Association between Depression, Pressure Pain Sensitivity, Stress and Autonomous Nervous System Function in Stable Ischemic Heart Disease: Impact of Beta-Adrenergic Receptor Blockade

Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a tilt table test (TTT). Beta-blocker treatment reduces the efferent beta-adrenergic ANS function, and thus, the physiological stress response. Objective: To test the effect of beta-blockers on changes in depression score in patients with IHD, as well as the influence on persistent stress and ANS dysfunction. Methods: Three months of non-pharmacological intervention aiming at reducing PPS and depression score in patients with stable IHD. Beta-blocker users (N = 102) were compared with non-users (N = 75), with respect to signs of depression measured by the Major Depressive Inventory questionnaire (MDI), resting PPS, and PPS and SBP response to TTT. Results: MDI score decreased 30% in non-users (p = 0.005) compared to 4% (p > 0.1) among users (between-group p = 0.003;effect size = 0.4). Resting PPS decreased in both the groups. Among most vulnerable patients with MDI ≥ 15, reductions in MDI score and resting PPS score correlated in non-users, only (r = 0.69, p = 0.007). Reduction in resting PPS correlated with an increase in PPS and SBP response to TTT. Conclusions: Stress intervention in patients with IHD was anti-depressive in non-users, only. Similarly, the association between the reduction in depression, reduction in persistent stress, and restoration of ANS dysfunction was only seen in non-users, suggesting a central role of beta-adrenergic receptors in the association between these factors.

Heart rate variability and the influence of craniosacral therapy on autonomous nervous system regulation in persons with subjective discomforts:a pilot study

BACKGROUND： Subjective discomforts in a preclinical range are often due to imbalanced autonomic nervous system activity, which is a focus of craniosacral therapy. OBJECTIVE： The aim of this work was to determine any changes in heart rate variability （HRV） in a study on craniosacral therapy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a quasi-experimental （controlled） study with cross-over design. In a private practice, measurements were performed on 31 patients with subjective discomforts before and after a control and an intervention period. HRV was determined using a device that requires a measuring time of 140 s and electrode contact only with the fingertips. Main PRIMARY OUTCOME MEASURES： HRV change under the influence of a defined onetime intervention （test intervention） with craniosacral therapy versus control （defined rest period）. RESULTS： Standard deviation of all RR-intervals （ms） and total power of RR-interval variability in the frequency range （ms2） were together interpreted as an indicator of test subjects＇ autonomic nervous activity and as a measure of their ability to cope with demands on their health. Neither of these parameters increased during the control period （P〉0.05）, whereas during the test intervention period there was an increase in both （P〈0.05, P〈0.01）. Nevertheless, interactions between treatment and the increase were statistically not significant （P〉0.05）. No changes were observed in the low frequency/high frequency ratio （sympathetic-vagal balance） in the course of the control or the test intervention period （P〉0.05）. CONCLUSION： Craniosacral treatment had a favourable effect on autonomic nervous activity. This in itself is an interesting result, but further research will be needed to distinguish specific effects of craniosacral therapy technique from less specific therapist-client interaction effects.

Sympathetic nervous system activation and heart failure:Current state of evidence and the pathophysiology in the light of novel biomarkers

Heart failure(HF)is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues.The sympathetic nervous system(SNS)is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes,circulating and neuronal catecholamine spillover,attenuated parasympathetic response,and augmented sympathetic outflow to the heart,kidneys and skeletal muscles.When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis,maladaptive ventricular and vascular remodeling,arrhythmogenesis,and poor prognosis in patients with HF.These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities.Therefore,this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF.Finally,special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.

Relationship between autonomic nervous system function and acute mountain sickness

Objective: To elucidate the role of the autonomic nervous system (ANS) in acute mountain sickness (AMS) during the initial phase at acute high-altitude exposure. Methods: Ninety-nine healthy sea-level residents rapidly ascended to Tibet plateau (3 675 m altitude) by airplane from Chengdu plain (560 m altitude). ANS function was tested in plain and day 2–4 in Tibet by heart rate variability (HRV), cold pressor test (CPT). AMS was evaluated by clinic symptomatic scores. All subjects were divided into non-AMS group (57, scores≤4) and AMS group (42, scores>4). Results: Compared with non-AMS group, AMS group had higher standard deviation of normal to normal intervals (SDNN), root mean square of delta RR (rMSSD), low-frequency (LF) power, and normalized low-frequency (LFnu) power in plain (P<0.05). After arrival at 3 675 m altitude, AMS group had greater reduction in percentage of delta RR>50 ms(PNN50), rMSSD (P<0.01) and SDNN, LF, total power (TP) (P<0.05). Although no significant differences in the increase of SP and DP during CPT were found between 2 groups in plain, the SP increase during CPT of AMS group was less than non-AMS group (P<0.05) at 3 675 m altitude. AMS symptomatic scores was not only positively correlated with SDNN, rMSSD, LF/HF in plain (P<0.05), but also negatively correlated with HFnu in plain (P<0.05). Conclusion: During the initial high altitude exposure, ANS modulation is generally blunted, but the relatively predominant sympathetic control is enhanced, and this characteristic change of ANS function is positively correlated with the development of AMS.

Experimental Study of the Effect of Autonomic Nervous System on the Transmural Dispersion of Ventricular Repolarization under Acute Myocardial Ischemia in Vivo

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization(TDR)under acute myocardial ischemia in intact canine was investigated.Using the monophasic action potential(MAP)recording technique,MAPs of the epicardium(Epi),midmyocardium(Mid)and endocardium(Endo)were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs.MAPD 90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization(EAD)before autonomic nervous stimulation and during autonomic nervous stimulation were compared.It was found that 10 min after acute myocardial ischemia,TDR was increased from 55±8 ms to 86±15 ms during sympathetic stimulation(P<0.01).The TDR(53±9 ms)during parasympathetic stimulation was not significantly different from that of the control(55±8 ms)(P>0.05).The EAD was elicited in the Mid of 2 dogs(16%)10 min after acute myocardial ischemia,but the EAD were elicited in the Mid of 7 dogs(58%)during sympathetic stimulation(P<0.01).It was concluded that:(1)Sympathetic stimulation can increase the transmural dispersion of repolari-zation and induce early afterdepolarizations in the Mid under acute myocardial ischemia,which provide the opportunity for the ventricular arrhythmia developing;(2)Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.

Effect of Autonomic Nervous System on the Transmural Dispersion of Ventricular Repolarization in Intact Canine

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action potentials (MAPs) of the epicardium (Epi), midmyocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge needle electrodes at the left ventricular free wall in 12 open chest dogs. MAPD 90 and transmural dispersion of repolarization among three myocardial layers as well as the incidence of the EAD before autonomic nervous stimulation and during autonomic nervous stimulation were compared. The results showed that the MAPD 90 of Epi, Mid and Endo before autonomic nervous stimulation were 278±11 ms, 316±16 ms and 270±12 ms respectively, the MAPD 90 of Mid was significantly longer than that of Epi or Endo ( P <0.01). MAPD 90 of Epi, Mid and Endo were shortened by 19±4 ms, 45±6 ms, 18±3 ms respectively during sympathetic stimulation. Compared with that of the control, the transmural dispersion of repolarization during sympathetic stimulation was shortened from 44±4 ms to 15±3 ms ( P <0.01), but early afterdepolarizations were elicited in the Mid of 5 dogs (41 %) during sympathetic stimulation. Parasympathetic stimulation did not significantly affect the MAPD 90 in the three layers. It is concluded that there is the transmural dispersion of ventricular repolarization in intact canine. Sympathetic stimulation can reduce transmural dispersion of repolarization, but it can produce early afterdepolarizations in the Mid. Parasympathetic stimulation does not significantly affect the transmural dispersion of ventricular repolarization.

Assessment of the autonomic nervous system is an appropriate biological marker for the well-being in erectile dysfunction

Aim： To investigate whether the autonomic nervous system （ANS） components are suitable biological markers for representing well-being in patients with erectile dysfunction （ED）. Methods： The present study included 74 male patients who had applied for check-ups in the cardiology outpatient clinic at Kirikkale University （Kirikkale, Turkey） and who had been diagnosed as having hyperlipidemia. Of these patients, 26 had an additional diagnosis of ED and made up the patient group. The remaining 48 patients formed the control group. Well-being was assessed with shortform 36 （SF-36）. The International Index of Erectile Function （IIEF） was used as a measure of libido and erectile function. Quantitative assessment of the ANS was made based on the analysis of heart rate variability by means of 24-h holter monitorization. Results： Comparisons between the ED and control groups showed significant differences only in energy scale of SF-36. The ED group also had significantly higher values of sympathetic activity. Except for the general health score of SF-36, which was found to be correlated with parasympathetic activity only in ED group, there were similar correlation patterns within the groups. Although well-being and sympathetic activity were correlated negatively, parasympathetic activity and well-being were correlated positively. Conclusion： Quantitative assessment of the ANS by heart rate variability analysis might be a suitable marker for well-being of patients with ED.

Changes in Autonomic Nervous System Activity and Mood of Healthy People after Mindfulness Art Therapy Short Version

The aim of this study was to investigate changes in autonomic nervous system (ANS) activity and mood caused by Mindfulness Art Therapy Short version (MATS). The participants were 20 Japanese college students who were separated into high and low risk groups based on the median score of the General Health Questionnaire (GHQ). MATS consisted of mindfulness exercise and making of art in one session. ANS activity (TP: total energy, LF/HF: sympathetic nervous, HF: parasympathetic nervous system, LF: both sympathetic and parasympathetic) and mood (TA: tension arousal, EA: energy arousal) were measured psychologically before and after MATS. In the high risk group, TP significantly decreased and LF, HF, and LF/HF did not change significantly;while TA significantly decreased and EA significantly increased. In the low risk group, TP and LF significantly increased and HF and LF/HF did not change significantly;while TA significantly decreased and EA showed a non-significant increase. These results suggest that MATS affects the ANS differently for participants with different states of mental health, and particularly promotes activity in low-risk participants. Psychologically, MATS decreased tension or anxiety and increased energy. These findings justify further use of this therapy.

Changes of autonomic nervous system function in healthy young men during initial phase at acute high-altitude exposure

Objective: To investigate the changes of autonomic nervous system (ANS) function during the initial phase at acute high-altitude exposure. Methods: Ninety-nine healthy sea-level male residents were studied in Chengdu plain and then Tibet plateau. Heart rate variability (HRV), cold pressor test (CPT), resting heart rate (HR) and blood pressure (BP) were measured at baseline (560 m altitude) and in 2 to 4 d after arriving at Tibet plateau (3 675 m altitude) to assess the ANS function. Results: Compared with baseline, on day 2 in Tibet the standard deviation of normal to normal intervals (SDNN), high-frequency (HF) power, total power (TP), root mean square of delta RR (rMSSD), percentage of delta RR>50 ms (PNN50), normalized high-frequency (HFnu) and fractal dimension (FD) decreased significantly (SDNN, HF, TP P<0.01, rMSSD, PNN50, HFnu, FD P<0.05), while the normalized low-frequency (LFnu) and LF/HF increased significantly (P<0.01). During day 3–4 in Tibet, SDNN, rMSSD, HF, TP and HFnu tended to rebound while LFnu and LF/HF decreased towards baseline day by day. In addition, in Tibet the increase in systolic pressure (SP) and diastolic pressure (DP) during CPT decreased significantly (P<0.01, 0.05), but resting HR increased compared with baseline (P<0.01). Conclusion: ANS modulation is generally blunted, and the relatively predominant sympathetic control is enhanced originally, then it reverts to the sea level states gradually during the initial days of acute high-altitude exposure.

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.

The Effects of Green Kiwifruit Ingestion on Digestive Health, Blood Flow, Skin Health, and the Autonomic Nervous System

We aimed to assess the impact of consuming two Zespri Hayward green kiwifruit a day on 11 healthy women subjects over a period of 4 consecutive weeks. We analyzed the effects of kiwifruit consumption on intestinal, abdominal, and bowel movement related discomfort, bowel movement frequency, peripheral blood flow, skin health, and autonomic nervous system activity. This study was a randomized control trial, consisting of a four-week intervention period. Participants were divided to ensure equal age distributions and then randomly placed into two intervention groups: a kiwifruit consumption group (n = 11) and a control group (no kiwifruit consumption) (n = 5). The kiwifruit consumption group was instructed to consume two kiwifruit a day during the 4-week intervention period, while subjects in the control group were instructed not to consume kiwifruit for the duration of the study. Besides a restriction from eating yogurt and other fruits, subjects were requested to eat their meals as per usual. The results of this study showed a significant decrease in intestinal, abdominal, and bowel movement discomfort, and a significant increase in bowel movement frequency, at 4 weeks of kiwifruit consumption compared to before consumption. In addition, subjects in the kiwifruit consumption group experienced a significant increase in blood flow, particularly in the index and middle finger at 2 and 4 weeks of kiwifruit consumption. Furthermore, subjects in the kiwifruit consumption group experienced a significant increase in skin brightness at 4 weeks of kiwifruit consumption compared to before consumption. The results of this study suggest that kiwifruit appears to be a delicious and safe option for intestinal, abdominal, and bowel movement discomfort interventions for healthy women. In addition, kiwifruit may aid in increasing bowel movement frequency, peripheral blood flow, and brightness of skin among healthy women as well.

The Effect of Brief, Low-Intensity Stretching Gymnastics on Autonomic Nervous System Activity and Cognitive Function

Purpose: Stretching exercise and gymnastics both have beneficial effects, such as improvement of autonomic nervous system activity and mood. Additionally, studies on the effects of exercise on cognitive function have been conducted covering a wide range of age groups and have attracted much attention. However, conventional studies have set up programs with implementation times of 20 to 30 minutes. Therefore, shorter stretching programs are needed in order to fit them more easily into one’s free time. We examined the effects of a short 7-minute stretching gymnastics regime on the autonomic nervous system activity and cognitive function in 21 healthy participants. Methods: In this study, the participants performed a 10-minute cognitive task, followed by either Stretch Well Gymnastics, Stretch Band Gymnastics, or Radio Gymnastics sessions on different days. The participants then performed the cognitive task again. Heart rate was measured continuously throughout the experiment and we analyzed the heart rate variability. The cognitive tasks completed by all of the participants were evaluated for inhibitory control and cognitive flexibility. Results: A significant increase was shown in the sympathetic nerve activity during the Stretch Well Gymnastics, compared to the Radio Gymnastics and Stretch Band Gymnastics. Parasympathetic nerve levels were significantly increased after the gymnastics, compared to during the gymnastics, although there were no significant differences between any of the tasks. Additionally, in both the Stroop task and the number-Letter task, reaction times were faster in all of the sessions. In particular, the Stroop task showed the highest values for the Radio Gymnastics sessions, with marginally significantly lower scores for the Stretch Well Gymnastics sessions. Conclusion: The results showed that these heart rate variability responses supported the effects of autonomic activity associated with conventional low-intensity exercise. Additionally, stretching gymnastics for less than 10 minutes showed a positive effect on inhibitory function and cognitive flexibility.

Nutritional stimulation of the autonomic nervous system

Disturbance of the inflammatory response in the gut is important in several clinical diseases ranging from inflmmatory bowel disease to postoperative ileus. Several feedback mechanisms exist that control the inflammatory cascade and avoid collateral damage. In the gast rointestinal tract, it is of particular importance tocontrol the immune response to maintain the balance that allows dietary up take and utilization of nutrientson one hand, while preventing invasion of bacteria and toxins on the other hand. The process of digestion and absorption of nutrients requires a relative hyporesponsiveness of the immune cells in the gut to luminacontents which is not yet fully understood. Recentlythe autonomic nervous system has been identifi ed asan important pathway to control local and systemic inflammation and gut barrier integrity. Activation of thepathway is possible via electrical or via pharm acological interventions, but is also achieved in a physiologicamanner by ingestion of dietary lipids. Administration of dietary lipids has been shown to be very effectivein reducing the inflammatory cascade and maintaining intestinal barrier integrity in several experimental studies. This beneficial effect of nutrition on the inflammatory response and intestinal barrier integrity opens new therapeutic opportunities for treatment of certain gastrointestinal disorders. Furthermore, this neural feedback mechanism provides more insight in the relative hyporesponsiveness of the immune cells in the gut. Here, we will discuss the regulatory function of the autonomic nervous system on the inflammatory response and gut barrier function and the potential benefit in a clinical setting.

Stress prevention by modulation of autonomic nervous system (heart rate variability): A preliminary study using transcranial direct current stimulation

Introduction: Transcranial Direct Current Stimulation (tDCS) is a non-invasive, technique for brain stimulation. Anodal stimulation causes neuronal depolarisation and long-term potentiation, while cathodal stimulation causes hyperpolarisation and long-term depression. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both. Associated with these reactions is a frequently reported increase in Low Frequency (LF) Heart Rate Variability (HRV), a decrease in High Frequency (HF) power, and/or an increase in the LF/HF ratio. Objectives and aims: The present work aims to explore the tDCS potential in the modulation of the Autonomic Nervous System (ANS), through indirect stimulation of Anterior Cingulate Cortex (ACC). Methods: Two subjects, a 39 year old female and a 49 year old male, gave informed consent. Saline soaked synthetic sponges involving two, thick, metalic (stainless steel) rectangles, with an area of 25 cm2 each have been used as electrodes, connected to Iomed Phoresor II Auto device. It has been delivered a 2 mA current, for 20 minutes, over the left Dorsolateral Prefrontal Cortex (DLPFC) (Anode). Spectrum analysis (cStress software) of HRV has been performed before and after tDCS administration. Results: The female/male subject results of LF power, HF power and LF/HF ratio, before tDCS administration, were, respectively: 50.1 nu/60 nu, 46.1 nu/21.7 nu and 1.087/2.771;and, after tDCS administration, respectively: 33.5 nu/52.7 nu, 47.6 nu/ 22.8 nu and 0.704/2.312. Conclusions: tDCS over the left DLPFC (left ACC) increased parasympathetic activity and decreased sympathetic activity, suggesting the importance of tDCS in the management of stress-related disorders.

α-Synuclein pathology from the body to the brain:so many seeds so close to the central soil

α-Synuclein is a protein that mainly exists in the presynaptic terminals.Abnormal folding and accumulation of α-synuclein are found in several neurodegenerative diseases,including Parkinson’s disease.Aggregated and highly phospho rylated a-synuclein constitutes the main component of Lewy bodies in the brain,the pathological hallmark of Parkinson s disease.For decades,much attention has been focused on the accumulation of α-synuclein in the brain parenchyma rather than considering Parkinson s disease as a systemic disease.Recent evidence demonstrates that,at least in some patients,the initial α-synuclein pathology originates in the peripheral organs and spreads to the brain.Injection of α-synuclein preformed fibrils into the gastrointestinal tra ct trigge rs the gutto-brain propagation of α-synuclein pathology.However,whether α-synuclein pathology can occur spontaneously in peripheral organs independent of exogenous α-synuclein preformed fibrils or pathological α-synuclein leakage from the central nervous system remains under investigation.In this review,we aimed to summarize the role of peripheral α-synuclein pathology in the pathogenesis of Parkinson’s disease.We also discuss the pathways by which α-synuclein pathology spreads from the body to the brain.

Quran memorisation and heart rate variability:How do they correlate?

BACKGROUND Heart rate variability(HRV)was shown to be affected by performing religious activities.AIM To examine the relationship between the level of Quran(the holy book of Muslims)memorisation and HRV among teenagers.METHODS This experimental study included 16 Tahfiz students and 16 non-Tahfiz students(n=32).The HRV was measured in three tasks:Recalling familiar verses,memorising new verses,and recalling the newly memorised verses of the Quran.HRV analysis was done using these parameters:Standard deviation of N-N(heartbeat peak)interval;low frequency(LF);high frequency(HF)and LF/HF ratio.RESULTS There were significant differences between tasks for all parameters(P<0.05).However,between the groups,only the LF/HF ratio had significant differences,with F=5.04,P<0.05.Pearson correlation showed a moderate positive correlation between the number of pages memorised and the LF/HF ratio(r=0.61,P<0.05).CONCLUSION Quran memorisation increased the HRV and our results suggested that this activity could be developed as an effective sympathovagal modulation training activity.

Orthostatic Hypotension: QTc Interval Prolongation during Head-Up Tilt

Background: The QT interval shortens in response to sympathetic stimulation. Head-up tilt-table (HUT) testing is a straightforward way to achieve brisk sympathetic stimulation. There is not enough information about the response of the QT interval to HUT, particularly, in patients with orthostatic hypotension (OH). Objective: Analyse the response of the RR, QT and QTc intervals in patients with OH and reflex syncope (NM) during HUT and find differences between groups. Methods: We reviewed the electrocardiograms and compare the RR and QT/QTc intervals during 1) baseline;2) HUT plus hyperventilation;3) positive test. Results: We studied 137 patients, 62 control group (no syncope and negative HUT). On average, the RR HUT interval was shorter than the resting RR by −171 ± 110.4 ms in controls;−228.6 ± 119.4 ms (NM) and −194 ± (OH) (P Conclusion: Significant differences between the reflex group and the OH during a positive test, the QTc decreased in the NM group, but in the OH population increased. This observation has not been described. We hypothesize that QTc prolongation could reflect autonomic nervous system downregulation and could explain to a degree, the increased mortality in this group.

How to properly evaluate cardiac vagal tone in oncology studies:a state-of-the-art review

Heart rate variability(HRV)analysis provides an assessment of cardiac vagal tone and consequently global cardiac health as well as systemic condition.In systemic diseases such as cancer and during treatments that affect the whole body,like chemotherapy,the vagus nerve activity is low and deregulated.Some studies focus on using HRV to predict mortality in oncology.However,in cancer patients,systemic alterations substantially increase artifacts during HRV measurement,especially atrial ectopic beats.Moreover,HRV may be altered by various factors(duration and time of measurement,breathing,drugs,and other confounding factors)that alter each metric in different ways.The Standard Deviation of all Normal to Normal intervals(SDNN)is the most commonly used metric to evaluate HRV in oncology,but it does not appear to be specific to the cardiac vagal tone.Thus,cardiac vagal activity diagnosis and vital prognosis of cancer patients can be biased.Our review presents the main HRV metrics that can be currently used in oncology studies and their links with vagus nerve and cancer.We present the influence of external factors and the required duration and time of measurement.Considering all these parameters,this review proposes seven key points for an assessment of HRV and cardiac vagal tone in patients with cancer.

Verification of the Physiological Therapeutic Effects of Harvesting Activities in a Patient with Moderate Alzheimer’s Disease with Long-Term Agricultural Experience

Background: Harvesting activities have proven effective in reducing stress in patients with dementia. At a psychiatric hospital, occupational therapists (OT) made patients with dementia perform vegetable harvesting activities as a part of their treatment. The patients became calmer and began to smile not only after but also before and during harvesting activity. Therefore, this study aimed to measure autonomic nervous system (ANS) responses over time in a female patient in her 80s with moderate Alzheimer’s disease (AD) who had experience in farming when performing harvesting activities. Additionally, this study aimed to consider factors associated with changes in ANS responses over time and to verify the physiological therapeutic effects of harvesting activities. Methods: An OT with more than 10 years of experience and a good relationship with the patient conducted one-on-one sessions with the patient. Harvesting activity was performed in a courtyard with trees. The patient harvested lettuce (three lettuce plants) grown in a planter while sitting on a chair. Additionally, the planter was set up on a desk. ANS responses were measured over time from before to after the activity for different events at six time periods. Changes in the patient’s ANS responses were assessed during each period. Results: With the involvement of environmental factors and OT during harvesting activities, parasympathetic nervous system (PNS) activity significantly increased. This may lead to improved mental stability. Conclusion: The findings of this study indicate that implementing harvesting activities may have a positive effect on the PNS in patients with AD with long-term agricultural experience. However, further studies with a larger sample size and multidimensional evaluations are needed.

Dysfunction of neuroendocrine system in sepsis and implication of hormone therapy

Sepsis and related syndromes are the major cause of multiple organ failure and death in patients with critical illnesses. Neuroendocrine dysfunction has long been thought to be an important event in sepsis. In clinic, optimal management of the hormones could alleviate severe complications in sepsis. In this article, we review the dysfunction ofneuroendocrine system as well as autonomic nervous system in sepsis, and summarize the respective therapy strategies.