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Objectives: This randomized clinical trial compared the effectiveness of music and informative videos as distraction tools to reduce the anxiety of patients during root canal treatment and retreatment. Method and materials: A total of 90 patients were enrolled in the study. The patients were randomly allocated to three groups: Group 1 listened to music during the treatment (n = 30), Group 2 watched an informative preoperative video (n = 30), and a control group underwent treatment without a distraction method (n = 30). Prior to treatment, the Corah Dental Anxiety Scale (CDAS) and a visual analog scale for pain were used to assess anxiety and preoperative pain. Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded before the intervention (T1), after the local anesthetic (T2), following pulp extirpation or removal of root fillings (T3), and immediately following rubber dam removal (T4). One-way ANOVA, followed by post-hoc Bonferroni tests for multiple comparisons, were used to compare mean values of systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation among the groups. A P value of 5% was considered as significant. Results: Listening to music reduced systolic blood pressure, heart rate (P < .001), and diastolic blood pressure (P = .003) in patients undergoing root canal treatment and retreatment at T4 compared to the baseline (T1). Music (P < .001) and informative video (P = .003) groups had significantly lower postoperative visual analog scale pain scores. Conclusion: Listening to music during root canal treatment and retreatment reduced anxiety levels in patients compared to informative preoperative videos and no distraction technique. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction resistance exercise studies often require caffeine abstinence to avoid cardiovascular effects that could change the blood flow restriction stimulus. However, effects may be attenuated for habituated users. Objective: To compare cardiovascular responses to blood flow restriction resistance exercise when habituated users consume or abstain from caffeine. Design: Thirty participants completed a 3-visit within-subject study beginning with familiarization and caffeine intake questionnaire. Methods: Visits 2 and 3 consisted of blood flow restriction resistance exercise (3 sets bicep curls to failure, 30% 1-repetition max, 40% arterial occlusion pressure [AOP]), following participants' normal caffeine consumption (CAFF) or abstaining (ABS). AOP, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate were measured preexercise and postexercise. Prevalues and preexercise to postexercise change scores for SBP, DBP, AOP (all millimeters of mercury), heart rate (in beats per minute), and repetitions were compared between conditions. Results are represented as mean (SD). Results: Preexercise AOP was similar for CAFF (137.8 [14.4]) and ABS (137.1 [14.9], BF10 = 0.2), although pre-SBP was higher for CAFF (115.4 [9.8]) than ABS (112.3 [9.4], BF10 = 1.9). Pre-DBP was similar between conditions. The exercise-induced change in AOP was greater for CAFF (18.4 [11.2]) than ABS (13.2 [14.9]), though evidence was anecdotal (BF10 = 0.7). Exercise-induced changes in SBP, DBP, and heart rate were similar between conditions (all BF10 ≤ 0.40). More repetitions were completed for CAFF (63 [26]) than ABS (57 [17], BF10 = 2.1). Conclusions: The findings of this study suggest that for habituated users, maintaining daily caffeine habits will not have substantial effects on common cardiovascular variables relevant to blood flow restriction. [ABSTRACT FROM AUTHOR]

Acute hypoxic ventilatory response is an important reflex that helps maintain breathing during low oxygen levels, but it is attenuated by most general anaesthetics. Analgesic doses of ketamine and esketamine are known to have respiratory stimulant effects. In their recent study in the British Journal of Anaesthesia , Jansen and colleagues show that low-dose esketamine preserved the acute hypoxic ventilatory response, while increasing breathing rate, systolic blood pressure, and heart rate. Participants also exhibited higher levels of alertness and unpleasant psychotropic effects compared with the control condition. We review the pharmaco-physiological effects of acute hypoxia and its interactions with esketamine. We provide a summary of the effects of hypoxia and esketamine on the neurocircuitry that leads to arousal, activation of the sympathetic nerve system, and increased drive to upper airway dilator and respiratory pump muscles. [ABSTRACT FROM AUTHOR]

Introduction: Delirium, frequently experienced by ischemic stroke patients, is one of the most common neuropsychiatric syndromes reported in the Intensive Care Unit (ICU). Stroke patients with delirium have a high mortality rate and lengthy hospitalization. For these reasons, early diagnosis of delirium in the ICU is critical for better patient prognosis. Therefore, we developed and validated prediction models to classify the real-time delirium status in patients admitted to the ICU or Stroke Unit (SU) with ischemic stroke. Methods: A total of 84 delirium patients and 336 non-delirium patients in the ICU of Ajou University Hospital were included. The 8 fixed features [Age, Sex, Alcohol Intake, National Institute of Health Stroke Scale (NIHSS), HbA1c, Prothrombin time, D-dimer, and Hemoglobin] identified at admission and 12 dynamic features [Mean or Variability indexes calculated from Body Temperature (BT), Heart Rate (HR), Respiratory Rate (RR), Oxygen saturation (SpO2), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP)] based on vital signs were used for developing prediction models using the ensemble method. Results: The Area Under the Receiver Operating Characteristic curve (AUROC) for delirium-state classification was 0.80. In simulation-based evaluation, AUROC was 0.71, and the predicted probability increased closer to the time of delirium occurrence. We observed that the patterns of dynamic features, including BT, SpO2, RR, and Heart Rate Variability (HRV) kept changing as the time points were getting closer to the delirium occurrence time. Therefore, the model that employed these patterns showed increasing prediction performance. Conclusion: Our model can predict the real-time possibility of delirium in patients with ischemic stroke and will be helpful to monitor high-risk patients. [ABSTRACT FROM AUTHOR]

This study aims to assess the outcomes of therapeutic options for aortic arch pathologies by comparing thoracic endovascular aortic repair (TEVAR) with open arch replacement (OAR) using woven polyester grafts from a mechanical and biomechanical perspective, with emphasis on ex vivo perfused human thoracic aortas reproducing heart rate and stroke volume conditions. Eleven non-diseased thoracic aortas from human cadavers were divided into TEVAR (n = 5) and OAR (n = 6) and tested using a custom-built mock circulation loop. Pressure, diameter, and stroke volume were monitored during perfusion before and after the intervention. Samples undergoing TEVAR showed a higher ascending systolic pressure post-intervention than OAR (TEVAR: 137 ± 9 mmHg vs OAR: 126 ± 6 mmHg, p = 0. 017). After the intervention, a significant discrepancy in the mean pressure differences between the ascending and descending aorta Δ P was observed (TEVAR: 9 ± 3 mmHg vs OAR: 1 ± 2 mmHg, p = 0. 004). Input impedance at zero frequency, approximating Windkessel resistance, was higher for TEVAR than for OAR (TEVAR: 1. 78 ± 0. 04 vs OAR: 1. 66 ± 0. 03 mmHg s/ml, p = 0. 004). A correlation was found between the resistance and the negative peak of the time-normalized wave intensity analysis (Kendall's coefficient τ = − 0. 35 and p = 0. 023). Another correlation was observed between resistance and Δ P (τ = 0. 51 , p = 0. 001). Looking at the replication of heart rate and stroke volume over the course of the study, the observed differences can largely be attributed to the type of intervention. The results suggest that TEVAR has adverse effects compared to OAR, particularly with regard to left ventricular afterload. Clinicians should consider the possibility of increased afterload and altered wave dynamics when deciding on TEVAR, particularly in patients with pre-existing impaired cardiovascular conditions. [Display omitted] • A unique comparison of two predominant interventions for aortic arch pathologies. • Evaluation of clinically feasible measures in a mock circulation loop. • Stressing the importance of biomechanics in the evaluation of patient outcomes. • Revealing the potential of physiological investigation of new grafts before trials. [ABSTRACT FROM AUTHOR]

Continued heat exposure can cause physiological and cellular responses. This study investigated the association between physiological responses and heat shock protein 70 (HSP70) expressions in Kuala Lumpur's urban vulnerable population. We conducted a cross-sectional study involving 54 participants from four areas classified as experiencing moderate to strong heat stress. Physiological measurements included core body temperature, heart rate, and diastolic and systolic blood pressure. RT-qPCR and ELISA were also performed on blood samples to assess HSP70 gene and protein expressions. Despite indoor heat stress, participants maintained normal physiological parameters while there were significant indications of HSP70 expression at both the gene and protein levels. However, our study found no significant correlation (p > 0.05) between physiological responses and HSP70 expressions. This study shows no interaction between physiological responses and HSP70 expressions in the study population, revealing the complex mechanisms of indoor heat stress in vulnerable individuals. [ABSTRACT FROM AUTHOR]

Context Hypertension (HTN) is regarded as a serious public health issue throughout the world. High blood pressure (BP) may be improved by carotenoid supplementation; however, randomized controlled trials (RCTs) provide conflicting evidence. Objective The aim of this study was to evaluate the effects of carotenoid supplementation on BP in RCTs by systematically review and meta-analysis. Data Sources A comprehensive literature search was performed in the Scopus, PubMed, and Web of Science databases until October 2023, with no limitation on the date or language of publication. Data Extraction Studies that evaluated the net effects of carotenoids in the form of supplements on BP in adults were selected. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated on the basis of a fixed or random-effects model. Sensitivity analysis, meta-regression, publication bias, and heterogeneity were assessed using standard methods. Cochrane quality assessments were used to evaluate the included studies' bias risks. Evidence certainty was calculated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework). Data Analysis Reports on a total of 19 RCTs involving 1151 participants were included in this review. Carotenoid supplementation significantly reduced the systolic BP (SBP) (WMD, –2.492 mmHg; 95%CI, –4.52, –0.47; P = 0.016) and diastolic BP (DBP) (WMD, –1.60 mmHg; 95%CI, –2.73, –0.47; P = 0.005). Greater effects were observed in Asian participants, those aged >50 years, nonhealthy participants, and participants with a baseline SBP ≥130 mmHg and DBP ≥80 mmHg, at dose >10 mg. Dose–response analysis showed that carotenoid supplementation decreased SBP and DBP levels at doses of, respectively, 0–25 and 0–20 mg/d. Evidence for all SBP, DBP, and heart rate values was high quality. Conclusions Carotenoid supplementation had a beneficial effect on BP parameters, especially in nonhealthy study participants with high BP baseline levels. PROSPERO registration no CRD42023402740. [ABSTRACT FROM AUTHOR]

Background: To investigate the relationship between anxiety and white coat hypertension (WCH) using the hospital anxiety and depression scale-anxiety (HADS-A) score. Methods: Participants lacking a pre-existing diagnosis of hypertension but displaying increased office blood pressure were included in this study. Subsequently, they were classified as either newly diagnosed sustained hypertension (SustHT) or white coat hypertension (WCH) patients, as determined by 24-hour ambulatory blood pressure monitoring measurements. The assessment of their anxiety levels was conducted using the HADS-A questionnaire. We performed regression, comparative, and sensitivity analyses to elucidate the association between anxiety and WCH. Results: In this cohort of 303 consecutive individuals (mean age 54 years, 46% female), 81 (26.7%) patients were diagnosed with WCH. Those with WCH were younger (49 vs. 56 years, P < .001), had higher heart rate (85 vs. 76 bpm, P < .001) and exhibited a female predominance (56% vs. 43%, P = .049) compared to individuals with SustHT. The HADS-A was higher in WCH than in SustHT (9.0 ± 2.9 vs. 6.6 ± 2.6, P < .001). Furthermore, HADS-A showed positive correlation with systolic and diastolic pressures measured in the outpatient clinic (r=0.523 and r=0.387, respectively; P < .001 for both). The full model with HADS-A had better discriminatory power (Harrell's c-index 0.82 vs. 0.77, P = .0025), increased calibration, and a greater net benefit than the base model without. The ROC curve analysis, using a cut-off of >6 for HADS-A, demonstrated a sensitivity of 76.5% and specificity of 53.6% in detecting WCH (Area Under the Curve=0.72, P < .001). Conclusions: Our study revealed that individuals with WCH, in comparison to those with SustHT, exhibit a higher level of anxiety as indicated by HADS-A. [ABSTRACT FROM AUTHOR]

Objective: The use of herbal teas can affect some physiological parameters of the body. Valerian has been used as a valuable medicinal plant. There are reports about sedative and sleep-inducing effects of Valeriana officinalis L. (VOT) on the nervous system. But in relation to its possible effect on the autonomic nervous system, the available information is limited. This study aimed to determine the effect of VOT on sympathovagal tone based on heart rate variability indices. Materials and Methods: In this semi-experimental study, 12 healthy volunteers were enrolled. At first, the participants received 50 ml of water as the control group, and then after the clearance time, they received VOT with a dilution of 50% with the same temperature and volume and were considered the intervention group. Assessment of sympathovagal tone was performed in terms of heart rate variability indices. There were 5 recording steps: baseline, after drinking water, and 5, 20, and 30 minutes after drinking VOT. Results: The mean±SD of the average heart rate per minute at the five recording steps after VOT was 65.4±15.5, 63.5 ±14.6, 62.7±15.6, 61.8±16.09, and 60.9 15.2, respectively (p<0.05). The average arterial systolic pressure at the five recording steps after VOT was 119.4±7.4, 117.9± 9, 114.3±7.9, 113.8±8.6, and 114±6.5 mmHg, respectively. Conclusion: A single cup of VOT significantly decreased the heart rate. This effect may be associated with a decrease in sympathetic activity and an increase in parasympathetic activity. [ABSTRACT FROM AUTHOR]

Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mechanisms underlying the development of CAC during prolonged high‐intensity endurance exercise are unknown. This study aims to determine if there are differences in cardiovascular haemodynamic measures and heart rate variability (HRV) in individuals with (CAC+) and without CAC (CAC−). Hemodynamic measures from 56 healthy, middle‐aged (median [interquartile range] 51 [43–58] years) individuals (41 men/15 women) participating in a 91 km [251.2 [217.2‐271.6] min] leisure sport mountain bike race were included in this study. Twenty‐five participants (20 men/5 women) were classified as CAC+ based on coronary computed tomographic assessment. Haemodynamic measures and HRV were quantified at the top of the hardest hill (THH) during the last quarter of the race. At the top of THH, CAC+ individuals had significantly higher systolic blood pressure (SBP) (235 [225–245] mmHg vs. 220 [193–238] mmHg, P = 0.008), higher diastolic blood pressure (DBP) (105 [95–110] mmHg vs. 95 [85–110] mmHg, P = 0.006), higher pulse pressure (130 [125–140] mmHg vs. 123 [110–130] mmHg, P = 0.039), higher mean rate pressure product (33,882 [30,872–35,053] bpm × mmHg vs. 31,028 [27,392–33,047] bpm × mmHg, P = 0.028), and larger increase in DBP from baseline (20 [20–30] mmHg vs. 10 [0–20] mmHg, P = 0.001), compared with CAC− individuals. Further, CAC+ participants showed a significant reduction in the low‐frequency component of HRV (HRVLF) (6.3 [2.4–11.5] ms2 vs. 12.4 [6.8–20.2] ms2, P = 0.044). In multivariable analysis, HRVLF was an independent predictor of the presence of CAC even after adjusting for established risk factors of atherosclerosis: age, sex, body mass index, maximum heart rate, V̇O2max${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{max}}}}$, smoking, resting SBP and resting DBP. CAC+ individuals had significant alterations in haemodynamic measures and HRVLF following prolonged high‐intensity endurance exercise compared with individuals without CAC. HRVLF was an independent predictor of CAC, suggesting an adverse autonomic response to high‐intensity endurance exercise in individuals with CAC. [ABSTRACT FROM AUTHOR]

Background: Epidural analgesia has become the most commonly used technique which not only provides perioperative surgical anaesthesia but also postoperative analgesia following lower abdomen and lower limb procedures is epidural anaesthesia. Present study was aimed to compare ropivacaine (0.75%) versus bupivacaine (0.5%) for epidural anaesthesia in patients undergoing lower abdominal and lower extremity surgeries. Material and methods: Present study was Randomized, single blinded, interventional study, conducted patients aged 20-60 years, any gender, body weight between 50 to 100 kgs, height between 150-180 cm, ASA I & II, undergoing lower abdominal and lower extremity surgeries. Patients were randomized into either of two groups by computer-generated software as B group (Received bupivacaine) & R group (Received ropivacaine). Results: There was no significant difference between two groups in the time of onset of sensory block, time of onset of Motor block & two segment regression. There was a significant difference between two groups in duration of motor block (more in B group) & duration of analgesia (more in R group). There was slight decrease in heart rate & systolic blood pressure at 5 and 10 min in group B. There was slight decrease in systolic blood pressure & mean arterial pressure at 10 and 15 min in group B. There was stability in oxygen saturation among patients of both groups. Conclusion: Duration of motor block was more in Bupivacaine group and duration of analgesia were more in Ropivacaine group patients. This implies that Ropivacaine has more efficacy compared to Bupivacaine. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide. Traditional methods of estimating blood loss and monitoring vital signs often delay intervention. The Shock Index (SI), calculated as heart rate divided by systolic blood pressure, is a potential early indicator of hemodynamic instability in PPH.Aim was to evaluate the role of SI and other vital signs like mean arterial pressure (MAP), pulse pressure (PP) and diastolic blood pressure (DBP) in predicting adverse maternal outcomes following PPH. METHODS: This prospective observational study included 70 women with PPH at a tertiary care hospital. Monitoring occurred at 15, 30 and 60 minutes postpartum. Blood loss was measured gravimetrically. SI thresholds and vital signs were analyzed to assess their correlation with blood loss severity and maternal outcomes. Results: SBP, DBP and MAP showed significant declines with increasing blood loss. SI values rose consistently, with higher thresholds correlating with adverse outcomes. An SI =1 was linked to the need for operative interventions, while an SI >1.3 indicated ICU admissions and increased morbidity. AMTSL reduced PPH incidence but required strict adherence to protocols. Conclusion: SI is a reliable and cost-effective tool for early identification of hemodynamic instability in PPH. It aids in timely interventions, especially in resource-limited settings. Standardizing SI in clinical practice can improve maternal outcomes. Future studies should validate these findings across diverse settings and populations. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and endotracheal intubation are known to cause significant hemodynamic responses that can be detrimental in susceptible patients. This study evaluated the efficacy of oral pregabalin premedication in attenuating these responses. METHODS: In this prospective randomized double-blind controlled study, 120 ASA I-II patients aged 18-60 years undergoing elective surgeries were randomly allocated into two groups (n=60 each). Group A received oral pregabalin 150mg and Group B received placebo 90 minutes before induction. Standard anesthetic protocol was followed. Hemodynamic parameters were recorded at baseline, pre-induction, and at 1,2,4,6,8,10 and 15 minutes after intubation. Results: In Group A (Pregabalin), heart rate peaked at 1 minute (102.28±7.583 bpm) and returned to baseline by 6 minutes (88.53±9.335 bpm). Systolic blood pressure peaked at 2 minutes (122.30±5.762 mmHg) and normalized by 4 minutes (117.23±6.074 mmHg). Diastolic blood pressure and mean arterial pressure increased at 1 minute (86.47±8.087 and 97.97±6.580 mmHg respectively) and fell below baseline by 4 minutes. The magnitude of these changes was significantly lower than in Group B (p<0.01). Control group showed persistently elevated parameters even at 15 minutes post-intubation. Conclusion: Oral pregabalin 150mg administered 90 minutes before induction effectively attenuates the hemodynamic stress response to laryngoscopy and intubation without significant adverse effects. [ABSTRACT FROM AUTHOR]

Aim: Assessment of blood pressure during exercise is routine in athletes, but normal values remain equivocal. This study examines the response of systolic blood pressure (SBP) to exercise in a large cohort of athletes and establishes normative values by sex and age. Methods: Competitive athletes free of cardiovascular disease underwent pre-participation exercise testing on a bicycle ergometer. Resting (SBPrest) and peak blood pressure (SBPpeak), heart rate (HRrest and HRpeak), and power output (WR) were recorded. Workload indexed values were calculated. Results: The cohort included 12,083 athletes (median age 15 years, 26.9% female). Median peak exercise SBP was similar between sexes, but WR-indexed measures including SBP/WR ratio and SBP/(WR/kg) slope were higher in females (0.9 vs. 0.7, p < 0.001; 10.94 vs. 9.52, p < 0.001). Univariate analyses revealed significant associations between SBPpeak and several predictors, including sex, age, weight, height, SBPrest, DBPrest, HRrest, HRpeak, and WR (all p <.001). Multivariate analysis showed that SBPrest (beta = 0.353, 95% CI [0.541, 0.609], p < 0.001), height (beta = 0.303, 95% CI [0.360, 0.447], p < 0.001), WR (beta = 0.171, 95% CI [0.029, 0.045], p < 0.001), and age (beta = 0.093, 95% CI [0.162, 0.241], p < 0.001) were the strongest predictors of SBPpeak. Conclusion: This study provides reference values for the interpretation of SBP responses to exercise in athletes. Multivariate analyses highlight the complex interplay of factors influencing peak SBP, including SBPrest, height, WR, age, DBPrest, sex, endurance sport category, and weight. In future studies, these findings may inform the development of personalised training strategies and risk stratification models in athletic populations. [ABSTRACT FROM AUTHOR]

Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post‐discharge. To clarify status post‐hospitalization, we related exercise stress echocardiography (ESE) in 15 recovering patients (RP) age 30–63 without myocarditis to matching published data from healthy subjects (HS). RP exercise, average duration 8.2 ± 2.2 SD, was halted by dyspnea or fatigue. RP baselines matched HS except for higher heart rate. At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% ± 7 vs. 73% ± 5, p < 0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e', 9.1 ± 2.5 vs. 6.6 ± 2.5, p < 0.006) compared with HS performing equal exercise (8.5 ± 2.6 min). Thus, when stressed, patients without known cardiac impairment showed diminished systolic contractile function and diastolic LV compliance vs. HS. RP peak heart rate was significantly higher (172 ± 18 vs. 153 ± 20); peak systolic blood pressure trended higher (192 ± 31 vs. 178 ± 19). Pulmonary artery systolic pressures among RP remained normal. ESE uniquely identified residual abnormality in cardiac contractile function not evident unstressed, exposing previously unrecognized residual influence of COVID‐19. This may reflect autonomic dysfunction, microvascular disease, or diffuse interstitial changes; these results may have implications for clinical management and later prognosis. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) has shown potential as a tool for monitoring thermal strain, but there is limited data to support its efficacy in older adults during prolonged heat exposures. We compared HRV between young (19–31 years, n = 20) and older (61–78 years, n = 39) adults during 9 h of heat exposure (40 °C, 9% RH). We also explored whether heart rate (HR) and/or HRV could be used to distinguish older adults who achieved elevated thermal strain, defined as either (1) an increase in core temperature >1.0 °C (occurring in 39%, 15/39) or (2) a reduction in systolic blood pressure >10 mm Hg (occurring in 67%, 26/39). Percentage of age-predicted maximal HR and percentage of heart rate reserve (HRR) were higher, whereas standard deviation of normal RR intervals, the square root of the mean of squared differences between successive RR intervals (RMSSD), high frequency power (HF), and cardiac vagal index (CVI) were lower in older compared to young adults during heat exposure (P ≤ 0.004). In older adults, increases in core temperature were correlated with percentage of age-predicted maximal HR, percentage of HRR, RMSSD, and CVI (P ≤ 0.031), whereas changes in systolic blood pressure were not significantly associated with HR or HRV indices (P ≥ 0.327). Receiver operating characteristic curve analysis indicated that HR and HRV indices had generally poor ability to identify older adults with elevated thermal strain (area under the curve ≤0.65). Age-related differences in HRV, consistent with vagal withdrawal among older adults, remained during daylong heat exposure, but marked heterogeneity of response likely contributed to HRV providing limited discriminatory value in identifying changes in core temperature or blood pressure in older adults. [ABSTRACT FROM AUTHOR]

Foot immersion and neck cooling are recommended cooling strategies for protecting heat-vulnerable persons during heat waves. While we recently showed that these strategies do not limit core temperature increases in older adults during prolonged heat exposure, we did observe small reductions in heart rate. Expanding on these findings, we examined the effects of foot immersion with and without neck cooling on cardiac autonomic function. Seventeen adults (9 females; 65–81 years) underwent 3 randomized, 6 h exposures to 38 °C and 35% relative humidity with: no cooling (control), foot immersion (20 °C water), or foot immersion with a wet towel (20 °C) around the neck. Cardiac autonomic responses were measured at baseline and end-exposure. These included heart rate variability, cardiac and systolic blood pressure responses to standing, indexed via the 30:15 ratio and supine-to-standing systolic pressure change, respectively, and baroreflex sensitivity during repeated sit-to-stand maneuvers. The 30:15 ratio was 0.04 [95% CI: 0.01, 0.07] greater with foot immersion and neck cooling (1.08 (SD: 0.04)) relative to control (1.04 (0.06); P = 0.018). Similarly, standing systolic blood pressure was elevated 9 [0, 17] mmHg with foot immersion and neck cooling (P = 0.043). That said, neither difference remained statistically significant after adjusting for multiplicity (Padjusted ≥ 0.054). No differences in 30:15 ratio or standing systolic blood pressure were observed with foot immersion alone, while heart rate variability and baroreflex sensitivity were unaffected by either cooling intervention. While foot immersion with neck cooling potentially improved cardiac autonomic responses in older adults exposed to simulated indoor overheating, these effects were small and of questionable clinical importance. [ABSTRACT FROM AUTHOR]

Background: Globus pharyngeus could be described as a benign sensation of lump or foreign object in the throat. The etiology of the globus as a solitary syndrome is still unknown, but it is proposed that stress could have an important role in symptom emergence. Aims: To evaluate the autonomic nervous regulation in patients with globus compared to healthy controls in reaction to stress. Methods: Patients included in the study were diagnosed based on ROME IV criteria for Disorders of Gut Brain Interaction. Besides globus, the patients did not suffer any other substantial medical condition. As a control group, measurement of healthy volunteers was performed. Both groups underwent the same stress protocol assessment in the same laboratory settings. The protocol consist of two types of stressors: cold pressor test and mental arithmetic test to test different types of autonomic reactivity. Results: Baroreflex sensitivity was significantly decreased in patients compared to controls in all phases of the protocol. Low-frequency band of systolic blood pressure variability was significantly increased during both stress phases in patients compared to controls. High-frequency band of heart rate variability was significantly decreased in patients compared to controls during the both of the stress phases. Conclusion: The results of this study shows discrete abnormalities in complex autonomic reflex control which are predominantly manifested in response to stressful stimuli indicating altered neurocardiac regulation as a reaction to stress associated with globus pharynegus. This fact could have an important role in the personalized management of globus patients such as biofeedback. [ABSTRACT FROM AUTHOR]

Excessive water consumption from liquid or reconstituted oral nutrition supplements may increase risk of fluid overload in renal patients. Nutri‐jelly, a ready‐to‐eat texture‐modified diet with 52.8% water, some protein, low potassium, phosphorus, and sodium, could be an alternative. However, its safety is unknown for adults undergoing hemodialysis (HD). This study investigated the short‐term physiological safety of Nutri‐Jelly intake and its preliminary impact on renal outcomes. A randomized open‐label, single‐arm, two‐sequence, two‐period cross‐over trial was conducted in 20 adults undergoing HD with inadequate protein intake (0.50 ‐ 0.70 g/ kg body weight/day). Participants were randomly allocated into 2 groups (n =10 each) and assigned in random sequence into both Without‐Jelly (HD 3 times during 7 days) and With‐Jelly periods (100 g Nutri‐Jelly twice daily along with HD 3 times during 7 days). A two‐week washout was between the periods. Outcome measures included adverse symptoms, changes in body weight, heart rate, blood pressure, and blood biochemical parameters relevant to renal outcomes. The results showed no intervention‐related adverse symptoms or significant changes in body weight, heart rate, systolic blood pressure, creatinine, albumin, and sodium. Potassium level and pre‐HD diastolic blood pressure were better controlled during the With Jelly than the Without Jelly Periods (p < 0.01 and p < 0.05, respectively). The eGFR was improved with no significant difference between the periods. The findings suggest that continuous intake of 100 g Nutri‐Jelly twice daily for 7 days is safe in adults undergoing hemodialysis. Its efficacy on renal‐related parameters warrants further investigations in long‐term studies. [ABSTRACT FROM AUTHOR]

Objectives: Hemodynamic gain index (HGI), a novel hemodynamic index obtained from cardiopulmonary exercise testing (CPX), is associated with adverse cardiovascular outcomes. However, its specific relationship with ventricular arrhythmias (VAs) is unknown. We aimed to assess the association of HGI with risk of VAs in a prospective study. Design: Hemodynamic gain index was estimated using heart rate and systolic blood pressure (SBP) responses ascertained in 1945 men aged 42–61 years during CPX from rest to maximum exercise, using the formula: [(Heart ratemax x SBPmax) – (Heart raterest x SBPrest)]/(Heart raterest x SBPrest). Cardiorespiratory fitness (CRF) was measured using respiratory gas exchange analysis. Hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for VAs. Results: Over a median follow-up duration of 28.2 years, 75 cases of VA were recorded. In analysis adjusted for established risk factors, a unit (bpm/mmHg) higher HGI was associated with a decreased risk of VA (HR 0.72, 95% CI: 0.55–0.95). The results remained consistent on adjustment for lifestyle factors and comorbidities (HR 0.72, 95% CI: 0.55–0.93). Comparing the top versus bottom tertiles of HGI, the corresponding adjusted HRs (95% CIs) were 0.51 (0.27–0.96) and 0.52 (0.28–0.94), respectively. The associations were attenuated on addition of CRF to the model. HGI improved risk discrimination beyond established risk factors but not CRF. Conclusions: Higher HGI is associated with a reduced risk of VAs in middle-aged and older Caucasian men, but dependent on CRF levels. Furthermore, HGI improves the prediction of the long-term risk for VAs beyond established risk factors but not CRF. [ABSTRACT FROM AUTHOR]

Hypotension is a common complication during neuraxial anesthesia, particularly among elderly patients due to agerelated declines in β-adrenergic sensitivity. Ephedrine, a mixed α- and β-agonist, is frequently used to counteract hypotension, yet its efficacy may vary with age. This study evaluated the age-related hemodynamic response to ephedrine in middle-aged and elderly patients under neuraxial anesthesia. Study designed with 100 patients divided into middle-aged (45--64 years) and elderly (≥65 years) groups, the research monitored key hemodynamic parameters such as systolic and diastolic blood pressure, mean arterial pressure (MAP), and heart rate during and after surgery. Elderly patients exhibited a reduced response to ephedrine, with lower increases in MAP (mean 81 ± 6 mmHg) compared to middle-aged patients (87 ± 6 mmHg). The elderly group also required additional vasopressors more frequently to achieve target blood pressures. Age significantly affects the efficacy of ephedrine in managing hypotension during neuraxial anesthesia. These findings highlight the significant impact of age on the effectiveness of ephedrine for managing hypotension in neuraxial anesthesia. Consequently, the study suggests the necessity for age-adjusted dosing and the exploration of alternative vasopressors for elderly patients to optimize hemodynamic outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: OFLUTD may present imbalances in the autonomic nervous system and hypothalamic-pituitary-adrenal axis, activating the sympathetic nervous system (SNS) and releasing catecholamines. We suggest that describing HRV indices in the short term in cats diagnosed with OFLUTD and investigating the influence of autonomic modulation on the pathophysiology of the disease can provide beneficial clinical management, which can be used as a predictor of ANS imbalance and increase patient survival. Obstructed patients had lower temperatures, evidencing the influence of uremic toxins on thermoregulation; increased total proteins, segmented neutrophils, lymphocytes, decreased platelets and electrolyte changes such as hypercalcaemia, hypocalcaemia, low bicarbonate levels (HCO3); and decreased pH, in addition to exhibiting high levels of urea and creatinine. Arterial chemoreceptors are involved in the autonomic balance of the heart and are sensitive to changes in arterial gas pressure and pH. There was a decrease in HRV in animals with OFLUTD and an improvement due to treatment. The evaluation of HRV parameters such as SDNN and the rMSSD could serve as preventive tools and aid in determining patient prognosis due to the imbalance of the ANS, as these parameters can provide prompt assistance and reduce the risk of death. Obstructive feline lower urinary tract disease (OFLUTD) is the most common complication of the urinary system, as metabolic and electrolyte changes can alter the functioning of the autonomic nervous system (ANS). The objective of this study was to describe the indices of heart rate variability (HRV) and their correlations with the observed alterations in Systolic Blood Pressure (SBP) and electrocardiographic, biochemical, and haemogasometric indices in cats diagnosed with OFLUTD. Sixty-five male cats up to 10 years of age were divided into two groups. The control group (CG) was composed of 25 healthy cats, and the obstructed group (OG) consisted of 40 cats with OFLUTD. The OG was evaluated by electrocardiography and blood pressure at four different time points. In the CG, electrocardiographic evaluation and SBP measurement were performed. A comparison of the HRV between the CG and OG (M0) revealed differences in the SDNN (standard deviation of all normal RR-NN) parameters (sympathetic and parasympathetic tone) and in the rMSSD (parasympathetic tone); there was a difference in the SBP, which was greater in the CG. There were higher rates in the CG. The HF and HR were greater in OG. The HRV serves as a preventive tool and predicts the severity of OFLUTD in patients due to an imbalance in the ANS. [ABSTRACT FROM AUTHOR]

Background: Extubation is a critical procedure in anesthesia and critical care, often accompanied by complications, such as bucking, coughing, and hemodynamic instability, particularly after major surgeries. The Bailey manoeuvre, involving deep extubation with the i-gel laryngeal mask airway (LMA), may mitigate these issues. The study was planned to compare the hemodynamic effects and side effect profiles of conventional awake endotracheal extubation and exchange extubation with the i-gel LMA. Aims and Objectives: The study was designed to compare hemodynamic stress response and respiratory complication between the conventional extubation group and the following exchange extubation group. Materials and Methods: In a prospective, randomized, single-blinded controlled study, 60 patients undergoing surgery under general anesthesia were divided into two groups: Group T (awake extubation) and Group L (exchange extubation with the i-gel LMA). Hemodynamic parameters and side effects were recorded and analyzed. Results: Group L exhibited significantly lower heart rates, systolic and diastolic blood pressures, and mean arterial pressures at various time points post-extubation compared to Group T. The incidence of hypertension was significantly higher in Group T (90%) versus Group L (50%). Bucking and coughing less in the i-gel LMA exchange group compared to the standard endotracheal tube extubation group. Conclusion: Exchange extubation with the i-gel LMA offers better hemodynamic stability and a lower incidence of hypertension compared to conventional awake extubation. This technique may be particularly beneficial for high-risk patients and those undergoing complex surgeries. [ABSTRACT FROM AUTHOR]

A three-in-one protocol comprised of pelvic external fixation, retroperitoneal pelvic packing, and angiography with or without embolization has been developed and used in our centre to improve survival outcomes of hemodynamically unstable pelvic fractures since 2008. Fourteen paediatric patients over a period of 15 years are reviewed in this case series. The mean age is 11.6 and standard deviation is 4.6. The mean injury severity score is 31.6. Sixty four percent underwent three-in-one protocol management. The overall survival rate at index hospital admission and at one year is 85.7% which is higher than the adult group (81%) from a study conducted at our centre and comparable to the rate in paediatric group. One patient had pelvic external fixator pin tract infection and two had lower limb ischemia post embolization. At 6 months follow up, one patient had pelvic pain and one had hip protrusio. We conclude that improvement in survival outcome also applies to the paediatric population. Technical differences in the paediatric group is highlighted to minimize potential complications. [ABSTRACT FROM AUTHOR]

Background: Considering the importance of cardiac rehabilitation after coronary artery bypass grafting (CABG) and the development of acupuncture over the past few decades, the aim of this study was to evaluate the effects of acupuncture on patients' exercise tolerance, heart rate and blood pressure after CABG. Methods: Thirty-four patients with a history of recent CABG were recruited between 2019 and 2020 for this clinical trial and randomly divided into two groups receiving acupuncture plus cardiac rehabilitation (group A) and cardiac rehabilitation alone (group B). In both groups, exercise-based rehabilitation exercise was performed. Group A additionally received acupuncture at PC6, PC4, HT7 and GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale score were evaluated before, during and after the course of the treatment. Results: Heart rate was significantly lower in group A compared to group B after completion of the course of the treatment (P = 0.022). However, there were no statistically significant differences between the two groups in systolic or diastolic blood pressure or Borg scale scores (P > 0.05). Nevertheless, the Borg scale scores showed a significant decrease within each group over time (P < 0.001), reflecting an improvement in the patients' ability to tolerate activity after cardiac rehabilitation with or without acupuncture. Conclusion: Acupuncture in combination with exercise-based cardiac rehabilitation was more effective at decreasing heart rate than cardiac rehabilitation alone after CABG. Both approaches appeared to be similarly effective at improving exercise tolerance. In this study, the addition of acupuncture at the aforementioned traditional acupuncture point locations to exercise-based cardiac rehabilitation did not affect blood pressure. Trial registration number: IRCT20171208037793N1 (Iranian Registry of Clinical Trials). [ABSTRACT FROM AUTHOR]

Aims: This study assessed the effect of immersive virtual reality (IVR) on anxiety and intraoperative pain in adult patients undergoing dental extractions with local anesthesia. Methods: In a single-blind, randomized clinical trial from September 2022 to December 2023 at a private dental clinic, 190 patients with dental anxiety were randomly assigned to either an IVR or a control group. Primary outcomes—dental anxiety and perioperative pain—were measured using the State-Trait Anxiety Inventory (STAI), Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS) before and after the procedure. Secondary outcomes included heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP), recorded at various stages. Results: The IVR group showed significant reductions in total anxiety, state anxiety, and MDAS scores compared to the control group (p < 0.001). Pain intensity was also lower in the IVR group (p = 0.03). Additionally, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were consistently lower in the IVR group across different stages. Post anesthesia, the IVR group showed notably lower mean SBP and DBP values (p < 0.001). After surgery, the IVR group also showed lower HR (p = 0.01), SBP (p < 0.001), and DBP (p < 0.001) compared to the control group. Conclusions: IVR significantly reduced STAI, STAI-S, and MDAS scores and decreased intraoperative pain compared to the control group. [ABSTRACT FROM AUTHOR]

Foods rich in polyphenols have beneficial effects on health. This study aimed to examine the impact of dark chocolate on endurance runners' arterial function. Forty-six male amateur runners, aged 25–55, participated. The initial assessments included clinical testing, arterial stiffness measurements, and a cardiopulmonary exercise test. The participants then consumed 50 g of dark chocolate (70% cocoa) daily for two weeks, maintaining their usual training routine. After this period, the baseline assessment was repeated. The results showed significant improvements. Pulse wave velocity decreased by 11.82% (p < 0.001), and augmentation index by 19.47% (p < 0.001). Systolic brachial blood pressure reduced by 2.12% (p < 0.05), diastolic by 2.79% (p < 0.05), and mean pressure by 2.41% (p < 0.05). Central arterial pressure also decreased, with systolic by 1.24% (p < 0.05), diastolic by 2.80% (p < 0.05), and mean pressure by 2.43% (p < 0.05). Resting heart rate increased by 4.57% (p < 0.05) and left ventricular ejection time decreased by 4.89% (p < 0.05), particularly in athletes over 40. Exercise time increased by 2.16% (p < 0.05), heart rate (max) by 1.15% (p < 0.05), VO2max by 2.31% (p < 0.05), and anaerobic threshold shifted by 6.91% (p < 0.001) in exercise time and 6.93% (p < 0.001) in VO2max. In conclusion, dark chocolate improves arterial function in endurance runners, enhancing vascular health. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV) is the change in time intervals between heart beats, reflecting the autonomic nervous system's ability to adapt to psychological and physiological demands. Slow breathing enhances parasympathetic activity, increasing HRV. Pranayama, a yoga breathing technique, affords the conscious regulation of respiration frequency. This study aimed to characterize HRV, blood pressure and peripheral oxygen saturation of basic yoga breathing slow techniques with regular yoga practitioners. Methods: In total, 45 yoga practitioners were included in the study (including 7 males, mean age of 54.04 ± 11.97 years) with varying levels of yoga experience (minimum 3 months, maximum 37 years). Participants performed three breathing conditions: baseline (control) and two yoga techniques (abdominal (adham) and complete (mahat)) breathing, each for 10 min in the supine position (i.e., savasana). For each condition, respiratory frequency, heart rate (HR), blood pressure and peripheral oxygen levels were collected. Results: The findings revealed that both abdominal and complete yoga breathing techniques promoted a decrease in respiratory frequency (p < 0.001, r = 0.61; p < 0.001, r = 0.61, respectively), and an increase in peripheral oxygen saturation (p < 0.001, r = 0.50; p < 0.001, r = 0.46, respectively), along with blood pressure decreases in all mean values, and a significant decrease in systolic pressure, considering all conditions (p = 0.034, W = 0.08). There were significant increases in standard deviation of HR during abdominal and complete yoga breathing techniques compared with the baseline (p = 0.003, r = 0.31; p < 0.001, r = 0.47, respectively), indicating enhanced parasympathetic activity. Moreover, the complete breathing technique exhibited the greatest variability in HRV measures, with several significant differences compared with abdominal breathing (standard deviation of HR, p < 0.001, r = 0.42; SD2, standard deviation of points perpendicular to the Poincaré parallel line, p < 0.003, r = 0.31; SD1/SD2, p < 0.003, r = 0.31), suggesting a more profound impact on autonomic modulation. Conclusions: simple, inexpensive and non-intrusive abdominal and complete yoga breathing techniques can effectively and momentarily enhance HRV and oxygen saturation in adults, mature adults and the elderly. [ABSTRACT FROM AUTHOR]

Background: The global COVID-19 lockdown restricted daily routines due to the psychological fear of infection, which imposed an unknown universal threat on female college students, affecting physiological health and well-being. However, scant information concerning the efficacy of yogic practice on female college students during the stressful COVID-19 pandemic situation is available. Methods: In a randomized controlled trial (n = 74, age = 21.65 [4.05] y), a study was conducted with a well-conceptualized yogic module for 5 days/week for 3 months (40 min daily in the morning) among yogic volunteers. Pre–post analysis of anthropometric, physiological, and biochemical indices in pandemic-stressed female college students was done for the control and yoga groups. Results: After 3 months of yogic practice, significant reduction (P <.05) in heart rate (d = 0.64, meandiff = 5.43), systolic blood pressure (d = 0.59, meandiff = 5.32), cortisol (d = 0.59, meandiff = 6.354), and triglycerides (P <.01, d = 0.45, meandiff = 13.95) was observed. After yogic follow-up significant improvement (P <.01) in high-frequency (d = 0.56, meandiff = −7.3), total power (d = 0.46, meandiff = −1150) and time domain parameters of heart rate variability led to ameliorate the stress index. Superoxide dismutase (P <.01, d = 0.78, meandiff = 0.69), catalase (P <.05, d = 0.48, meandiff = −7.37), glutathione (P <.001, d = 0.83, meandiff = −4.15), high-density lipoprotein (P <.05, d = 0.48, meandiff = −11.07), and dopamine (P <.001, d = 0.97, meandiff = −135.4) values along with inflammatory markers (P <.001) significantly improved among yogic volunteers after regular practice. Conclusions: Our findings suggest that a 3-month well-conceptualized yogic intervention during COVID-19 may be considered as a prophylactic tool to improve female college students' universal psychophysiological health by ameliorating autonomic functions, cardiometabolic risk factors, and immune metabolisms in an economical and environment-friendly manner. [ABSTRACT FROM AUTHOR]

Background: There is a well-known comorbidity between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) which is only partially explained by common risk factors. Markers of cardiovascular autonomic dysfunction (CVAD), such as orthostatic hypotension and increased resting heart rate, are strongly associated with CAD. The autonomic nervous system also innervates the airways, and several studies have shown an association between autonomic dysfunction and COPD. However, less is known about whether CVAD and impairment of respiratory capacity are related in the population. We thus aimed to assess the relationship between markers of subtle CVAD and lung function in middle-aged subjects. Methods: In this cross-sectional study, we analysed data from CVAD assessment (orthostatic blood pressure and heart rate measurements) and pulmonary function tests from 5886 individuals from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Subjects were middle aged and randomly selected from the Swedish population. Linear regression models and ANOVA analyses were used to relate orthostatic blood pressure and resting heart rate to lung function parameters (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC-ratio, diffusion capacity for carbon monoxide (DLCO), respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20), decrease in resistance from R5 to R20 (R5-R20), reactance in distal airways (X5), resonant frequency (Fres) and reactance area (AX)). Results: Increasing systolic orthostatic blood pressure, decreasing diastolic orthostatic blood pressure, and increased resting heart rate associated with lower FVC (all p < 0.001) and FEV1 (p = 0.001; p = 0.005; p < 0.001, respectively) in models including age, sex and height. Apart from diastolic orthostatic blood pressure and FEV1, all relationships remained significant after adjustment for possible confounders. Increased resting heart rate was associated with reduced DLCO (p < 0.001). Conclusions: Increasing systolic orthostatic blood pressure, decreasing diastolic orthostatic blood pressure, and increased resting heart rate are associated with lower lung function, after adjustments for age, sex and height. These finding indicates associations between signs of cardiovascular autonomic dysfunction and lower lung function in the general population. However, the observed differences in lung function were small and the clinical application is unclear. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV) analysis has shown promise as a valuable complementary tool for clinical assessment in trauma cases. This study aims to evaluate the utility of HRV in monitoring different severities of hemorrhagic shock (HS) and its correlation with traditional hemodynamic and metabolic parameters. Methods: Male Sprague–Dawley rats were divided into different experimental groups, including those with and without vagotomy, and were exposed to different classes of decompensatory HS. To induce varying severities of HS, volume resuscitation was delayed by gradually returning 0%, 20%, or 50% of the shed blood volume at the end of the compensation phase, referred to as 0% DFR, 20% DFR, and 50% DFR class, respectively. Hemodynamic parameters were monitored, and HRV was calculated. Levels of TNF-α and IL-10 were determined in lung tissue at the end of the experiments. Correlations between HRV, hemodynamic parameters, inflammatory gene expression and arterial blood gas variables were evaluated. Results: HRV showed increased power of the low-frequency (LF) and respiratory sinus arrhythmia (RSA) in all groups during the hypotension phase of HS (Nadir 1). Subdiaphragmatic vagotomy blunted the increase in the LF component in the Nadir 1. After volume resuscitation, systolic blood pressure (SBP), RSA and LF returned to baseline in the 0% DFR and 20% DFR classes. However, animals in 50% DFR class exhibited a reduced SBP and LF and lower pH. Notably, strong correlations were found between LF and SBP as well as tissue hypoperfusion markers. The expression of TNF-α in the lung was increased in all HS groups, while this gene expression was significantly higher in the vagotomized animals. Conclusion: The alterations in HRV components were found to be significantly correlated with the hemodynamic and metabolic status of the animals, while showing no association with inflammatory responses. Additionally, the intervention of subdiaphragmatic vagotomy significantly impacted both HRV components and inflammatory responses. Collectively, these findings suggest the potential of HRV components for the assessment of the presence and severity of HS. [ABSTRACT FROM AUTHOR]

Background: Several heart rate variability (HRV) parameters were reported to be associated with residual renal function (RRF) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). However, it is unclear whether using HRV or other autonomic nervous system (ANS) activity indexes can predict RRF decline in CAPD patients. Methods: Patients undergoing CAPD in 2022 from the First Affiliated Hospital of Nanjing Medical University were enrolled in this study. Their clinical characteristics, 5-min HRV parameters and average voltage of 5-min skin sympathetic nerve activity (aSKNA) were collected. According to the 12-month glomerular filtration rate (GFR) decline rate compared with the upper quartile, these patients were categorized into two groups: RRF decline (RRF-D) group and RRF stable (RRF-S) group. Clinical factors and ANS activity indexes for predicting 1-year RRF decline were analyzed using logistic regression, and a nomogram model was further established. The relationships between volume load related indexes and aSKNA were displayed by Spearman's correlation graphs. Results: Ninety-eight patients (53 women, average age of 46.7 ± 13.0 years old) with a median dialysis vintage of 24.5 months were enrolled in this study. Seventy-three patients were categorized into the RRF-S group and 25 patients into the RRF-D group. Compared with RRF-S group, patients in the RRF-D group had higher systolic blood pressure (BP; p = 0.019), higher GFR (p = 0.016), higher serum phosphorous level (p = 0.030), lower total Kt/V (p = 0.001), and lower levels of hemoglobin (p = 0.007) and albumin (p = 0.010). The RRF-D group generally exhibited lower HRV parameters and aSKNA compared with the RRF-S group. A nomogram model included clinical factors (sex, systolic BP, hemoglobin, GFR, and total Kt/V) and aSKNA showed the largest AUC of 0.940 (95% CI: 0.890–0.990) for predicting 1-year RRF decline. Conclusion: The nomogram model included clinical factors (sex, systolic BP, hemoglobin, GFR and total Kt/V) and ANS activity index (aSKNA) might be a promising tool for predicting 1-year RRF decline in CAPD patients. [ABSTRACT FROM AUTHOR]

There is considerable evidence documenting associations between tobacco smoking, including initiation, maintenance, and relapse of addiction, with diminished cardiovascular responses to acute psychological stress. However, less is known about how smokers respond to repeated stress across time. The current study examined patterns of cardiovascular reactivity and adaptation to recurrent stress among 24‐h abstinence smokers, smokers who continued to smoke at their normal rate, and non‐smokers. Smokers were randomly assigned to one of two groups; ad libitum (n = 42), or 24 h abstinence (n = 61); non‐smokers (n = 43) provided comparative referencing. Across the two laboratory sessions, participants (n = 149) were asked to complete a modified version of the trier social stress test, while monitoring systolic and diastolic blood pressure, and heart rate activity. Results showed that while non‐smokers had elevated cardiovascular reactivity to begin with, they showed a greater capacity to habituate to recurrent stress across sessions. The data also suggest that smokers displayed lower cardiovascular reactivity to acute psychological stress and showed little habituation to repeated stress. In adjusted models, smokers exhibited less systolic blood pressure habituation to stress. This response profile in smokers may be a potential mechanism that leads to further cardiotoxic effects on health. [ABSTRACT FROM AUTHOR]

Introduction: Study comparatively evaluated the effect of metoprolol (intravenous followed by oral) treatment along with control drug (isosorbide dinitrate and diazepam) in a prospective randomized control trial manner. Here, patients were stratified according to age, infarct size, infarction type and type of ventricular arrhythmias before administrations of drug intravenous and oral metoprolol and others for total 70 patients. All patients were studied up to 365 days here and no death recorded in metoprolol therapy while 37% death occurred in control drug group. Thus, sufficient improvement in reduction of cardiac deaths recorded via metoprolol as compared to (Control) isosorbide dinitrate and diazepam (37%). Not only is that improvement in the reduction of chest pain, better controlled heart rate with reduction in the incidence of post-infarction arrhythmias, controlled systolic blood pressure, better reduction and limitation of infarct size, better electrocardiographic findings and reduced serum CPK-MB value also been recorded. In conclusion early administration of metoprolol and treatment in AMI improves the health (cardiac) status of patients suffering from myocardial infarction and thereby, significant reduction in death rate, reinfarction did not occur in metoprolol treated group as compared to 17.1% cases had reinfarction in control group. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Method: A total of 200 patients (50–75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. Results: In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090–1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043–1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. Conclusion: Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment. [ABSTRACT FROM AUTHOR]

Sport‐related concussion (SRC) is associated with cardiovascular autonomic nervous system (ANS) dysfunction. This study examines resting cardiovascular ANS activity in adolescents with SRC compared to controls early post‐injury and after clinical recovery, analyzing its correlation with symptom severity and recovery outcomes. Cardiovascular ANS function was evaluated using heart rate variability (HRV), systolic blood pressure variability (SBPV) and baroreflex sensitivity (BRS). Symptoms were assessed via the Post‐Concussion Symptom Scale, and recovery outcomes were categorized by recovery duration. Following acute SRC, no significant differences in HRV, SBPV or BRS were found between SRC and control groups, nor between those with delayed or normal recovery. Post‐recovery, SRC participants had higher low frequency (LF) SBPV than controls and their initial assessment. When concussed participants were symptomatic, LF SBPV correlated directly with overall, cognitive, and fatigue symptom severity, while high frequency (HF) HRV inversely correlated with affective symptoms (Spearman's rho: 0.4–0.6). Resting cardiovascular ANS function remains unchanged in adolescent athletes acutely after SRC, suggesting it has limited diagnostic and prognostic potential. Although some correlations between individual symptom domains and ANS activity were observed, they were not significantly different from asymptomatic controls, limiting the ability to interpret these findings. [ABSTRACT FROM AUTHOR]

Fuel dispensing at fuel stations is performed manually by unprotected male gas station attendants in Sri Lanka, who have long working hours. These workers are exposed to hydrocarbon fuels associated with multiple health effects by modulation of the autonomic nervous system. This study was performed to determine cardiovascular autonomic functions among fuel pump attendants in Sri Lanka. Fuel pump attendants (n = 50) aged between 19 and 65 years were identified for the study from seven fuel stations. They were compared with age‐ and gender‐matched controls (n = 46) without occupational exposure to fuel. A physical examination was performed before the autonomic function and heart rate variability (HRV) assessment. There were no significant differences in weight, height, or BMI between the study and the control populations (p > 0.05). Both the systolic blood pressure (SBP) (Mann Whitney U (MWU) = 743.5, p = 0.003) and diastolic blood pressure (DBP) (MWU = 686.5, p = 0.001) were significantly higher among the gas station attendants compared to controls. Valsalva ratio was significantly higher among the study group (MW U = 874.00, p = 0.043) compared to controls. The HRV analysis showed significantly higher SDNN and SD2 (MWU = 842.00, p = 0.034, and MWU = 843.50, p = 0.035 respectively) among the gas station attendants compared to controls. The changes to the cardiovascular autonomic parameters among those exposed to fuel vapor as a gas station attendant indicate an increase in sympathetic outflow to the vessels. In the occupational setting as fuel pump attendants need periodic monitoring. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation for inhalation anaesthesia in pigs is not considered a good anaesthetic method as it is technically difficult because of oral anatomy and the presence of excess tissues in the oropharyngeal region. Moreover, the major limitation of inhalation anaesthesia is that it requires the use of a cumbersome and costly anaesthetic machine, including a suitable breathing system and vaporizer and is the exposure of operating-room personnel to the pollution in the ambient air. Therefore, the present study was undertaken to evaluate the effect of propofol, ketamine and their combination 'Ketofol' as a TIVA in pigs. Methods: The study was conducted in eighteen piglets of either sex. The piglets were randomly divided into three groups with six animals in each group. All the three groups were premedicated with Atropine sulphate @ 0.04 mg/kg body weight and Xylazine Hydrochloride @ 1 mg/kg body weight I.M. and Medazolam @ 0.5 mg/kg body weight I.M. with minimum forcible restraint as preanaesthetic. In group-I, propofol @ 5 mg/kg body weight, in group-II, ketamine @ 5 mg/kg body weight and in group-III, ketofol @ 4 mg/kg body weight was administered intravenously for induction after 15 minutes of pre-anaesthetic administration. Surgical anaesthesia was maintained for 90 minutes in all three groups viz. group-I, group-II and group-III with propofol @ 2.5 mg/kg, ketamine @ 2.5 mg/kg and ketofol @ 2 mg/kg body weight respectively by intermittent bolus injection (IBI) technique. Clinical and cardiopulmonary profiles were evaluated before administration of the anaesthetic agent (0 minutes) then at 15, 30, 60 and 90 minutes during and after administration of anaesthetic agents to evaluate their anaesthetic effect. Result: The study revealed that induction time (IT), duration of analgesia (DOA), duration of recumbency (DOR) and recovery time (RT) interval showed better result in the combination of ketamine and propofol group as compared to propofol and ketamine-induced individual group. The temperature and respiration rate was significantly decreased in all the groups at 30 minutes during TIVA whereas heart rate was significantly increased in all the groups at 15 minutes. The combination of ketamine and propofol group showed a consistent diastolic pressure and systolic pressure during the entire period of anaesthesia. The SPO2 in the ketamineinduced group showed a significant decrease (P<0.01) as compared to the propofol and ketofol group. It was concluded that the anaesthetic drug combinations resulted in smooth and uneventful induction with mild cardiopulmonary depressions and rapid recovery. [ABSTRACT FROM AUTHOR]

Aims: Dopamine beta‐hydroxylase (DβH) inhibitors, like zamicastat, hold promise for treating pulmonary arterial hypertension. This study aimed to validate the mechanism of action of zamicastat by studying its effect on the overdrive of the sympathetic nervous system (SNS). Methods: A single‐centre, prospective, double‐blind, randomized, placebo‐controlled, crossover study evaluated the effect of 400 mg zamicastat in 22 healthy male subjects. Cold pressor test (CPT) was performed at screening and each treatment period on Days −1 and 10. Plasma and 24 h‐urine levels of dopamine (DA), epinephrine (EPI) and norepinephrine (NE), and plasma DβH activity, were measured. Results: Compared to placebo, zamicastat showed a − 4.62 mmHg decrease in systolic blood pressure during the cold stimulus vs. rest phases on Day 10 of CPT (P =.020). Zamicastat decreased mean arterial pressure response to cold stimulus during CPT (−2.62 mmHg; P =.025). At Day 10, zamicastat significantly increased plasma DA, before CPT (12.63 ng/L; P =.040) and after CPT (19.22 ng/L; P =.001) as well as the estimated plasma EPI change from baseline after CPT (P =.040). Inhibition of plasma DβH activity ranged from 19.8% to 25.0%. At Day 10, significant reductions in 24‐h urinary excretion of EPI (P =.002) and NE (P =.001) were observed. Zamicastat Cτ geometric mean ± GSD ranged from 45.86 ± 1.46 ng/mL on Day 3 to 58.64 ± 1.52 ng/mL on Day 10, with moderate inter‐individual variability (CV: 32.6%–36.6%). Steady state was already achieved on Day 6. Conclusions: Our results demonstrated the effect of zamicastat on the overdrive sympathetic response to cold stimulus, confirming its potential as SNS modulator. [ABSTRACT FROM AUTHOR]

Aims: We explored whether esketamine anesthesia during hysteroscopic surgery can reduce intraoperative hemodynamic fluctuations and improve patient benefit. Methods: A total of 170 patients undergoing hysteroscopic surgery were enrolled, and 151 patients were finally included in the analysis, among which 19 used vasoactive drugs during surgery. Patients were randomly assigned to either the esketamine anesthesia group (E group) or the sufentanil anesthesia group (S group). The primary outcomes were blood pressure and heart rate during the surgery. Secondary outcomes included resistance to laryngeal mask insertion, demand for propofol and remifentanil, nausea and vomiting, Richmond Agitation and Sedation Scale (RASS), dizziness and pain intensity after resuscitation, vasoactive medication treatment, hospitalization time and expenses. Results: E group had a more stable heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure than the S group (p < 0.001). Patients in E group had a higher demand for propofol (p < 0.001) but better RASS scores (p < 0.001) after resuscitation. The incidence of intraoperative vasoactive medication use was higher in the S group (18.4% vs. 6.7%, p = 0.029). There were no statistically significant differences in terms of resistance to laryngeal mask insertion, remifentanil demand, time required for resuscitation, postoperative pain, dizziness, nausea or vomiting. Conclusions: Compared with sufentanil, esketamine‐induced anesthesia during hysteroscopic surgery can reduce intraoperative hemodynamic fluctuations and the incidence of intraoperative vasoactive medication. Although esketamine‐induced anesthesia may increase the demand for propofol during surgery, it does not affect the anesthesia recovery time and the quality of patient recovery is better. [ABSTRACT FROM AUTHOR]

Hemorrhage is a leading cause of death in the prehospital setting. Since trauma-induced pain often accompanies a hemorrhagic insult, the administered pain medication must not interfere with critical autonomic regulation of arterial blood pressure and vital organ perfusion. The purpose of this study was to test two unrelated hypotheses: 1) sublingual sufentanil (Dsuvia) impairs tolerance to progressive central hypovolemia and 2) sublingual sufentanil attenuates pain sensation and the accompanying cardiovascular responses to a noxious stimulus. Twenty-nine adults participated in this double-blinded, randomized, crossover, placebo-controlled trial. After sublingual administration of sufentanil (30 μg) or placebo, participants completed a progressive lower-body negative pressure (LBNP) challenge to tolerance (aim 1). After a recovery period, participants completed a cold pressor test (CPT; aim 2). Addressing the first aim, tolerance to LBNP was not different between trials (P = 0.495). Decreases in systolic blood pressure from baseline to the end of LBNP also did not differ between trials (time P < 0.001, trial P = 0.477, interaction P = 0.587). Finally, increases in heart rate from baseline to the end of LBNP did not differ between trials (time P < 0.001, trial P = 0.626, interaction P = 0.424). Addressing the second aim, sufentanil attenuated perceived pain (P < 0.001) in response to the CPT, though the magnitude of the change in mean blood pressure during the CPT (P = 0.078) was not different between trials. These data demonstrate that sublingual sufentanil does not impair tolerance to progressive central hypovolemia. Additionally, sublingual sufentanil attenuates perceived pain, but not the accompanying mean blood pressure responses to the CPT. NEW & NOTEWORTHY: Addressing two unique aims, we observed that sublingual sufentanil administration does not impair tolerance or cardiovascular responses to lower-body negative pressure (LBNP)-induced progressive central hypovolemia. Second, despite pain perception being reduced, sublingual sufentanil did not attenuate mean blood pressure responses to a cold pressor test (CPT). [ABSTRACT FROM AUTHOR]

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG. Trial Registration Number: IRCT20150905023897N4. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal vascular indices and hemodynamic parameters at 35–37 weeks' gestation in pregnancies complicated by gestational diabetes mellitus (GDM), those with pre‐existing diabetes mellitus (DM) and those without GDM or pre‐existing DM. Methods: This was a prospective observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, and measurement of vascular indices and hemodynamic parameters using a non‐invasive operator‐independent device. These included carotid‐to‐femoral pulse‐wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. The values in the GDM and pre‐existing DM groups were compared to those in the unaffected group. Results: We examined 6746 women, of whom 396 were excluded because they had chronic hypertension or developed pre‐eclampsia or gestational hypertension. The study population of 6350 pregnancies contained 99 (1.6%) with pre‐existing Type‐I or Type‐II DM and 617 (9.7%) that developed GDM, including 261 (42.3%) that were treated with diet alone, 239 (38.7%) treated with metformin alone and 117 (19.0%) treated with insulin with or without metformin. Among women with GDM and those with pre‐existing DM, compared to those without GDM or pre‐existing DM, there was a higher median cardiac output and heart rate, central systolic and diastolic blood pressure and pulse‐wave velocity, but there was no significant difference in stroke volume or total peripheral resistance. There were no significant differences within the GDM group according to treatment type, except for higher heart rate in women treated with metformin alone compared to the group treated with diet alone. Conclusion: Women with GDM and those with pre‐existing DM have evidence of early vascular disease in the third trimester, and this may contribute to their increased long‐term cardiovascular risk. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of pheochromocytomas is associated with circulatory dynamics instability, necessitating systemic management of the patient in the intensive care unit after surgery. Early mobilization after pheochromocytoma surgery is not described in the guidelines, and to our knowledge, no reports have specifically focused on circulatory dynamics during early mobilization after surgery. Case presentation: A 31-year-old Japanese woman was diagnosed with bilateral pheochromocytoma and underwent a second-stage adrenalectomy for bilateral pheochromocytoma at our hospital. We evaluated circulatory dynamics during a passive upright posture on postoperative days 1 and 4. She was placed on a tilt bed in the supine position (0° head) for 15 min, passive upright posture (60°) for 15 min, and supine position again for 10 min. In the passive upright posture, both systolic and diastolic blood pressure decreased, and the heart rate increased by 10 bpm over approximately 10 minutes. After the postural change from the passive upright posture to the supine position, the heart rate decreased to a level lower than in the supine prior to the passive upright posture. The same measurements were taken on postoperative day 4. Systolic blood pressure decreased in the passive upright posture, but diastolic blood pressure remained unchanged. The heart rate also increased earlier after passive upright posture compared with that on the day after surgery. When the patient returned to the supine position from the passive upright posture, the heart rate decreased even further compared with its level prior to the passive upright posture, as observed on the day after surgery. Conclusion: Circulatory dynamics may fluctuate after surgery for pheochromocytoma due to a relative decrease in epinephrine and norepinephrine secretion. In this case, the patient's response may be close to normal by the fourth postoperative day, but circulatory dynamics fluctuations were noted on both the first and fourth postoperative days when the patient was supine after passive upright posture. Although the substantial variability of perioperative circulatory dynamics in patients with pheochromocytoma has improved considerably with the development of perioperative management guidelines, circulatory dynamics should be carefully monitored during early mobilization and after its completion. [ABSTRACT FROM AUTHOR]

Background: This study was designed and implemented to investigate the addition of dexmedetomidine to Serratus Anterior Plane Block (SAP) with ropivacaine in reducing pain in patients undergoing post-thoracotomy surgery. Methods: This study included patients classified as American Society of Anesthesiology (ASA) Physical Status II, with a body mass index (BMI) under 40, who were undergoing thoracotomy at Imam Khomeini Hospital in Ahvaz. The subjects were randomly divided into two groups using a randomized controlled trial design. After surgery, in the recovery room, SAP was performed for patients with ropivacaine (0.4 ml/kg of 0.2% ropivacaine solution) (group R) and ropivacaine plus dexmedetomidine (0.5 μg/kg) (group RD). Pain (with verbal rating scale, VNRS), blood pressure (systolic, diastolic, and mean arterial pressure (MAP)), heart rate (HR), and blood oxygen saturation (O2 sat) were measured and recorded before the intervention, and 1, 6, 12, 24, and 48 h after the intervention. Results: Finally, 74 patients were included in this study. Both groups exhibited significant pain reduction at one hour, with sustained pain relief observed in the RD group at 6, 12, and 24 h (P < 0.001). The RD group also showed having lower values HR and MAP at 6 and 12 h (P < 0.001). Patients in the RD group received painkillers faster (P = 0.005) and required lower total narcotic usage (P < 0.0001). Two RD group patients experienced transient bradycardia, which resolved without treatment. Conclusion: The findings of this study show that SAP block with dexmedetomidine is an effective and safe drug along with ropivacaine as a nerve-blocking agent in thoracotomy candidates. [ABSTRACT FROM AUTHOR]

Background: The exponential growth in mobile phone usage has raised concerns about electromagnetic field (EMF) exposure and its health risks. Blood pressure and BMI, which impair heart function due to decreased adrenoreceptor responsiveness, parasympathetic tone withdrawal, and increased sympathetic activity, may further exacerbate these risks. However, the effects of radiofrequency electromagnetic (RF‐EM) exposure from mobile phones on electrocardiograms (ECGs) and heart rate variability (HRV) in individuals remain unclear. Purpose: Building upon our previous findings on HRV changes due to mobile phone proximity, this study is aimed at significantly enhancing the analytical approach used to assess the effects of mobile phones on cardiac parameters. This study exploits data from a previous study but with a different purpose. The aim of this study is twofold: (a) to examine whether exposure to mobile phones changes the five variables (P‐R, QRS, QT, ST, and HR) in a multivariate manner and (b) to examine whether the blood pressure and/or the body mass index (BMI), which acts as a proxy for obesity, have an effect on the change of these five variables. For both aspects of the study, four cycles are performed. Method: We conducted multivariate analysis on previously collected electrical cardiac measurement data from 20 healthy male subjects exposed to mobile phone EMF, with the mobile phones placed at four different body locations. The one‐sample Hotelling T2 test on the mean vector of differences was utilised instead of multiple paired t‐tests. This multivariate method comprehensively analyzes data features and accounts for variable correlations, unlike multiple univariate analyses. Given our small sample size, we employed the MMPC variable selection algorithm to identify predictor variables significantly related to mean changes. Results: Significant alterations in ECG intervals and heart rate were noted in the subjects before and after the first EMF exposure cycle, independent of their BMI. Notably, heart rate, P‐R, and QRS intervals fell postexposure while QT and ST intervals increased. These changes were influenced by variations in systolic blood pressure, with BMI showing no significant effect. Conclusion: The observed modifications in cardiac electrical measurements due to mobile phone EMF exposure are attributed to the effects of EMF itself, with no impact from BMI on the extent of these changes. [ABSTRACT FROM AUTHOR]

Baroreflex is critical to maintain blood pressure homeostasis, and the quantification of baroreflex regulation function (BRF) can provide guidance for disease diagnosis, treatment, and healthcare. Current quantification of BRF such as baroreflex sensitivity cannot represent BRF systematically. From the perspective of complex systems, we regard that BRF is the emergence result of fluctuate states and interactions in physiological mechanisms. Therefore, the three‐layer emergence is studied in this work, which is from physiological mechanisms to physiological indexes and then to BRF. On this basis, since the entropy in statistical physics macroscopically measures the fluctuations of system's states, in this work, the principle of maximum entropy is adopted, and a new index called PhysioEnt is proposed to quantify the fluctuations of four physiological indexes, i.e., baroreflex sensitivity, heart rate, heart rate variability, and systolic blood pressure, which aims to represent BRF in the resting condition. Further, two datasets with different subjects are analyzed, and some new findings can be obtained, such as the contributions of the physiological interactions among organs/tissues. With measurable indexes, the proposed method is expected to support individualized medicine. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare the efficacy of bolus dose of Phenylephrine Versus Mephentermine for hypotension correction in patients undergoing elective caesarean section surgery. Methodology: After obtaining approval from the ethical committee and obtaining informed consent, 60 parturients aged between 18 - 40 years of age and gestational age from 34 to 40 weeks posted for elective lower segment cesarean section were included. They were randomly divided into Group P (n=30) and Group M (n=30). The parameters observed were level of Anaesthesia, hemodynamic variables, number of doses required to correct hypotension and adverse effects. Results: A total of 60 patients were analyzed. Within 5 minutes of Spinal anaesthesia there was no significant difference between Group-P and Group-M on drop of average Systolic blood pressure, Diastolic blood pressure and average Heart rates at different minutes. But after administering the drug for hypotention correction Group P shows very high average SBP and DBP correction compared to Group M which is statistically significant (p<0.0001) and Group P shows a fall in the heart rate compared to Group M which is statistically significant (p<0.0001). Conclusion: Phenylephrine is observed to be hemodynamically more suitable than Mephentermine in patients undergoing elective caesarean section surgery. [ABSTRACT FROM AUTHOR]

Background: The indications for endoscopy have increased enormously as it has matured from a purely diagnostic procedure to a therapeutic subspecialty. Number of studies has been done to compare propofol and dexmedetomidine for sedation for outdoor endoscopy procedure in patients with impaired liver function. In recent years, dexmedetomidine has been used as an alternative to propofol in providing sedation. Study Design: Open-label Randomised Controlled Trial. Aims: In this study we aim to compare haemodynamic, respiratory and safety profile of dexmedetomidine with propofol for ERCP in patients with impaired liver function. Materials and Methods: A total of 50 patients of American Society of Anaesthesiologists grade II aged 18 to 60 years were divided into two groups (25 each) depending upon the use of the drug under investigation in accordance with randomized, open label, controlled trial. In patients receiving propofol a bolus of 1mg/kg were given then propofol infusion was started at 1mg/kg/hr for maintenance of sedation whereas in patients receiving dexmedetomidine a loading dose of 1mcg/kg was given over 10 mins then infusion was started at 0.5mcg/kg/hr. The changes in the heart rate (HR), systolic blood pressure (SBP) diastolic blood pressure (DBP) and mean arterial blood pressure (MAP), respiratory rate and oxygen saturation(SpO2) were noted before during and after recovery from sedation during ERCP and analysed statistically. Results: Our study showed no significant difference in Heart rate, systolic blood pleasure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR) and oxygen saturation (SpO2) in the dexmedetomidine group when compared with propofol group. But incidences of complications are less in Propofol group when compared with dexmedetomidine group. Conclusion: No significant difference found in sedation with Propofol and dexmedetomidine during ERCP in haemodynamic and respiratory parameters but safety profile of Propofol is better than dexmedetomidine in impaired liver function. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV) is an emerging marker for cardiovascular health. This study explores the association between HRV and blood pressure control in hypertensive patients. To evaluate the relationship between HRV parameters and the control of blood pressure in patients diagnosed with hypertension. Materials and Methods: A cross-sectional study was conducted with 100 hypertensive patients (52 males and 48 females), aged 55.6 ± 10.2 years. Participants were classified into well-controlled and poorly controlled blood pressure groups based on standard criteria. HRV parameters, including SDNN and RMSSD, were measured and analyzed. Correlation analysis was performed to assess the relationship between HRV and blood pressure. Results: The study found that patients with well-controlled blood pressure had significantly higher HRV values. The mean SDNN in the well-controlled group was 42.3 ms, compared to 30.1 ms in the poorly controlled group (p < 0.01). Similarly, the mean RMSSD was 34.7 ms in the well-controlled group versus 25.5 ms in the poorly controlled group (p < 0.01). There was a moderate positive correlation between SDNN and systolic blood pressure (r = 0.45, p < 0.001) and between RMSSD and diastolic blood pressure (r = 0.38, p < 0.001). Conclusion: Higher HRV is associated with better blood pressure control in hypertensive patients. HRV may serve as a valuable non-invasive marker for monitoring hypertension. Further studies are warranted to understand the underlying mechanisms and clinical applications. [ABSTRACT FROM AUTHOR]