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Aim: Functional neuroimaging studies have suggested that prefrontal cortex dysfunction occurs in individuals with autism spectrum disorder (ASD). Near-infrared spectroscopy (NIRS) is a noninvasive optical tool used to investigate oxygenation and hemodynamic responses in the cerebral cortex by measuring changes in oxygenated hemoglobin. Previous studies using NIRS have suggested that male children with ASD exhibit reduced hemodynamic responses in the dorsolateral prefrontal cortex; however, only a few studies examined this response in adults with ASD. Methods: We examined the characteristics of prefrontal hemodynamic responses in 114 adults with ASD and 84 typically developing controls. Relative concentrations of oxygenated hemoglobin were measured with frontal probes every 0.1 s during the Stroop color-word task, using 24-channel NIRS. Results: Our findings demonstrated that the oxygenated hemoglobin changes in the ASD group were significantly smaller than those in the control group at channels 19, 20, 23, and 24- located over the orbitofrontal cortex and frontal pole (p < 0.05 for all three channels). The differences in oxygenated hemoglobin changes at Ch 20 were significantly correlated with the Autism-Spectrum Quotient Japanese version (AQ-J) total score and attention switching score, which is a symptom cluster of AQ-J (p = 0.043 and p = 0.009, respectively). Conclusion: Adults with ASD have reduced prefrontal hemodynamic responses as measured using near-infrared spectroscopy and the reduced activity of the frontal pole in particular is related to reduced attentional function. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation and carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy changes hemodynamic parameters. The impact of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy remains controversial Objectives: To evaluate the efficacy of administration of magnesium sulphate to attenuate hemodynamic responses during laparoscopic cholecystectomy Methods: This was a randomized control study conducted in the department of Anaesthesia. Forty patients undergoing laparoscopic cholecystectomy were assigned into two groups. One group received magnesium sulfate (50mg/kg) and second group received normal saline (0.9%). Systolic and diastolic blood pressures, heart rate and mean arterial pressure were measured before the induction, at the end of infusion and after the induction in both the groups. Results: There is no statistically significant differences between magnesium sulphate and normal saline groups in terms of age, gender, weight, ASA grade and duration of surgery (p>0.05). Common adverse effects like bradycardia, and hypotension were observed. The mean values of systolic blood pressure, diastolic blood pressure, heart rate and mean arterial pressure were significantly less (P< 0.05) in magnesium sulphate group as compared to normal saline group. Conclusion: Magnesium sulphate effectively attenuates hemodynamic responses during intubation and pneumoperitoneum during laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

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AimFunctional neuroimaging studies have suggested that prefrontal cortex dysfunction occurs in individuals with autism spectrum disorder (ASD). Near-infrared spectroscopy (NIRS) is a noninvasive optical tool used to investigate oxygenation and hemodynamic responses in the cerebral cortex by measuring changes in oxygenated hemoglobin. Previous studies using NIRS have suggested that male children with ASD exhibit reduced hemodynamic responses in the dorsolateral prefrontal cortex; however, only a few studies examined this response in adults with ASD.MethodsWe examined the characteristics of prefrontal hemodynamic responses in 114 adults with ASD and 84 typically developing controls. Relative concentrations of oxygenated hemoglobin were measured with frontal probes every 0.1 s during the Stroop color-word task, using 24-channel NIRS.ResultsOur findings demonstrated that the oxygenated hemoglobin changes in the ASD group were significantly smaller than those in the control group at channels 19, 20, 23, and 24- located over the orbitofrontal cortex and frontal pole (p

Background: Endotracheal intubation can elicit significant hemodynamic responses, necessitating effective management to reduce potential complications. This study compared the efficacy of Fentanyl and Nalbuphine in attenuating these responses. Methods: A total of 100 patients undergoing endotracheal intubation were randomized into two groups, receiving either Fentanyl or Nalbuphine. Heart rate, systolic and diastolic blood pressures, mean arterial pressure, rate pressure product, and oxygen saturation were measured at various time points pre- and post-intubation. Results: Nalbuphine significantly reduced heart rate from 3 minutes post-intubation (p<0.05), and was more effective in lowering systolic and diastolic blood pressures (p as low as 0.0001). Mean arterial pressure was better managed with Nalbuphine, particularly noticeable from 3 minutes onward (p<0.05). Rate pressure product was consistently lower in the Nalbuphine group, starting from 1 minute post-intubation (p<0.05). Oxygen saturation levels remained stable and comparable in both groups. Conclusion: Nalbuphine showed superior efficacy in attenuating the hemodynamic responses to endotracheal intubation compared to Fentanyl. Its significant impact on heart rate and blood pressure control, without compromising respiratory function, suggests it as a preferable alternative in clinical anesthesia practice. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and intubation are critical procedures that can cause significant hemodynamic changes. This study compares the effectiveness of lignocaine and two different doses of dexmedetomidine in managing these hemodynamic changes. Objectives: To evaluate and compare the efficacy of 1.5 mg/kg lignocaine and two doses of dexmedetomidine (0.5 μg/kg and 1 μg/kg) in attenuating the hemodynamic responses during laryngoscopy and intubation. Methods: This randomized, controlled trial involved 200 patients scheduled for elective surgeries requiring general anesthesia. The patients were divided into four groups based on the medication and dosage they received: Group LL (Lignocaine - Low Dose) was given 1 mg/kg lignocaine, Group LH (Lignocaine - High Dose) received 2 mg/kg lignocaine, Group DL (Dexmedetomidine - Low Dose) was administered 0.5 μg/kg dexmedetomidine, and Group DH (Dexmedetomidine - High Dose) received 1 μg/kg dexmedetomidine. Hemodynamic parameters, such as heart rate and blood pressure, were recorded before, during, and after the intubation process. Results: The trial revealed significant variations in hemodynamic responses among the four groups. Group DH (Dexmedetomidine - High Dose) exhibited the most substantial attenuation of hemodynamic responses, with a 45% reduction in heart rate variability and a 40% decrease in systolic blood pressure spikes during intubation. Group DL (Dexmedetomidine - Low Dose) also showed notable effectiveness, with a 30% reduction in heart rate variability and a 25% decrease in systolic blood pressure changes. The lignocaine groups displayed varying levels of effectiveness; Group LH (Lignocaine - High Dose) achieved a 20% reduction in heart rate variability and a 15% decrease in systolic blood pressure, whereas Group LL (Lignocaine - Low Dose) showed a 10% reduction in heart rate variability and a 5% decrease in systolic blood pressure. These results indicate a more pronounced dose-dependent efficacy of dexmedetomidine in managing hemodynamic responses during intubation compared to lignocaine. Conclusion: Both lignocaine and dexmedetomidine are effective in attenuating hemodynamic responses during laryngoscopy and intubation. The comparison between the two drugs and their doses provides valuable insights for clinical practice in anesthesia. [ABSTRACT FROM AUTHOR]

Aim: Endotracheal intubation, a critical procedure in anaesthesia, can induce significant hemodynamic fluctuations, posing risks, especially to patients with cardiovascular concerns. This study compares the effects of dexmedetomidine and fentanyl, two agents commonly used to mitigate these responses, on endotracheal intubation conditions and associated hemodynamic changes. Material and Method: Conducted at tertiary care training and research hospital, this study involved 60 patients aged 40-60, all classified American Society of Anesthesiologists (ASA) I-II, undergoing elective upper and lower extremity surgeries. Excluding patients with contraindicating conditions, the subjects were divided into two groups to receive either dexmedetomidine or fentanyl, along with propofol and vecuronium, for induction. Hemodynamic parameters were continuously monitored, and intubation conditions were assessed using the Cooper scoring system. Results: The study found that both dexmedetomidine and fentanyl effectively stabilised hemodynamic parameters during intubation. However, the fentanyl group displayed significantly higher total scores on the Cooper intubation conditions scale, indicating more favourable conditions for endotracheal intubation in terms of ease and patient comfort. Conclusion: While both dexmedetomidine and fentanyl are effective in maintaining hemodynamic stability during endotracheal intubation, fentanyl demonstrates a slight advantage in optimising intubation conditions. This distinction offers valuable insight for anesthesiologists in tailoring anaesthetic strategies and balancing patient safety with procedural efficiency in surgical settings. [ABSTRACT FROM AUTHOR]

Laryngoscopy and endotracheal intubation form one of the main steps in general anesthesia. This process elicit a significant sympatho-adrenal responses. So abolishing such responses is a necessary step in the safe induction of general anesthesia. In patients with cardiac or cerebrovascular disease, this response often cause serious complications. This has necessitated the use of various adjuvants such as opioids, beta-blockers, nitroglycerine, lidocaine, and magnesium sulfate, with varying degrees of effectiveness. And in this study the focus will be on lidocaine in two ways of administration for this purpose. Aim of study: To find the most effective way of lidocaine administration in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. Patients and method: A 78 patients categorized into 3 groups, control (C) group of 26 patients received 5 ml of IV normal saline with the induction drugs, intravenous lidocaine (IVL) group of 26 cases received 1.5 mg/kg 2% IV lidocaine 2 minutes prior to laryngoscopy and intubation while nebulized lidocaine (NL) group 0f 26 cases received a 4 ml of 2% lidocaine nebulized by cirrus nebulizer with 5 L/min oxygen flow which usually takes from 10 to 15 minutes then induction immediately started. Results: Among the 3 groups, demographic data shows no significant difference. Comparing the C and NL group there is significant difference between them in advantage of lidocaine nebulizer for hemodynamic response attenuation, in C and IVL group comparison there is significant difference in some readings which reflects incomplete blunting effect. So lidocaine nebulizer shows a better results of cardiovascular stability. Conclusion: Nebulized lidocaine found to be significantly effective in attenuation of hemodynamic changes that accompany direct laryngoscopy and endotracheal intubation. [ABSTRACT FROM AUTHOR]

Background: Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery. Methods: Forty patients who underwent CABG surgery at the Cardiac Surgical Academy Ain Shams University Hospital were randomly allocated to receive SGB or placebo between June 2020 and February 2021. After fulfilling the inclusion criteria, patients were classified as American Society of Anesthesiologists III and IV. Patients were randomly assigned to one of two groups utilizing a computer-generated block number in a sealed envelope. Group S (20 patients) received SGB, and Group C (20 patients) included matched controls who received a placebo solution in the SGB. Primary outcome was perioperative changes in heart rate and systolic and diastolic blood pressures. Secondary outcomes included the incidence of atrial and ventricular fibrillation, and myocardial ischemia in addition to the times from ICU admission to extubation, ICU stay, and hospital stay. Results: A statistically substantial increase in systolic and diastolic blood pressure as well as increased incidence of AF and VF was found in the control group compared to the SGB group with p values <0.001, <0.001, 0.037, and 0.028, respectively. Conclusion: SGB can reduce the hemodynamic responses to surgery and anesthesia, intraoperative tachyarrhythmias, and ICU and hospital stays. [ABSTRACT FROM AUTHOR]

Exercising at submaximal intensity with a hand dynamometer causes mild hemodynamic adaptations that can improve cardiovascular function. However, hemodynamic responses and fatigue have not been adequately studied in an isometric exercise protocol combined with blood flow restriction (BFR). Our study aimed to examine and compare acute hemodynamic responses and muscle fatigue after an isometric exercise session using a handgrip dynamometer, with and without BFR. Twelve volunteers performed the exercise protocol, with and without BFR, at random, with the BFR pressure set at 140 mmHg. Arterial blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and muscle fatigue were measured before, during, and 15 min after the completion of the exercise session. Without BFR, we noticed a slight, albeit statistically insignificant, HR increase. The variations found in systolic and diastolic pressure were small and statistically insignificant. Furthermore, blood oxygen saturation (SpO2) did not change significantly. Significantly higher levels of fatigue were found in exercise with BFR, compared to without BFR, at the end of each set of isometric contractions. In conclusion, a handgrip exercise session with mild BFR does not alter the acute hemodynamic responses to exercise in healthy volunteers. However, it results in higher muscle fatigue compared to that experienced after exercise without BFR.

Background The traditional nitroglycerin (NTG) head-up tilt test (HUTT) is time-consuming and the test duration is a barrier to widespread utilization in clinical practice. It was hypothesized that a short-duration protocol is not inferior to the traditional protocol regarding the positivity rate and has a similar distribution of hemodynamic response. Methods and results Patients undergoing HUTT were randomized 1:1 to a 10 min passive phase plus a 10 min 0.3 mg NTG if the passive phase was negative (Fast) or to a 20 min passive phase plus a 15 min 0.3 mg NTG if the passive phase was negative (Traditional). A sample size of 277 patients for each group achieved 80% power to detect an expected difference of 0% with a non-inferiority margin of -10% using a one-sided t -test and assuming a significant level alpha of 0.025. A total of 554 consecutive patients (mean age 46.6 ± 19.3 years, 47.6% males) undergoing HUTT for suspected vasovagal syncope were randomly assigned to the Fast (n = 277) or Traditional (n = 277) protocol. A positive response was defined as the induction of syncope in presence of hypotension/bradycardia, and was observed in 167 (60.3%) patients with Fast and in 162 (58.5%) patients with the Traditional protocol. There was a trend of lesser vasodepressor response (14.8% Fast vs. 20.6% Traditional) which was significant during the passive phase (P = 0.01). Conclusion The diagnostic value of the Fast HUTT protocol is similar to that of the Traditional protocol and therefore the Fast protocol can be used instead of the Traditional protocol. [ABSTRACT FROM AUTHOR]

Exercising at submaximal intensity with a hand dynamometer causes mild hemodynamic adaptations that can improve cardiovascular function. However, hemodynamic responses and fatigue have not been adequately studied in an isometric exercise protocol combined with blood flow restriction (BFR). Our study aimed to examine and compare acute hemodynamic responses and muscle fatigue after an isometric exercise session using a handgrip dynamometer, with and without BFR. Twelve volunteers performed the exercise protocol, with and without BFR, at random, with the BFR pressure set at 140 mmHg. Arterial blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and muscle fatigue were measured before, during, and 15 min after the completion of the exercise session. Without BFR, we noticed a slight, albeit statistically insignificant, HR increase. The variations found in systolic and diastolic pressure were small and statistically insignificant. Furthermore, blood oxygen saturation (SpO2) did not change significantly. Significantly higher levels of fatigue were found in exercise with BFR, compared to without BFR, at the end of each set of isometric contractions. In conclusion, a handgrip exercise session with mild BFR does not alter the acute hemodynamic responses to exercise in healthy volunteers. However, it results in higher muscle fatigue compared to that experienced after exercise without BFR. [ABSTRACT FROM AUTHOR]

Targeted muscle reinnervation (TMR) surgery involves the coaptation of amputated nerves to nearby motor nerve branches with the purpose of reclosing the neuromuscular loop in order to reduce phantom limb pain. The purpose of this case study was to create a phantom limb therapy protocol for an amputee after undergoing TMR surgery, where the four main nerves of his right arm were reinnervated into the chest muscles. The goal of this phantom limb therapy was to further strengthen these newly formed neuromuscular closed loops. The case participant (male, 21- years of age, height = 5′8″ and weight = 134 lbs) presented 1- year after a trans-humeral amputation of the right arm along with TMR surgery and participated in phantom limb therapy for 3 months. Data collections for the subject occurred every 2 weeks for 3 months. During the data collections, the subject performed various movements of the phantom and intact limb specific to each reinnervated nerve and a gross manual dexterity task (Box and Block Test) while measuring brain activity and recording qualitative feedback from the subject. The results demonstrated that phantom limb therapy produced significant changes of cortical activity, reduced fatigue, fluctuation in phantom pain, improved limb synchronization, increased sensory sensation, and decreased correlation strength between intra-hemispheric and inter-hemispheric channels. These results suggest an overall improved cortical efficiency of the sensorimotor network. These results add to the growing knowledge of cortical reorganization after TMR surgery, which is becoming more common to aid in the recovery after amputation. More importantly, the results of this study suggest that the phantom limb therapy may have accelerated the decoupling process, which provides direct clinical benefits to the patient such as reduced fatigue and improved limb synchronization. [ABSTRACT FROM AUTHOR]

The effects of different resistance exercises on cardiovascular responses remain elusive. Therefore, the present study aimed to investigate acute cardiovascular responses to unilateral and bilateral upper and lower limb resistance exercise. Young healthy males (n = 22; 26.9 ± 5.4 years, 170.0 ± 6.0 cm, 77.0 ± 10.8 kg) participated in the present study. Four experimental sessions were carried out, each consisting of one of the four exercises: unilateral and bilateral knee extension, unilateral and bilateral biceps curl. Cardiovascular responses (heart rate; HR, systolic blood pressure; SBP, and rate-pressure product; RPP) were measured at rest and after each of the three sets in each resistance exercise. All sets were performed until concentric muscle failure with a rest interval of two min. The HR, SBP, and RPP progressively increased during all sessions with uni- and bilateral exercises of the lower and upper limbs. Importantly, bilateral exercises, mainly of the lower limbs, induced greater increases in HR, and RPP than unilateral exercises of the upper and lower limbs. Regarding SBP, bilateral knee extension exercise induced greater increases than unilateral biceps curl. From a practical standpoint, exercise professionals may consider prescribing unilateral upper and lower limb exercises to alleviate cardiovascular stress, because even when performed until concentric muscle failure, this exercise mode seems to induce lower cardiovascular demand during the resistance training session. [ABSTRACT FROM AUTHOR]

Targeted muscle reinnervation (TMR) surgery involves the coaptation of amputated nerves to nearby motor nerve branches with the purpose of reclosing the neuromuscular loop in order to reduce phantom limb pain. The purpose of this case study was to create a phantom limb therapy protocol for an amputee after undergoing TMR surgery, where the four main nerves of his right arm were reinnervated into the chest muscles. The goal of this phantom limb therapy was to further strengthen these newly formed neuromuscular closed loops. The case participant (male, 21- years of age, height = 5′8″ and weight = 134 lbs) presented 1- year after a trans-humeral amputation of the right arm along with TMR surgery and participated in phantom limb therapy for 3 months. Data collections for the subject occurred every 2 weeks for 3 months. During the data collections, the subject performed various movements of the phantom and intact limb specific to each reinnervated nerve and a gross manual dexterity task (Box and Block Test) while measuring brain activity and recording qualitative feedback from the subject. The results demonstrated that phantom limb therapy produced significant changes of cortical activity, reduced fatigue, fluctuation in phantom pain, improved limb synchronization, increased sensory sensation, and decreased correlation strength between intra-hemispheric and inter-hemispheric channels. These results suggest an overall improved cortical efficiency of the sensorimotor network. These results add to the growing knowledge of cortical reorganization after TMR surgery, which is becoming more common to aid in the recovery after amputation. More importantly, the results of this study suggest that the phantom limb therapy may have accelerated the decoupling process, which provides direct clinical benefits to the patient such as reduced fatigue and improved limb synchronization.

Discrimination of cues predicting non-nociceptive/nociceptive stimuli is essential for predicting whether a non-painful or painful stimulus will be administered and for eliciting placebo/nocebo (pain reduction/pain enhancement) effects. Dysfunction of the neural system involved in placebo effects has been implicated in the pathology of chronic pain, while female sex is one of the important risk factors for development of chronic pain in young adults. The dorsolateral prefrontal cortex (dl-PFC) is suggested to be involved in placebo effects and is sensitive to sex and age. In this study, to examine the neural mechanisms by which sex and age alter placebo and nocebo effects, we analyzed cerebral hemodynamic activities in the dl-PFC in different sex and age groups during a differential conditioning task. During the training session, two different sounds were followed by low- and high-intensity electrical shocks. In the following recording session, electrical shocks, the intensity of which was mismatched to the sounds, were occasionally administered to elicit placebo and nocebo effects. In young female participants, both placebo effects and hemodynamic responses to the conditioned sounds in the right dl-PFC were significantly lower than those in elderly female participants, while there were no age differences in male participants. The hemodynamic responses to the sound paired with the safe stimulus in the right dl-PFC were significantly correlated with placebo effects, except in the young female group. These results suggest that blunted placebo effects in the young female participants are ascribed to blunted responses to the sound associated with the safe stimulus in the right dl-PFC, and that sex- and age-related factors may alter the responsiveness of the right dl-PFC to associative cues predicting a safe stimulus. [ABSTRACT FROM AUTHOR]

PurposeEnhanced external counterpulsation (EECP) is a new non-drug treatment for coronary artery disease (CAD). However, the long-term effect of EECP on endothelial dysfunction and exercise tolerance, and the relationship between the changes in the endothelial dysfunction and exercise tolerance in the patients with coronary heart disease are still unclear.MethodsA total of 240 patients with CAD were randomly divided into EECP group (n = 120) and control group (n = 120). All patients received routine treatment of CAD as the basic therapy. Patients in the EECP group received 35 1-h daily sessions of EECP during 7 consecutive weeks while the control group received the same treatment course, but the cuff inflation pressure was 0–10 mmHg. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and inner diameter (ID) of the right carotid artery were examined using a Color Doppler Ultrasound and used to calculate the fluid shear stress (FSS). Serum levels of human vascular endothelial cell growth factor (VEGF), vascular endothelial cell growth factor receptor 2 (VEGFR2), and human angiotensin 2 (Ang2) were determined by enzyme-linked immunosorbent assay (ELISA). Exercise load time, maximal oxygen uptake (VO2max), metabolic equivalent (METs), anaerobic threshold (AT), peak oxygen pulse (VO2max/HR) were assessed using cardiopulmonary exercise tests.ResultsAfter 1 year follow-up, the EDV, PSV, ID, and FSS were significantly increased in the EECP group (P < 0.05 and 0.01, respectively), whereas there were no significant changes in these parameters in the control group. The serum levels of VEGF and VEGFR2 were elevated in the EECP and control groups (all P < 0.05). However, the changes in VEGF and VEGFR2 were significantly higher in the EECP group than in the control group (P < 0.01). The serum level of Ang2 was decreased in the EECP group (P < 0.05) and no obvious changes in the control group. As for exercise tolerance of patients, there were significant increases in the exercise load time, VO2max, VO2max/HR, AT and METs in the EECP group (all P < 0.05) and VO2max and METs in the control group (all P < 0.05). Correlation analyses showed a significant and positive correlations of VEGF and VEGFR2 levels with the changes in FSS (all P < 0.001). The correlations were still remained even after adjustment for confounders (all Padjustment < 0.001). Linear regression displays the age, the medication of ACEI (angiotensin-converting enzyme inhibitors) or ARB (angiotensin receptor blockers), the diabetes and the changes in VEGF and VEGFR2 were positively and independently associated with the changes in METs after adjustment for confounders (all Padjustment < 0.05).ConclusionThe data of our study suggested that EECP is a useful therapeutic measurement for amelioration of endothelial dysfunction and long-term elevation of exercise tolerance for patients with coronary heart disease.Clinical trial registration[http://www.chictr.org.cn/], identifier [ChiCTR1800020102].

The present study examined cerebral hemodynamic responses and functional connectivity during joint attention either initiated by infants (Initiating Joint Attention, IJA condition) or by their partner (Responding to Joint Attention, RJA condition). To capture responses to natural social cues in infants aged 7–12 months using functional near-infrared spectroscopy (fNIRS), we employed an interactive-live paradigm for IJA and RJA. During the measurement, an adult sat facing an infant, and objects, such as small stuffed animals, paired with sound toys were presented to the right or left side of the screen. In the RJA condition, the adult gazed at the infants' eyes and then to the objects to encourage the infants to follow the adult's gaze. On the other hand, in the IJA condition, the adult followed the infant's gaze as it shifted to the presented object. Our results indicate that the concentration of oxy-Hb in the bilateral ventral prefrontal region had significantly decreased, then followed by an increase in the right dorsal prefrontal region in the RJA. In addition, a selective activation in the bilateral dorsal prefrontal region was seen in the IJA condition. Moreover, the infants exhibited increased functional connectivity especially within the right ventral prefrontal region during RJA condition when compared with IJA conditions. These findings suggest that RJA and IJA recruit specific brain networks localized in the prefrontal cortex of infants.

Abstract Objectives Phantom sound perception (tinnitus) may arise from altered brain activity within auditory cortex. Auditory cortex neurons in tinnitus animal models show increased spontaneous firing rates. This may be a core characteristic of tinnitus. Functional near‐infrared spectroscopy (fNIRS) has shown similar findings in human auditory cortex. Current fNIRS approaches with cap recordings are limited to ∼3 cm depth of signal penetration due to the skull thickness. To address this limitation, we present an innovative fNIRS approach via probes adapted to the external auditory canal. The adapted probes were placed deeper and closer to temporal lobe of the brain to bypass confining skull bone and improve neural recordings. Methods Twenty adults with tinnitus and 20 nontinnitus controls listened to periods of silence and broadband noise (BBN) during standard cap and adapted ear canal fNIRS neuroimaging. The evaluators were not blinded, but the protocol and postprocessing for the two groups were identical. Results Standard fNIRS measurements in participants with tinnitus revealed increased auditory cortex activity during silence that was suppressed during auditory stimulation with BBN. Conversely, controls displayed increased activation with noise but not during silence. Importantly, adapted ear canal fNIRs probes showed similar hemodynamic responses seen with cap probes in both tinnitus and controls. Conclusions In this proof of concept study, we have successfully fabricated, adapted, and utilized a novel fNIRS technology that replicates established findings from traditional cap fNIRS probes. This exciting new innovation, validated by replicating previous and current cap findings in auditory cortex, may have applications to future studies to investigate brain changes not only in tinnitus but in other pathologic states that may involve the temporal lobe and surrounding brain regions. Level of Evidence NA.

The dorsolateral prefrontal cortex (dlPFC) is functionally linked to the descending pain modulation system and has been implicated in top down pain inhibition, including placebo analgesia. Therefore, functions of the dlPFC may be impaired in patients with chronic pain. Postherpetic neuralgia (PHN) is one of several syndromes with chronic neuropathic pain. In the present study, we investigated possible dysfunction of the dlPFC in chronic pain using patients with PHN. In a conditioning phase, heathy controls (n = 15) and patients with PHN (n = 7) were exposed to low (LF) and high (HF) frequency tones associated with noxious stimuli: weak (WS) and strong (SS) electrical stimulation, respectively. After the conditioning, cerebral hemodynamic activity was recorded from the bilateral dlPFC while the subjects were subjected to the cue tone-noxious electrical stimulation paradigm, in which incorrectly cued noxious stimuli were sometimes delivered to induce placebo and nocebo effects. The results indicated that hemodynamic responses to the LF tone in the right dlPFC was significantly lower in patients with PHN compared to the healthy controls. Furthermore, the same hemodynamic responses in the right dlPFC were correlated with placebo effects. In addition, clinical symptoms of PHN were negatively correlated to cerebral hemodynamic responses in the right dlPFC and magnitudes of the placebo effects. The results suggest that the right dlPFC, which is closely associated with the descending pain modulation system, is disturbed in PHN.

Objective: The aim of this study is to compare the hemodynamic responses caused by labetalol and lidocaine during tracheal extubation. Study design: Randomized controlled trial. Place and duration of study: Jinnah Postgraduate and Medical Center, Karachi, from 5th September 2018 to 4th March 2019. Material and Methods: This was conducted in neuro-surgical operative rooms. A total of 124 patients undergoing craniotomies for space-occupying lesions under general endotracheal tube anesthesia of age between 18-65 years of either gender were included. Patients with sinus bradycardia or heart block, congestive heart failure, and asthma were excluded. All patients had their pre and post-operative vital signs (BP, HR, and MAP) recorded. Upon discontinuation of the inhalational agent bolus of labetalol 0.1mg/kg or lidocaine (1.5 mg/kg) was given intravenously. Patients were followed for at least 30 min post-operatively. Results: It was found that in group-A (IV lidocaine), the mean change in HR was 22.60±9.09, SBP of 20.96±10.53, DBP of 12.81±7.24, and MAP of 14.44±7.14 while in group-B (IV Labetalol), the mean change in HR was 24.11±0.12, SBP of 20.95±9.87, DBP of 12.13±5.31 and MAP of 13.37±5.26. Both groups have shown a significant reduction in mean hemodynamic parameters within groups. There is statistically significant reduction in heart rate in group-A (p-value= 0.0001) however for other hemodynamic parameters the difference between the two groups was not statistically significant. Conclusion: This study concluded that mean changes in the hemodynamic responses by IV labetalol are not statistically different. [ABSTRACT FROM AUTHOR]

The rise of functional magnetic resonance imaging (fMRI) has led to a deeper understanding of cortical processing of pain. Central to these advances has been the identification and analysis of "functional networks", often derived from groups of pre-selected pain regions. In this study our main objective was to identify functional brain networks related to pain perception by examining whole-brain activation, avoiding the need for a priori selection of regions. We applied a data-driven technique—Constrained Principal Component Analysis for fMRI (fMRI-CPCA)—that identifies networks without assuming their anatomical or temporal properties. Open-source fMRI data collected during a thermal pain task (33 healthy participants) were subjected to fMRI-CPCA for network extraction, and networks were associated with pain perception by modelling subjective pain ratings as a function of network activation intensities. Three functional networks emerged: a sensorimotor response network, a salience-mediated attention network, and the default-mode network. Together, these networks constituted a brain state that explained variability in pain perception, both within and between individuals, demonstrating the potential of data-driven, whole-brain functional network techniques for the analysis of pain imaging data. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1).Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2.Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014).Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

Background: Dexmedetomidine is a highly selective alpha 2 agonist with dose dependent sedative sympatholytic analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on hemodynamic responses to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecytectomy. We have used a loading dose of 0.5mcg/kg over 10 minutes followed by infusion of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy. Methods: Patient of either sex aged between 18-50 yrs, belonging to ASA (American society of anaesthesiology) I and II posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment written valid consent was taken. 60 patients were enrolled and a written valid informed consent was taken. The patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation. Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups. Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.

This study aimed to evaluate cardiovascular responses during the six-minute walk test (6MWT) in obese women. For this, the sample consisted of 69 volunteers, who were divided into three groups based on the body mass index: 1) normal body mass (n=16); 2) overweight (n=36) and 3) obese (n=17). All volunteers performed the 6MWT and during the test, systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and distance were determined. The obese group showed an exacerbated response to SBP (normal: 136,6 ± 4,8 mmHg vs. overweight: 131,1 ± 2,8 mmHg vs. obese: 156,5 ± 5,8 mmHg; p<0,05) and DBP (normal: 80,0 ± 1,6 mmHg vs. overweight: 82,2 ± 1,4 mmHg vs. obese: 88,2 ± 3,0 mmHg; p<0,05) during the six-minute walk test, while they had HR (normal: 101,8 ± 4,5 bpm vs. overweight: 102,5 ± 3,1 bpm vs. obese: 109,2 ± 4,2 bpm; p<0,05) similar to the other groups. In addition, the three groups walked the same distance during the test, indicating similar submaximal physical capacity (normal: 442,8 ± 20,5 m vs. overweight: 433,4 ± 10,4 m vs. obese: 422,9 ± 18,6 m; p>0,05). It was concluded that obese women had an exacerbated systolic and diastolic blood pressure response and heart rate similar to the normal and overweight groups during the 6MWT, despite presenting similar physical performance to the other groups. [ABSTRACT FROM AUTHOR]

This study tested the hypothesis that muscle blood flow restriction reduces muscle and cerebral oxygenation at rest. In 26 healthy males, aged 33 ± 2 yrs, physiological variables were continuously recorded during a 10-min period in 2 experimental conditions: a) with muscle blood flow restriction through thigh cuffs application inflated at 120 mm Hg (With Cuffs, WC) and b) without restriction (No Cuffs, NC). Muscle and cerebral oxygenation were reduced by muscle blood flow restriction as suggested by the increase in both muscle and cerebral deoxygenated hemoglobin (Δ[HHb]; p < 0.01) and the decrease of muscle and cerebral oxygenation index (Δ[HbDiff]; p < 0.01). Hemodynamic responses were not affected by such muscle blood flow restriction, whereas baroreflex sensitivity was reduced (p = 0.009). The perception of leg discomfort was higher (p < 0.001) in the WC than in the NC condition. This study suggests that thigh cuffs application inflated at 120 mm Hg is an effective method to reduce muscle oxygenation at rest. These changes at the muscular level seem to be sensed by the central nervous system, evoking alterations in cerebral oxygenation and baroreflex sensitivity. Novelty: Thigh cuffs application inflated at 120 mm Hg effectively reduces muscle oxygenation at rest. Limiting muscle oxygenation appears to reduce cerebral oxygenation, and baroreflex sensitivity, at rest. Even in healthy subjects, limiting muscle oxygenation, at rest, affects neural integration. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of intravenous Magnesium Sulphate in attenuating the hemodynamic response, Systolic Blood Pressure, in hypertensive patients undergoing laryngoscopy and endotracheal intubation compared with a Control Group. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr to Oct 2018. Methodology: A total of 110 diagnosed patients of hypertension, taking anti-hypertensive medication, between 30-65 years of age, belonging to either gender, and undergoing elective surgery were enrolled. Patients were given intravenous Magnesium Sulphate (30 mg/kg) in 20 ml normal saline over a period of 03 minutes before induction of general anesthesia while control Group was given 20 ml of normal saline (placebo). Systolic Blood Pressure for both Groups was recorded on a performa by an observer two minutes after intubation. Results: The mean age of patients in treatment Group was 43.95±8.39 years and in control Group, 43.84±8.36 years. Out of 110 patients, 41(37.27%) were males and 69(62.73%) were females. The efficacy of MgSO4 was 16(29.09%) and in control Group, it was 04(7.27%) with p-value of 0.003(<0.05). Conclusion: Intravenous Magnesium Sulphate is efficacious in attenuating hemodynamic response to laryngoscopy and intubation in hypertensive patients. [ABSTRACT FROM AUTHOR]

The trends in movement-related functional activity measurement for brain-computer interface (BCI) are mostly associated with the central lobe of the brain. This consideration may be a faulty approach for the paralyzed patient. This limitation demands an alternative approach for movement-related BCI. For the first time, we propose the prefrontal hemodynamics for implementing movement-related BCI. This paper aims to model the activation pattern and the classification performances of the prefrontal hemodynamics regarding the movement-related events. Utilizing functional near-infrared spectroscopy (fNIRS) the changes in the concentration of the oxidized hemoglobin and deoxidized hemoglobin regarding voluntary and imagery movements are acquired. With necessary preprocessing, the fNIRS signals are statistically analyzed to localize the most significant activated regions regarding the applied stimuli. The experiment shows that movement-related events have a strong correlation with the prefrontal hemodynamics. The patterns of the movement-related hemodynamics are modeled by polynomial regression and used to classify the voluntary and imagery events based on the maximum similarity approach. The resulting classification accuracies are found promising that proves the effectiveness of the prefrontal fNIRS signal to be effective in movement-related brain functionality analysis.

Background: Tracheal extubation is the process of removing a tube from the trachea. It is associated with an increase in heart rate, blood pressure, intracranial pressure, intraocular pressure, coughing, bronchospasm, laryngospasm, and bleeding. Many techniques, as well as drugs, have been attempted for attenuation of the airway and cardiovascular responses. Propofol and lidocaine are widely available drugs in resource-limited settings even though their relative effectiveness for smooth extubation is not well established. Objectives: To assess the effectiveness of intravenous lidocaine and propofol on the attenuation of extubation-induced hemodynamic responses in the adult elective surgical patient from November 01, 2019, to February 30, 2020, at Asella teaching and referral hospital, Ethiopia. Methods: Institutional-based prospective observational cohort study design was conducted on 72 ASA I patients who underwent elective surgery. The study participants were allocated into three groups equally based on anesthetists' extubation plan; Group P, 0.5 mg/kg propofol, group L, 1.5 mg/kg lidocaine administered 2 min before extubation and group C was a control group. Data were analyzed by SPSS version 20 after the normality of the data was checked by the Shapiro Wilk test. One-way ANOVA followed by a Tukey posthoc test has been employed to find the pair-wise significance and a p-value of 0.05. After extubation; heart rate, systolic, diastolic, and mean arterial blood pressure were decreased significantly in groups of propofol and lidocaine within 10 min. Propofol shows better results in maintaining stable systolic blood pressure up to 3 min, while heart rate, diastolic, and mean arterial pressure were maintained stable up to 5 min after extubation (p = 0.001). Conclusions: 0.5 mg/kg propofol or 1.5 mg/kg lidocaine might help to attenuate extubation induced hemodynamic responses.

Introduction: The effects of adrenaline contained in the local anaesthetic on vital signs have been reported under general anaesthesia or sedation. The ClearSight™ system measures cardiac parameters, including cardiac index, stroke volume, systemic vascular resistance index, continuous blood pressure, and heart rate, non-invasively and continuously. Aim: This study aimed to assess the effect of adrenaline contained in the local anaesthetic on cardiac function in conscious participants. Materials and methods: Eight healthy adults were recruited for the study. Local anaesthesia was administered to the maxillary gingiva using 3.6 mL of 2% lidocaine with 1/80,000 of adrenaline (group AD) or without adrenaline (group non-AD) on separate days. The above listed cardiac parameters were recorded with the ClearSight™ system. All data were continuously monitored until these values returned to normal levels. Results: The cardiac index and heart rate increased by 40% in group AD. Moreover, the cardiac index and systemic vascular resistance index in group AD required 50 min to recover to the pre-injection levels. Heart rate variations showed no intergroup differences, and variations in systolic continuous blood pressure persisted for only 30 min. Conclusions: The effect of anaesthetic injection containing adrenaline on cardiac function may persist even after the vital signs return to normal.

PurposeEnhanced external counterpulsation (EECP) can improve carotid circulation in patients with coronary artery disease. However, the response of carotid hemodynamic parameters induced by EECP in patients with high cardiovascular risk factors remains to be clarified. This study aimed to investigate the acute effect of EECP on the hemodynamic parameters in the carotid arteries before, during, and immediately after EECP in patients with hypertension, hyperlipidemia, and type 2 diabetes.MethodsEighty-three subjects were recruited into this study to receive 45-min EECP, including patients with simple hypertension (n = 21), hyperlipidemia (n = 23), type 2 diabetes (n = 18), and healthy subjects (n = 21). Hemodynamic parameters in both common carotid arteries (CCAs) were measured and calculated from Doppler ultrasound images. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), systolic/diastolic flow velocity ratio (VS/VD), flow rate (FR), and resistance index (RI) were monitored before, during, and immediately after 45-min EECP.ResultsEDV and VS/VD were significantly reduced, while RI of CCAs was significantly increased among four groups during EECP (all P < 0.01). Additionally, the ID of CCAs and the FR of left CCA increased in patients with hyperlipidemia during EECP (P < 0.05). PSV of left CCA was reduced in patients with type 2 diabetes (P < 0.05). Moreover, immediately after EECP, ID was significantly higher in patients with hyperlipidemia. The RI of patients with hypertension and PSV and VS/VD of patients with type 2 diabetes were significantly lower compared with baseline (all P < 0.05).ConclusionEECP created an acute reduction in EDV, PSV, and VS/VD, and an immediate increase in the RI, FR, and ID of CCAs among the four groups. Additionally, a single 45-min session of EECP produced immediate improvement in the ID of patients with hyperlipidemia, the RI of patients with hypertension, and the PSV and VS/VD of patients with type 2 diabetes. The different hemodynamic responses induced by EECP may provide theoretical guidance for making personalized plans in patients with different cardiovascular risk factors.

Purpose: Enhanced external counterpulsation (EECP) can improve carotid circulation in patients with coronary artery disease. However, the response of carotid hemodynamic parameters induced by EECP in patients with high cardiovascular risk factors remains to be clarified. This study aimed to investigate the acute effect of EECP on the hemodynamic parameters in the carotid arteries before, during, and immediately after EECP in patients with hypertension, hyperlipidemia, and type 2 diabetes. Methods: Eighty-three subjects were recruited into this study to receive 45-min EECP, including patients with simple hypertension (n = 21), hyperlipidemia (n = 23), type 2 diabetes (n = 18), and healthy subjects (n = 21). Hemodynamic parameters in both common carotid arteries (CCAs) were measured and calculated from Doppler ultrasound images. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), systolic/diastolic flow velocity ratio (VS/VD), flow rate (FR), and resistance index (RI) were monitored before, during, and immediately after 45-min EECP. Results: EDV and VS/VD were significantly reduced, while RI of CCAs was significantly increased among four groups during EECP (all P < 0.01). Additionally, the ID of CCAs and the FR of left CCA increased in patients with hyperlipidemia during EECP (P < 0.05). PSV of left CCA was reduced in patients with type 2 diabetes (P < 0.05). Moreover, immediately after EECP, ID was significantly higher in patients with hyperlipidemia. The RI of patients with hypertension and PSV and VS/VD of patients with type 2 diabetes were significantly lower compared with baseline (all P < 0.05). Conclusion: EECP created an acute reduction in EDV, PSV, and VS/VD, and an immediate increase in the RI, FR, and ID of CCAs among the four groups. Additionally, a single 45-min session of EECP produced immediate improvement in the ID of patients with hyperlipidemia, the RI of patients with hypertension, and the PSV and VS/VD of patients with type 2 diabetes. The different hemodynamic responses induced by EECP may provide theoretical guidance for making personalized plans in patients with different cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Objective: The empirical evidence explicitly demonstrates that meditation practice enhances both brain functions and mental well-being. A meditative relaxation approach called the mind sound resonance technique (MSRT) has shown promising effects on children, adolescents, and people with psychological illnesses. This study aimed to investigate the effects of MSRT practice on brain hemodynamics, heart rate variability (HRV), mindfulness, and anxiety levels in college students., Methods: Fifty volunteers in all genders (females, n = 30; males, n = 20) aged between 19 and 30 years were chosen from an educational institute and allocated into two groups, i.e., MSRT (n = 25) and supine rest (SR; n = 25). Enrolled participants were measured cerebral hemodynamics and HRV before, during, and after the MSRT or SR practice. The self-reported assessments including state anxiety and mindfulness were assessed before and after the intervention., Results: The results demonstrated that practicing MSRT significantly improved oxygenation (p < 0.05) in the right prefrontal cortex (PFC) and increased low-frequency (LF) (p < 0.05) and decreased high-frequency (HF) (p < 0.05) component of HRV when compared to the baseline. The between-group analysis showed a significant difference between MSRT and SR in the standard deviation of the normal-to-normal (SDNN) (p < 0.05) component of HRV., Conclusion: These crumbs of evidence imply that MSRT sessions may foster the development of anxiety-related coping skills by elevating mindfulness, promoting PFC oxygenation, and modulating HRV in MSRT practitioners., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee (IEC) of Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, Bengaluru, India issued approval RES/IEC-SVYASA/213/2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohanty et al.)

A single exposure to stress can induce functional changes in neurons, potentially leading to acute stress disorder or post-traumatic stress disorder. In this study, we used in vivo wide-field optical mapping to simultaneously measure neural calcium signals and hemodynamic responses over the whole cortical area. We found that cortical mapping to whisker stimuli was altered under acute stress conditions. In particular, callosal projections in the anterior cortex (primary/secondary motor, somatosensory forelimb cortex) relative to barrel field (S1BF) of somatosensory cortex were weakened. On the contrary, the projections in posterior cortex relative to S1BF were mostly unchanged or were only occasionally strengthened. In addition, changes in intra-cortical connection were opposite to those in inter-cortical connection. Thus, the S1BF connections to the anterior cortex were strengthened while those to the posterior cortex were weakened. This suggests that the well-known barrel cortex projection route was enhanced. In summary, our in vivo wide-field optical mapping study indicates that a single acute stress can impact whole-brain networks, affecting both neural and hemodynamic responses.

Functional near-infrared spectroscopy (fNIRS) measures the functional activity of the cerebral cortex. The concentration changes of oxygenated (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) can be detected and associated with activation of the cortex in the investigated area (neurovascular coupling). Recorded signals of hemodynamic responses may contain influences from physiological signals (systemic influences, physiological artifacts) which do not originate from the cerebral cortex activity. The physiological artifacts contain the blood pressure (BP), respiratory patterns, and the pulsation of the heart. In order to perform a comprehensive analysis of recorded fNIRS data, a proper correction of these physiological artifacts is necessary. This article introduces NICA – a novel toolbox for near-infrared spectroscopy calculations and analyses based on MATLAB. With NICA it is possible to process and visualize fNIRS data, including different signal processing methods for physiological artifact correction. The artifact correction methods used in this toolbox are common average reference (CAR), independent component analysis (ICA), and transfer function (TF) models. A practical example provides results from a study, where NICA was used for analyzing the measurement data, in order to demonstrate the signal processing steps and the physiological artifact correction. The toolbox was developed for fNIRS data recorded with the NIRScout 1624 measurement device and the corresponding recording software NIRStar.

Objectives: Phantom sound perception (tinnitus) may arise from altered brain activity within auditory cortex. Auditory cortex neurons in tinnitus animal models show increased spontaneous firing rates. This may be a core characteristic of tinnitus. Functional near‐infrared spectroscopy (fNIRS) has shown similar findings in human auditory cortex. Current fNIRS approaches with cap recordings are limited to ∼3 cm depth of signal penetration due to the skull thickness. To address this limitation, we present an innovative fNIRS approach via probes adapted to the external auditory canal. The adapted probes were placed deeper and closer to temporal lobe of the brain to bypass confining skull bone and improve neural recordings. Methods: Twenty adults with tinnitus and 20 nontinnitus controls listened to periods of silence and broadband noise (BBN) during standard cap and adapted ear canal fNIRS neuroimaging. The evaluators were not blinded, but the protocol and postprocessing for the two groups were identical. Results: Standard fNIRS measurements in participants with tinnitus revealed increased auditory cortex activity during silence that was suppressed during auditory stimulation with BBN. Conversely, controls displayed increased activation with noise but not during silence. Importantly, adapted ear canal fNIRs probes showed similar hemodynamic responses seen with cap probes in both tinnitus and controls. Conclusions: In this proof of concept study, we have successfully fabricated, adapted, and utilized a novel fNIRS technology that replicates established findings from traditional cap fNIRS probes. This exciting new innovation, validated by replicating previous and current cap findings in auditory cortex, may have applications to future studies to investigate brain changes not only in tinnitus but in other pathologic states that may involve the temporal lobe and surrounding brain regions. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]

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Background: The High Intensity Interval Training (HIIT) has had space in social networks that disseminate its practice and also among practitioners of physical exercises in a global way. Objective: To verify if the stimuli order (HIIT-RT or RT-HIIT) changes the acute hemodynamic response. Methods: 10 young adult male participants aged between 18 and 30 years (24.7 ± 2.2). For the test protocols the High intensity interval training (HIIT) and the conventional resistance training (RT) were performed in Cross-over using a Spinning Exercise Bike in addition to the apparatus: Bench press; Leg Press; Pull down; Leg curl; Low Rower. The hemodynamic variables were collected at rest, post-training, and 10', 20' and 30 'minutes of recovery. Results: A significant difference was found in HR and SBP at the end of the training in the SBP and DBP variables there were significant differences in the 20' and 30' minutes and in the MAP there was a significant difference in all recovery times with RT and HIIT higher post-workout and recovery values. Conclusion: The stimuli order changes the acute hemodynamic response. When the orders were analyzed (HIIT-RT; RT-HIIT), the order that presented the best results was HIIT-RT. It presented changes during exercise as they presented better post-training responses. [ABSTRACT FROM AUTHOR]

Functional near-infrared spectroscopy (fNIRS) measures the functional activity of the cerebral cortex. The concentration changes of oxygenated (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) can be detected and associated with activation of the cortex in the investigated area (neurovascular coupling). Recorded signals of hemodynamic responses may contain influences from physiological signals (systemic influences, physiological artifacts) which do not originate from the cerebral cortex activity. The physiological artifacts contain the blood pressure (BP), respiratory patterns, and the pulsation of the heart. In order to perform a comprehensive analysis of recorded fNIRS data, a proper correction of these physiological artifacts is necessary. This article introduces NICA – a novel toolbox for near-infrared spectroscopy calculations and analyses based on MATLAB. With NICA it is possible to process and visualize fNIRS data, including different signal processing methods for physiological artifact correction. The artifact correction methods used in this toolbox are common average reference (CAR), independent component analysis (ICA), and transfer function (TF) models. A practical example provides results from a study, where NICA was used for analyzing the measurement data, in order to demonstrate the signal processing steps and the physiological artifact correction. The toolbox was developed for fNIRS data recorded with the NIRScout 1624 measurement device and the corresponding recording software NIRStar. [ABSTRACT FROM AUTHOR]

This research aims to investigate the development of muscle fatigue and the recovery process revealed by tissue oxygenation. The tissue hemodynamics were measured by near-infrared spectroscopy (NIRS) during a 30-min pre-exercise rest, a 40-cycle heel-lift exercise and a 30-min post-exercise recovery. Wavelet transform was used to obtain the normalized wavelet energy in six frequency intervals (I–VI) and inverse wavelet transform was applied to extract exercise-induced oscillations from the hemodynamic signals. During the exercise phase, the contraction-related oscillations in the total hemoglobin signal (ΔtHb) showed a decreasing trend while the fluctuations in the tissue oxygenation index (TOI) displayed an increasing tendency. The mean TOI value was significantly higher (p < 0.001) under recovery (65.04% ± 2.90%) than that under rest (62.35% ± 3.05%). The normalized wavelet energy of the ΔtHb signal in frequency intervals I (p < 0.001), II (p < 0.05), III (p < 0.05) and IV (p < 0.01) significantly increased by 43.4%, 23.6%, 18.4% and 21.6% during the recovery than that during the pre-exercise rest, while the value in interval VI (p < 0.05) significantly decreased by 16.6%. It could be concluded that NIRS-derived hemodynamic signals can provide valuable information related to muscle fatigue and recovery. [ABSTRACT FROM AUTHOR]

Patients with peripheral artery disease (PAD) have an accentuated exercise pressor reflex (EPR) during exercise of the affected limb. The underlying hemodynamic changes responsible for this, and its effect on blood flow to the exercising extremity, are unclear. We tested the hypothesis that the exaggerated EPR in PAD is mediated by an increase in total peripheral resistance (TPR), which augments redistribution of blood flow to the exercising limb. Twelve patients with PAD and 12 age- and sex-matched subjects without PAD performed dynamic plantar flexion (PF) using the most symptomatic leg at progressive workloads of 2–12 kg (increased by 1 kg/min until onset of fatigue). We measured heart rate, beat-by-beat blood pressure, femoral blood flow velocity (FBV), and muscle oxygen saturation (SmO2 ) continuously during the exercise. Femoral blood flow (FBF) was calculated from FBV and baseline femoral artery diameter. Stroke volume (SV), cardiac output (CO), and TPR were derived from the blood pressure tracings. Mean arterial blood pressure and TPR were significantly augmented in PAD compared with control during PF. FBF increased during exercise to an equal extent in both groups. However, SmO2 of the exercising limb remained significantly lower in PAD compared with control. We conclude that the exaggerated pressor response in PAD is mediated by an abnormal TPR response, which augments redistribution of blood flow to the exercising extremity, leading to an equal rise in FBF compared with controls. However, this increase in FBF is not sufficient to normalize the SmO2 response during exercise in patients with PAD. NEW & NOTEWORTHY In this study, peripheral artery disease (PAD) patients and healthy control subjects performed graded, dynamic plantar flexion exercise. Data from this study suggest that previously reported exaggerated exercise pressor reflex in patients with PAD is driven by greater vasoconstriction in nonexercising vascular territories which also results in a redistribution of blood flow to the exercising extremity. However, this rise in femoral blood flow does not fully correct the oxygen deficit due to changes in other mechanisms that require further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release. Aim: To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain. Material and methods: In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1% and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO2 gas, the position change, depletion of CO2, and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery). Results: Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05). Conclusions: Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period. [ABSTRACT FROM AUTHOR]

Recently, the functional near-infrared spectroscopy (600–900 nm electromagnetic wave) (f -NIRS)-based rehabilitation researches have been studied for understanding the human brain. Although f -NIRS can successfully measure the relative blood concentration changes of oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) as an assessment tool to identify significant clinical intervention during pre- and post-rehabilitation therapy for stroke survivors, there is insufficient information particularly on the use of f -NIRS as a clinical translation in upper extremity function rehabilitation. In order to widely utilize the f -NIRS for upper extremity rehabilitation, device information, experiment design, measurement procedure, and analyzing method are described for clinician aspect in this study. In addition, further research trend was introduced from previous studies for stroke survivor rehabilitation. The authors believed that the information provided in this study can be a useful guideline to encourage future researchers to focus on upper extremity function rehabilitation of stroke survivors. [ABSTRACT FROM AUTHOR]

This study presents the first implementation of functional ultrasound (fUS) imaging of the spinal cord to monitor local hemodynamic response to epidural electrical spinal cord stimulation (SCS) on two small and large animal models. SCS has been successfully applied to control chronic refractory pain and recently was evolved to alleviate motor impairment in Parkinson's disease and after spinal cord injury. At present, however, the mechanisms underlying SCS remain unclear, and current methods for monitoring SCS are limited in their capacity to provide the required sensitivity and spatiotemporal resolutions to evaluate functional changes in response to SCS. fUS is an emerging technology that has recently shown promising results in monitoring a variety of neural activities associated with the brain. Here we demonstrated the feasibility of performing fUS on two animal models during SCS. We showed in vivo spinal cord hemodynamic responses measured by fUS evoked by different SCS parameters. We also demonstrated that fUS has a higher sensitivity in monitoring spinal cord response than electromyography. The high spatial and temporal resolutions of fUS were demonstrated by localized measurements of hemodynamic responses at different spinal cord segments, and by reliable tracking of spinal cord responses to patterned electrical stimulations, respectively. Finally, we proposed optimized fUS imaging and post-processing methods for spinal cord. These results support feasibility of fUS imaging of the spinal cord and could pave the way for future systematic studies to investigate spinal cord functional organization and the mechanisms of spinal cord neuromodulation in vivo.

In this study we used Visible Heart® methodologies featuring cyclic temperature modulation of porcine hearts in order to establish characteristic temperature responses. This isolated and perfused model is a more predictable and modifiable analog for human heart preservation and isolates the response of the cardiac tissue. We comprehensively monitored isolated porcine hearts undergoing temperature change and demonstrated optimization of isolated cardiac function under mild hypothermia. We tracked metrics of cardiac function as continuous variables during temperature changes (~ 31 to 39 °C), eliciting a well-defined reduction in metabolic demand and in heart rate modulation. Optimization of function appeared to occur around 34.7 ± 0.9 °C (n = 13). Cardiac response was further investigated in the presence of active pacing in order to assess pacing capture and the heart's functional response without a means of regulating rate. Our results may have direct clinical implications for emerging heart preservation methods prior to transplantation, as well as benefits for investigators using isolated heart models for preclinical device testing. Clinically, this porcine model is a basis for finding new ways to extend the window of viability for transplantable organs, thereby restoring or improving graft function and potentially enhancing recipient outcomes. [ABSTRACT FROM AUTHOR]