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Objective The aim of this study was to explore the influencing factors of orthostatic intolerance in adolescent idiopathic scoliosis patients after surgery for the first time out of bed movement. Methods A retrospective analysis was conducted on the clinical data of 226 adolescent idiopathic scoliosis patients admitted to Nanjing Drum Tower Hospital from June 2021 to June 2023. Based on whether upright intolerance occurred during the first postoperative ambulation, patients with upright intolerance were included in the upright intolerance group, and patients without upright intolerance were included in the non upright intolerance group. Collect general data of two groups of patients, as well as their blood pressure at different positions during their first postoperative out of bed activity. Conduct univariate and multivariate logistic regression analysis on the influencing factors of upright intolerance during their first postoperative out of bed activity in adolescent idiopathic scoliosis patients. Results Out of 226 patients who underwent their first postoperative ambulation, 102 experienced orthostatic intolerance, accounting for 45.13% (102/226) of the cases. The systolic and diastolic blood pressure in both sitting and standing positions were lower in the orthostatic intolerance group than in the non orthostatic intolerance group (P < 0.05). Through univariate analysis, it can be seen that the postoperative bed rest time, sitting pain score, standing pain score, postoperative hospitalization time, and proportion of posture adaptation training in the orthostatic intolerance group were significantly different from those in the non orthostatic intolerance group (P < 0.05). Through multiple logistic regression analysis, it can be seen that long postoperative bed rest time, degree of sitting pain, degree of standing pain, and lack of posture adaptation training are risk factors for upright intolerance (P < 0.05). Conclusion Long postoperative bed rest time, sitting pain, standing pain, and lack of posture adaptation training are the main risk factors affecting upright intolerance of adolescent idiopathic scoliosis patients after surgery for the first time out of bed activity. [ABSTRACT FROM AUTHOR]

Objective: To discuss the association between hemodynamic patterns and the risk of ischemic stroke in the people with chronic orthostatic intolerance (OI), and to provide the basis for the early assessment of the onset of ischemic stroke. Methods: A total of 638 residents aged ≥40 years from three streets/townships in Changchun City of Jilin Province were selected as the subjects by multistage random sampling method. Transcranial Doppler (TCD) combined with head-up tilt test (HUTT) were used to evaluate the hemodynamic patterns of the people with OI, and the OI research cohort was established. The patients were divided into orthostatic hypotension (OH) group, orthostatic hypertension (OHT) group, postural tachycardia syndrome (POTS) group, and orthostatic cerebral hypoperfusion syndrome (OCHOs) group according to the changes of hemodynamics. The subjects were followed up once every six months for two years, and the first incidence of ischemic stroke of the subjects was regarded as the observation endpoint; the baseline data and incidence of ischemic stroke of the subjects during the follow-up period were collected; Cox proportional hazards model was used to analyze the association factors with the risk of ischemic stroke. Results: A total of 121 subjects were diagnosed with OI, including 80 subjects (66.12%) in OH group, 35 subjects (28.93%) in OHT group, 5 (4.13%) subjects in POTS group, and 1 subject (0.82%) in OCHOs group. During the follow-up period, the overall people had 43 confirmed new cases of ischemic stroke. After controlling the related confounding factors, compared with non-OI individuals, the risk of ischemic stroke in the entire OI people, as well as in the OH and OHT patients, was increased by 1.527 times [hazard ratio (HR) =2.527, 95% confidence interval (CI) : 1.269－5.032, P<0.01)], 2.268 times (HR=3.268, 95% CI: 1.603－6.663, P=0.001), and 2.153 times (HR=3.153, 95% CI: 1.213－8.916, P=0.008), respectively. Conclusion: OI is associated with the increased risk of ischemic stroke, particularly in the patients in OH and OHT groups. [ABSTRACT FROM AUTHOR]

Objective To investigate the diagnostic value of transcranial Doppler (TCD) combined with headup tilt test (HUTT) in patients with orthostatic cerebral hypoperfusion syndrome (OCHOs). Methods We selected the patients going to hospital due to syncope or suspected orthostatic intolerance, and their etiology was considered as OCHOs. Cerebral blood flow parameters and hemodynamic parameters of patients were collected separately by TCD and HUTT, and healthy control group was set up. TCD cerebral blood flow parameters and HUTT hemodynamic parameters were compared between the OCHOs patients and the control group. Results A total of 56 OCHOs patients (case group) and 21 healthy adults in the control group are enrolled. In terms of TCD cerebral blood flow parameters, compared with the supine position, the absolute values of the decrease of systolic, enddiastolic and mean cerebral blood flow velocity in the case group are significantly higher than those in the control group during the tilt upright position; the absolute values of the increase of pulse index and circulation resistance index are also significantly higher than those in the control group (P < 0. 01). There is no significant difference in HUTT hemodynamic parameters between the two groups (P > 0. 05). The receiver operator characteristic curve is drawn. Compared with the supine position, systolic, end-diastolic and mean cerebral blood flow velocity in the case group decrease by 14. 5, 9. 5 and 13. 5 cm / s, respectively during the tilt upright position. Their sensitivity is separately 94. 6%, 87. 5% and 91. 1% while the specificity is separately 95. 2%, 85. 7% and 95. 2% in diagnosing OCHOs (P < 0. 01). Conclusion TCD combined with HUTT plays an important role in diagnosing OCHOs. [ABSTRACT FROM AUTHOR]

Objective: To examine the cardiovascular response to orthostatic stress of 4 wk tail suspended rat. Methods: A modified tail suspension method was used and the mean arterial blood pressure (MAP) and heart rate (HR) upon head-up tilt (HUT) or lower body negative pressure (LBNP) were recorded. Results: Compared to the control rats (CON), 4 wk tail suspended (SUS) rats had no difference in MAP or HR on rest. Both HUT and LBNP could reduce MAP and enhance HR in both groups of rat. But the magnitude of MAP change was significantly larger in SUS rats relative to that in CON rats while the change of HR showed no significant difference between the two groups. Conclusion: The ability to keep MAP stable upon orthostatic stress was compromised in 4 wk SUS rats and the animal model with mid-term treatment was suited for the research on mechanisms of orthostatic intolerance following weightlessness. [ABSTRACT FROM AUTHOR]

Objective: To analyze the disease spectrums underlying orthostatic intolerance (OI) and sitting intolerance (SI) in Chinese children, and to understand the clinical empirical treatment options., Methods: The medical records including history, physical examination, laboratory examination, and imagological examination of children were retrospectively studied in Peking University First Hospital from 2012 to 2021. All the children who met the diagnostic criteria of OI and SI were enrolled in the study. The disease spectrums underlying OI and SI and treatment options during the last 10 years were analyzed., Results: A total of 2 110 cases of OI and SI patients were collected in the last 10 years, including 943 males (44.69%) and 1 167 females (55.31%) aged 4－18 years, with an average of (11.34±2.84) years. The overall case number was in an increasing trend over the year. In the OI spectrum, postural tachycardia syndrome (POTS) accounted for 826 cases (39.15%), followed by vasovagal syncope (VVS) (634 cases, 30.05%). The highest proportion of SI spectrum was sitting tachycardia (STS) (8 cases, 0.38%), followed by sitting hypertension (SHT) (2 cases, 0.09%). The most common comorbidity of OI and SI was POTS coexisting with STS (36 cases, 1.71%). The highest proportion of treatment options was autonomic nerve function exercise (757 cases, 35.88%), followed by oral rehydration salts (ORS) (687 cases, 32.56%), metoprolol (307 cases, 14.55%), midodrine (142 cases, 6.73%), ORS plus metoprolol (138 cases, 6.54%), and ORS plus midodrine (79 cases, 3.74%). The patients with POTS coexisting with VVS were more likely to receive pharmacological intervention than the patients with POTS and the patients with VVS (41.95% vs. 30.51% vs . 28.08%, χ 2 = 20.319, P < 0.01), but there was no significant difference in the proportion of treatment options between the patients with POTS and the patients with VVS., Conclusion: POTS and VVS in children are the main underlying diseases of OI, while SI is a new disease discovered recently. The number of children with OI and SI showed an increasing trend. The main treatment methods are autonomic nerve function exercise and ORS. Children with VVS coexisting with POTS were more likely to take pharmacological treatments than those with VVS or POTS only.