 24 h ambulatory blood pressure analysis showed significantly higher values of systolic blood pressure and pulse pressure in the reflux group than in the control group.CONCLUSION: Patients with GERD have distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.