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Type 1 diabetes (T1D) is associated with general- and diabetes-specific stress which has multiple adverse effects. Hence measuring stress is of great importance. An algometer measuring pressure pain sensitivity (PPS) has been shown to correlate to certain stress measures in adults. However, it has never been investigated in children and adolescents. The aim of our study was to examine associations between PPS and glycated hemoglobin (HbA1c), salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D. Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits. Salivary cortisol, PPS and questionnaires were collected, measured, and answered on site. HbA1c was collected from medical files. We found correlations between PPS and HbA1c (rho = 0.35, P = 0.046), cortisol (rho = -0.25, P = 0.02) and Perceived Stress Scale (rho = -0.44, P = 0.02) in different subgroups based on age. Males scored higher in PPS than females (P < 0.001). We found PPS to be correlated to HbA1c but otherwise inconsistent in results. High PPS values indicated either measurement difficulties or hypersensibility towards pain. Grauslund AC, Lindkvist EB, Thorsen SU, Ballegaard S, Faber J, Svensson J, Berg AK. Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes? World J Clin Pediatr 2024; 13(1): 89619 [DOI: 10.5409/wjcp.v13.i1.89619], Type 1 diabetes (T1D) is associated with general- and diabetes-specific stress which has multiple adverse effects. Hence measuring stress is of great importance. An algometer measuring pressure pain sensitivity (PPS) has been shown to correlate to certain stress measures in adults. However, it has never been investigated in children and adolescents. The aim of our study was to examine associations between PPS and glycated hemoglobin (HbA1c), salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D. Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits. Salivary cortisol, PPS and questionnaires were collected, measured, and answered on site. HbA1c was collected from medical files. We found correlations between PPS and HbA1c (rho = 0.35, P = 0.046), cortisol (rho = -0.25, P = 0.02) and Perceived Stress Scale (rho = -0.44, P = 0.02) in different subgroups based on age. Males scored higher in PPS than females (P < 0.001). We found PPS to be correlated to HbA1c but otherwise inconsistent in results. High PPS values indicated either measurement difficulties or hypersensibility towards pain.

Type 1 diabetes (T1D) is associated with general- and diabetes-specific stress which has multiple adverse effects. Hence measuring stress is of great importance. An algometer measuring pressure pain sensitivity (PPS) has been shown to correlate to certain stress measures in adults. However, it has never been investigated in children and adolescents. The aim of our study was to examine associations between PPS and glycated hemoglobin (HbA1c), salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D. Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits. Salivary cortisol, PPS and questionnaires were collected, measured, and answered on site. HbA1c was collected from medical files. We found correlations between PPS and HbA1c (rho = 0.35, P = 0.046), cortisol (rho = -0.25, P = 0.02) and Perceived Stress Scale (rho = -0.44, P = 0.02) in different subgroups based on age. Males scored higher in PPS than females (P < 0.001). We found PPS to be correlated to HbA1c but otherwise inconsistent in results. High PPS values indicated either measurement difficulties or hypersensibility towards pain. Grauslund AC, Lindkvist EB, Thorsen SU, Ballegaard S, Faber J, Svensson J, Berg AK. Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes? World J Clin Pediatr 2024; 13(1): 89619 [DOI: 10.5409/wjcp.v13.i1.89619], Type 1 diabetes (T1D) is associated with general- and diabetes-specific stress which has multiple adverse effects. Hence measuring stress is of great importance. An algometer measuring pressure pain sensitivity (PPS) has been shown to correlate to certain stress measures in adults. However, it has never been investigated in children and adolescents. The aim of our study was to examine associations between PPS and glycated hemoglobin (HbA1c), salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D. Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits. Salivary cortisol, PPS and questionnaires were collected, measured, and answered on site. HbA1c was collected from medical files. We found correlations between PPS and HbA1c (rho = 0.35, P = 0.046), cortisol (rho = -0.25, P = 0.02) and Perceived Stress Scale (rho = -0.44, P = 0.02) in different subgroups based on age. Males scored higher in PPS than females (P < 0.001). We found PPS to be correlated to HbA1c but otherwise inconsistent in results. High PPS values indicated either measurement difficulties or hypersensibility towards pain.

Introduction.COVID-19 caused a health emergency worldwide given its rapid transmissibility and spread. The high frequency of diverse clinical manifestations, once the acute phase concluded, was shocking. The later is termed post COVID-19 syndrome. Autonomic dysfunction could be one of the causes of persistent symptoms and be related to it. Objective.To evaluate the presence of Postural Orthostatic Tachycardia and autonomic disorders in a group of patients with post COVID-19 syndrome. Material and method. An evaluation of 18 patients aged 25 to 70 years with symptoms of poor tolerance to exertion and tachycardia at rest or change of position was carried out. All included patients underwent C-reactive protein, Ferritin and LDH, as well as like the NASA 10-Minute Lean Test. Results. Of 18 patients evaluated, 12 patients were diagnosed with autonomic disorders with a median age of 45 years, 7 patients were defined as Postural Orthostatic Tachycardia, 3 as Inappropriate Sinus Tachycardia, 1 as Neurocardiogenic Syncope and 1 as Orthostatic Hypotension. Conclusions. It is evident that autonomic disorders may be present in post COVID-19 syndrome in patients who experience persistent neurological and cardiovascular symptoms. Clinicians should be aware that these autonomic disorders may be a complication of COVID-19., Introducción: La COVID-19 produjo una emergencia sanitaria en todo el mundo dada su rápida transmisibilidad y propagación, siendo impactante la alta frecuencia de diferentes manifestaciones una vez superada la fase aguda, o sea, el síndrome post Covid-19. La disfunción autonómica podría ser una de las causas de sintomatología persistente y estar relacionada con el síndrome post Covid-19. Objetivo: Evaluar la presencia de Taquicardia Ortostática Postural y trastornos autonómicos en un grupo de pacientes con síndrome post Covid-19. Material y método: Se realizó evaluación de 18 pacientes con edades de 25 a 70 años con síntomas de poca tolerancia al esfuerzo y taquicardia en reposo o cambio de posición, a todos los pacientes incluidos se les realizó Proteína C Reactiva, Ferritina y LDH, así como la Prueba Lean de la NASA de 10 minutos. Resultados: De 18 pacientes evaluados, 12 pacientes se diagnosticaron con trastornos autonómicos con una mediana de edad de 50 años, 7 pacientes fueron definidos como Taquicardia Ortostática Postural, 3 como Taquicardia Sinusal inapropiada, 1 como Sincope Neurocardiogénico y 1 como Hipotensión Ortostática. Conclusiones: Se evidencia que los trastornos autonómicos pueden estar presente en síndrome post Covid-19 en pacientes que experimentan síntomas neurológicos y cardiovasculares persistentes. Los médicos deben ser conscientes de que estos trastornos autonómicos pueden ser una complicación de la COVID-19

Introduction: Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care. Patients and method: In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up. Results: The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time. Conclusion: In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

Patients with severe traumatic brain injury (TBI) may have autonomic dysfunction, one manifestation of which is orthostatic intolerance. This potentially impairs physical rehabilitation. However, the exact mechanisms remain elusive. In 30 patients participating in a trial of early tilt training versus standard care and 15 healthy volunteers, 5-min electrocardiography was recorded in the supine position and during 70° head-up tilt. Heart rate variability was analyzed by the low- and high-frequency (LF and HF) power, the LF-HF ratio, the total power, the ratio of the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive differences (RMSSD), the detrended fluctuations, and sample entropy. In patients in the upright compared to the supine position, SDNN (p < 0.001), RMSSD (p < 0.001), and total power (p = 0.004) all decreased, while the remaining variables were unchanged; no long-term differences in heart rate variability in the supine position were found between early tilt training and standard care. In the healthy volunteers, all measures besides SDNN and total power changed significantly between supine and upright position. In patients with severe TBI compared to healthy volunteers, several measures of heart rate variability changed differentially during mobilization from the supine to the upright position.

Patients with severe traumatic brain injury (TBI) may have autonomic dysfunction, one manifestation of which is orthostatic intolerance. This potentially impairs physical rehabilitation. However, the exact mechanisms remain elusive. In 30 patients participating in a trial of early tilt training versus standard care and 15 healthy volunteers, 5-min electrocardiography was recorded in the supine position and during 70° head-up tilt. Heart rate variability was analyzed by the low- and high-frequency (LF and HF) power, the LF-HF ratio, the total power, the ratio of the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive differences (RMSSD), the detrended fluctuations, and sample entropy. In patients in the upright compared to the supine position, SDNN (p < 0.001), RMSSD (p < 0.001), and total power (p = 0.004) all decreased, while the remaining variables were unchanged; no long-term differences in heart rate variability in the supine position were found between early tilt training and standard care. In the healthy volunteers, all measures besides SDNN and total power changed significantly between supine and upright position. In patients with severe TBI compared to healthy volunteers, several measures of heart rate variability changed differentially during mobilization from the supine to the upright position.

Background: Septic shock is common in the intensive care unit (ICU). The pathophysiology is poorly understood but prolonged sympathetic activation leading to autonomic dysfunction may be involved. Pupillary light response (PLR) is a fast, inexpensive, noninvasive way to measure autonomic nervous system function. The aim of the study was to observe dilation velocity of the PLR (PLRdil.vel.) in patients with and without septic shock and explore whether other factors influenced the possible association. We hypothesized that the presence of septic shock in intensive care patients is associated with changes in sympathetic autonomic tone, which can be observed as changes in PLRdil.vel. Methods: In this prospective observational cohort study, we included 91 adult patients acutely admitted to a mixed ICU. The patients were followed for the development of septic shock until ICU discharge. PLRdil.vel. was measured with a portable pupillometer two times a day. We used linear mixed models to analyze for an association between PLRdil.vel and septic shock along with several covariables. Results: Ninety-one patients were enrolled and of these, 35 were in septic shock. Septic shock was associated with a slowed PLRdil.vel of 0.3 mm/s (95% confidence intervals [CI −0.4; −0.2]). Conclusions: Septic shock may be associated with changes in sympathetic autonomic tone which is supported by the findings from this study that septic shock was associated with a slower dilation velocity in the pupillary light reflex. Further studies should examine if the pupillary dilation velocity may serve as surrogate marker for changes in sympathetic autonomic nervous system activity in intensive care patients in septic shock. If so, future interventional studies should test if use of the pupillary dilation velocity may be used for earlier detection of septic shock, which could mean earlier institution of treatment measures for this condition.

Introduction: Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care. Patients and method: In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up. Results: The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time. Conclusion: In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

Background: Septic shock is common in the intensive care unit (ICU). The pathophysiology is poorly understood but prolonged sympathetic activation leading to autonomic dysfunction may be involved. Pupillary light response (PLR) is a fast, inexpensive, noninvasive way to measure autonomic nervous system function. The aim of the study was to observe dilation velocity of the PLR (PLRdil.vel.) in patients with and without septic shock and explore whether other factors influenced the possible association. We hypothesized that the presence of septic shock in intensive care patients is associated with changes in sympathetic autonomic tone, which can be observed as changes in PLRdil.vel. Methods: In this prospective observational cohort study, we included 91 adult patients acutely admitted to a mixed ICU. The patients were followed for the development of septic shock until ICU discharge. PLRdil.vel. was measured with a portable pupillometer two times a day. We used linear mixed models to analyze for an association between PLRdil.vel and septic shock along with several covariables. Results: Ninety-one patients were enrolled and of these, 35 were in septic shock. Septic shock was associated with a slowed PLRdil.vel of 0.3 mm/s (95% confidence intervals [CI −0.4; −0.2]). Conclusions: Septic shock may be associated with changes in sympathetic autonomic tone which is supported by the findings from this study that septic shock was associated with a slower dilation velocity in the pupillary light reflex. Further studies should examine if the pupillary dilation velocity may serve as surrogate marker for changes in sympathetic autonomic nervous system activity in intensive care patients in septic shock. If so, future interventional studies should test if use of the pupillary dilation velocity may be used for earlier detection of septic shock, which could mean earlier institution of treatment measures for this condition.

Long COVID syndrome has emerged as a long-lasting consequence of acute SARS-CoV-2 infection in adults. In addition, children may be affected by Long COVID, with potential clinical issues in different fields, including problems in school performance and daily activities. Yet, the pathophysiologic bases of Long COVID in children are largely unknown, and it is difficult to predict who will develop the syndrome. In this multidisciplinary clinical review, we summarise the latest scientific data regarding Long COVID and its impact on children. Special attention is given to diagnostic tests, in order to help the physicians to find potential disease markers and quantify impairment. Specifically, we assess the respiratory, upper airways, cardiac, neurologic and motor and psychological aspects. Finally, we also propose a multidisciplinary clinical approach.

Heart rate variability (HRV) abnormalities are potential early biomarkers in Parkinson's disease (PD) but their relationship with central autonomic network (CAN) activity is not fully understood. We analyzed the synchronization between HRV and brain activity in 31 PD patients and 21 age-matched healthy controls using blood-oxygen-level-dependent (BOLD) signals from resting-state functional brain MRI and HRV metrics from finger plethysmography recorded for 7.40 min. We additionally quantified autonomic symptoms (SCOPA-AUT) and objective autonomic cardiovascular parameters (blood pressure and heart rate) during deep breathing, Valsalva, and head-up tilt, which were used to classify the clinical severity of dysautonomia. We evaluated HRV and BOLD signals synchronization (HRV-BOLD-sync) with Pearson lagged cross-correlations and Fisher's statistics for combining window-length-dependent HRV-BOLD-Sync Maps and assessed their association with clinical dysautonomia. HRV-BOLD-sync was lower significantly in PD than in controls in various brain regions within CAN or in networks involved in autonomic modulation. Moreover, heart-brain synchronization index (HBSI), which quantifies heart-brain synchronization at a single-subject level, showed an inverse exposure-response relationship with dysautonomia severity, finding the lowest HBSI in patients with severe dysautonomia, followed by moderate, mild, and, lastly, controls. Importantly, HBSI was associated in PD, but not in controls, with Valsalva pressure recovery time (sympathetic), deep breathing E/I ratio (cardiovagal), and SCOPA-AUT. Our findings support the existence of heart-brain de-synchronization in PD with an impact on clinically relevant autonomic outcomes.

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

BackgroundPatients with post-acute sequelae of COVID-19 (PASC) often experience the addition of new symptoms after recovery from COVID-19 illness. These may include orthostatic intolerance and autonomic dysfunction, and postural orthostatic tachycardia syndrome has been described to occur in a proportion of patients with PASC.Case summaryIn this report, we present a 32-year-old pregnant woman (G3P2) who experiences severe orthostatic symptoms as part of her PASC syndrome, which is decoupled from normal physiologic changes of pregnancy. At 25 weeks of gestation, she was evaluated for increasing episodes of dyspnoea, marked tachycardia with minimal exertion, intermittent non-exertional chest pain, and presyncope. This patient had a moderate course of COVID-19 at 12 weeks of gestation, for which she received monoclonal antibody therapy (casirivimab/imdevimab). The patient then had complete resolution of COVID-19 symptoms and felt well for 1 month prior to developing orthostatic symptoms at 25 weeks of gestation. Evaluation with a NASA Lean Test revealed marked orthostatic tachycardia, as well as delayed orthostatic hypotension. Given her COVID-19 illness 4 months prior, PASC involving autonomic dysfunction was diagnosed.DiscussionPatients with orthostatic symptoms in PASC should be carefully evaluated with dedicated active stand tests, such as the NASA Lean Test, to characterize the autonomic response to standing. In pregnant patients, an understanding of normal pregnancy physiology is crucial to correctly identify abnormal findings in such tests.

Background: Electroencephalography (EEG) is widely used to monitor critically ill patients. However, EEG interpretation requires the presence of an experienced neurophysiologist and is time-consuming. Aim of this study was to evaluate whether parameters derived from an automated pupillometer (AP) might help to assess the degree of cerebral dysfunction in critically ill patients. Methods: Prospective study conducted in the Department of Intensive Care of Erasme University Hospital in Brussels, Belgium. Pupillary assessments were performed using the AP in three subgroups of patients, concomitantly monitored with continuous EEG: “anoxic brain injury”, “Non-anoxic brain injury” and “other diseases”. An independent neurologist blinded to patient's history and AP results scored the degree of encephalopathy and reactivity on EEG using a standardized scale. The mean value of Neurologic Pupil Index (NPi), pupillary size, constriction rate, constriction and dilation velocity (CV and DV) and latency for both eyes, obtained using the NPi®-200 (Neuroptics, Laguna Hills, CA, USA), were reported. Results: We included 214 patients (mean age 60 years, 55% male). EEG tracings were categorized as: mild (n = 111, 52%), moderate (n = 65, 30%) or severe (n = 16, 8%) encephalopathy; burst-suppression (n = 19, 9%) or suppression background (n = 3, 1%); a total of 38 (18%) EEG were classified as “unreactive”. We found a significant difference in all pupillometry variables among different EEG categories. Moreover, an unreactive EEG was associated with lower NPi, pupil size, pupillary reactivity, CV and DV and a higher latency than reactive recordings. Low DV (Odds ratio 0.020 [95% confidence intervals 0.002–0.163]; p < 0.01) was independently associated with an unreactive EEG, together with the use of analgesic/sedative drugs and high lactate concentrations. In particular, DV values had an area under the curve (AUC) of 0.86 [0.79–0.92; p < 0.01] to predict the presence of unreactive EEG. In, SCOPUS: ar.j, info:eu-repo/semantics/published

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different

Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports' references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.

Introduction Evidence is emerging about an extra-pulmonary involvement of SARS-CoV-2, including the nervous system. Autonomic dysfunction in patients recovering from acute coronavirus disease 2019 (COVID-19) has been recently described. Dysautonomic symptoms have been reported in the acute phase of the disease, but clear evidence is lacking, especially in the non-critical forms of the infection. Objective The aim of this study is to assess the prevalence of dysautonomia in acute, non-critically ill COVID-19 patients. Methods In this observational, cross-sectional study, we compared 38 non-critically ill patients with acute COVID-19 (COVID + group) to 38 healthy volunteers (COVID - group) in order to assess the prevalence of signs and symptoms of dysautonomia through the administration of the composite autonomic symptom score 31 (COMPASS-31) and an active standing test. Comparisons between groups were performed by means of both univariate and multivariate analyses. Results The prevalence of orthostatic hypotension was significantly higher in the COVID + group. Higher total scores of COMPASS-31 were observed in the COVID + group than controls. Significant differences between groups emerged in the secretomotor, orthostatic intolerance, and gastrointestinal COMPASS-31 domains. All these results maintained the statistical significance after the adjustment for concomitant drugs with a known effect on the autonomic nervous system assumed by the study participants, except for the differences in the gastrointestinal domain of COMPASS-31. Conclusion Our results suggest that an autonomic dysfunction could be an early manifestation of COVID-19, even in the contest of mild forms of the infection.

Background and purpose: Ataxia and cough are rare features in hereditary sensory and autonomic neuropathies (HSAN), a group of diseases of mostly unknown genetic cause. Biallelic repeat expansions in RFC1 are associated with cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS). This study aimed to investigate the prevalence of RFC1 repeat expansions in a cohort of HSAN patients. Methods: After unremarkable whole-exome sequencing (WES) analysis, we performed repeat-primed PCR to detect intronic RFC1 expansions in 12 HSAN families, who all presented with chronic cough. Results: In these patients, 75% carried biallelic expansions of the pathogenic AAGGG motif. Compared with RFC1−/− cases, RFC1+/+ cases presented more consistently with positive sensory and autonomic symptoms. Afferent ataxia was more severe in the RFC1+/+ cohort and cerebellar ataxia was a common feature (21%). Conclusions: We demonstrate that RFC1 is a frequent cause of (WES-negative) HSAN with chronic cough and ataxia. The diagnostic yield of RFC1 repeat-primed PCR was surprisingly high, given that HSAN is genetically poorly understood. This combination of HSAN, ataxia, and chronic cough symptoms represents a new nosological entity within the neuropathy-ataxia spectrum., SCOPUS: ar.j, info:eu-repo/semantics/published

Heart rate variability (HRV) abnormalities are potential early biomarkers in Parkinson's disease (PD) but their relationship with central autonomic network (CAN) activity is not fully understood. We analyzed the synchronization between HRV and brain activity in 31 PD patients and 21 age-matched healthy controls using blood-oxygen-level-dependent (BOLD) signals from resting-state functional brain MRI and HRV metrics from finger plethysmography recorded for 7.40 min. We additionally quantified autonomic symptoms (SCOPA-AUT) and objective autonomic cardiovascular parameters (blood pressure and heart rate) during deep breathing, Valsalva, and head-up tilt, which were used to classify the clinical severity of dysautonomia. We evaluated HRV and BOLD signals synchronization (HRV-BOLD-sync) with Pearson lagged cross-correlations and Fisher's statistics for combining window-length-dependent HRV-BOLD-Sync Maps and assessed their association with clinical dysautonomia. HRV-BOLD-sync was lower significantly in PD than in controls in various brain regions within CAN or in networks involved in autonomic modulation. Moreover, heart-brain synchronization index (HBSI), which quantifies heart-brain synchronization at a single-subject level, showed an inverse exposure-response relationship with dysautonomia severity, finding the lowest HBSI in patients with severe dysautonomia, followed by moderate, mild, and, lastly, controls. Importantly, HBSI was associated in PD, but not in controls, with Valsalva pressure recovery time (sympathetic), deep breathing E/I ratio (cardiovagal), and SCOPA-AUT. Our findings support the existence of heart-brain de-synchronization in PD with an impact on clinically relevant autonomic outcomes.

The autonomic nervous system (ANS) regulates the cardiovascular system. A growing body of experimental and clinical evidence confirms significant dysfunction of this regulation during sepsis and septic shock. Clinical guidelines do not currently include any evaluation of ANS function during the resuscitation phase of septic shock despite the fact that the severity and persistence of ANS dysfunction are correlated with worse clinical outcomes. In the critical care setting, the clinical use of ANS-related hemodynamic indices is currently limited to preliminary investigations trying to predict and anticipate imminent clinical deterioration. In this review, we discuss the evidence supporting the concept that, in septic shock, restoration of ANS-mediated control of the cardiovascular system or alleviation of the clinical consequences induced by its dysfunction (e.g. excessive tachycardia, etc.), may be an important therapeutic goal, in combination with traditional resuscitation targets. Recent studies, which have used standard and advanced monitoring methods and mathematical models to investigate the ANS-mediated mechanisms of physiological regulation, have shown the feasibility and importance of monitoring ANS hemodynamic indices at the bedside, based on the acquisition of simple signals, such as heart rate and arterial blood pressure fluctuations. During the early phase of septic shock, experimental and/or clinical studies have shown the efficacy of negative-chronotropic agents (i.e. beta-blockers or ivabradine) in controlling persistent tachycardia despite adequate resuscitation. Central α-2 agonists have been shown to prevent peripheral adrenergic receptor desensitization by reducing catecholamine exposure. Whether these new therapeutic approaches can safely improve clinical outcomes remains to be confirmed in larger clinical trials. New technological solutions are now available to non-invasively modulate ANS outflow, such as transcutaneous vagal stimulation, with in, SCOPUS: re.j, info:eu-repo/semantics/published

BackgroundSlow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?.Study design and methodsA total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations.ResultsHRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6-10 (20.7%), 11-15 (18.9%), 16-22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58-0.66) for identifying FEV1<30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33-2.34]); CAT≥10 (OR=1.42[1.18-1.71]); mMRC≥2 (OR=1.42[1.19-1.69]); GOLD 4 (OR=1.98[1.44-2.73]) and GOLD D (OR=1.51[1.18-1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07-3.12], P=0.027).ConclusionHRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, sugge

BackgroundSlow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?.Study design and methodsA total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations.ResultsHRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6-10 (20.7%), 11-15 (18.9%), 16-22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58-0.66) for identifying FEV1<30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33-2.34]); CAT≥10 (OR=1.42[1.18-1.71]); mMRC≥2 (OR=1.42[1.19-1.69]); GOLD 4 (OR=1.98[1.44-2.73]) and GOLD D (OR=1.51[1.18-1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07-3.12], P=0.027).ConclusionHRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, sugge

Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures., Peer Reviewed

SAMMANFATTNING Bakgrund: Vid hjärnundersökningar finns även andra strukturer utanför hjärnan som är innerverade av nervsystemet. Det är möjligt att sjukdomen i hjärnan avspeglas där också. Det finns många sjukdomar och tillstånd med liknande symptom och att ställa rätt diagnos kan vara svårt. Många sjukdomar påverkar det autonoma nervsystemet och ett sätt att hitta rätt diagnos kan vara att undersöka hur det fungerar. Syfte: Att se vilka variationer av radioaktivitetsupptag som fanns i parotiskörtlarna mellan patienterna som avbildades med 11C-PE2I PET/DT. Samt att kunna se om denna information kan utnyttjas till att identifiera dysfunktion av autonoma nervsystemet (MRT-bilder är även en tillhjälps verktyg). Metod: Studiedesignen var en retrospektiv kvantitativ studie. Hundra (konsekutiva) patienter indelades i grupper så som: normal, Parkinsons, Parkinsons sjukdom med kombination av vaskulära förändringar och atypisk Parkinson sjukdom. Isotopupptag i basala ganglier och parotiskörtlar har mätts. Några patienters MRT- bilder var tillgängligt till kvantifiering. Resultat: kombinerade gruppen med Parkinsons sjukdom, atypisk Parkinsons sjukdom och vaskulära förändringar har en uppreglering av antalet fria dopaminreceptorer i parotis jämfört med friska (även i bara PSP samt bara vaskulära grupper) med (p <0.05). Slutsats: Det finns variation av upptaget mellan en del av grupper därmed kan sjukdomen i hjärnan avspeglas i körtlar också. Nyckelord: Neurodegenerativa sjukdomar, Autonom dysfunktion, 11CPE2I-PET/DT, parotiskörtlar, basala ganglier, Background: At brain examination, there are also other structures outside the brain that are innervated by the nervous system. It is possible that the disease of the brain is reflected there as well. There are many diseases and conditions with similar symptoms and making the right diagnosis can be difficult. Many diseases affect the autonomic nervous system and one way to find the right diagnosis may be to investigate how it works. Purpose: to see what variations in radioactivity uptake were found in the parotic glands between the patients depicted with the 11C-PE2I PET/CT. As well as being able to see how valuable this information is in being used to identify dysfunction of the autonomic nervous system (MRT- images are also an aids tool). Method: The study design was a retrospective quantitative study. One hundred (consecutive) patients were divided in groups such as normal, Parkinson's, Parkinson's disease with combination of vascular changes and atypical Parkinson's disease. Isotope uptake in basal ganglia and parotic glands has been measured. Some patients' MRT images were available for quantification. Result: the results show that the combined group of Parkinson's disease, atypical Parkinson's disease and vascular changes has an upregulation of the number of free dopamine receptors in parotid compared to healthy ones (also in PSP only and only vascular groups) with (p <0.05). Conclusion: There is variation of uptake between some of the groups thus the disease in the brain can be reflected in glands as well. Keywords: Neurodegenerative Diseases, Autonomic Dysfunction, 11CPE2I-PET/CT, Parotid Glands, Basal Ganglia

BackgroundSlow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?.Study design and methodsA total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations.ResultsHRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6-10 (20.7%), 11-15 (18.9%), 16-22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58-0.66) for identifying FEV1<30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33-2.34]); CAT≥10 (OR=1.42[1.18-1.71]); mMRC≥2 (OR=1.42[1.19-1.69]); GOLD 4 (OR=1.98[1.44-2.73]) and GOLD D (OR=1.51[1.18-1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07-3.12], P=0.027).ConclusionHRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, sugge

SAMMANFATTNING Bakgrund: Vid hjärnundersökningar finns även andra strukturer utanför hjärnan som är innerverade av nervsystemet. Det är möjligt att sjukdomen i hjärnan avspeglas där också. Det finns många sjukdomar och tillstånd med liknande symptom och att ställa rätt diagnos kan vara svårt. Många sjukdomar påverkar det autonoma nervsystemet och ett sätt att hitta rätt diagnos kan vara att undersöka hur det fungerar. Syfte: Att se vilka variationer av radioaktivitetsupptag som fanns i parotiskörtlarna mellan patienterna som avbildades med 11C-PE2I PET/DT. Samt att kunna se om denna information kan utnyttjas till att identifiera dysfunktion av autonoma nervsystemet (MRT-bilder är även en tillhjälps verktyg). Metod: Studiedesignen var en retrospektiv kvantitativ studie. Hundra (konsekutiva) patienter indelades i grupper så som: normal, Parkinsons, Parkinsons sjukdom med kombination av vaskulära förändringar och atypisk Parkinson sjukdom. Isotopupptag i basala ganglier och parotiskörtlar har mätts. Några patienters MRT- bilder var tillgängligt till kvantifiering. Resultat: kombinerade gruppen med Parkinsons sjukdom, atypisk Parkinsons sjukdom och vaskulära förändringar har en uppreglering av antalet fria dopaminreceptorer i parotis jämfört med friska (även i bara PSP samt bara vaskulära grupper) med (p <0.05). Slutsats: Det finns variation av upptaget mellan en del av grupper därmed kan sjukdomen i hjärnan avspeglas i körtlar också. Nyckelord: Neurodegenerativa sjukdomar, Autonom dysfunktion, 11CPE2I-PET/DT, parotiskörtlar, basala ganglier, Background: At brain examination, there are also other structures outside the brain that are innervated by the nervous system. It is possible that the disease of the brain is reflected there as well. There are many diseases and conditions with similar symptoms and making the right diagnosis can be difficult. Many diseases affect the autonomic nervous system and one way to find the right diagnosis may be to investigate how it works. Purpose: to see what variations in radioactivity uptake were found in the parotic glands between the patients depicted with the 11C-PE2I PET/CT. As well as being able to see how valuable this information is in being used to identify dysfunction of the autonomic nervous system (MRT- images are also an aids tool). Method: The study design was a retrospective quantitative study. One hundred (consecutive) patients were divided in groups such as normal, Parkinson's, Parkinson's disease with combination of vascular changes and atypical Parkinson's disease. Isotope uptake in basal ganglia and parotic glands has been measured. Some patients' MRT images were available for quantification. Result: the results show that the combined group of Parkinson's disease, atypical Parkinson's disease and vascular changes has an upregulation of the number of free dopamine receptors in parotid compared to healthy ones (also in PSP only and only vascular groups) with (p <0.05). Conclusion: There is variation of uptake between some of the groups thus the disease in the brain can be reflected in glands as well. Keywords: Neurodegenerative Diseases, Autonomic Dysfunction, 11CPE2I-PET/CT, Parotid Glands, Basal Ganglia

Dementia with Lewy bodies (DLB) is recognized as the second most common form of dementia in aged people. It is well known that patients with DLB often develop various autonomic symptoms. Here, we present a case in which there was sick sinus syndrome mimicking the DLB-related autonomic dysfunctions. After the pacemaker implantation, the patient's symptom perfectly extinguished. It is essential for psychiatrists or other professionals who are mainly seeing dementia patients to rule out critical causes that may mimic autonomic symptoms in patients with DUB.

Dementia with Lewy bodies (DLB) is recognized as the second most common form of dementia in aged people. It is well known that patients with DLB often develop various autonomic symptoms. Here, we present a case in which there was sick sinus syndrome mimicking the DLB-related autonomic dysfunctions. After the pacemaker implantation, the patient's symptom perfectly extinguished. It is essential for psychiatrists or other professionals who are mainly seeing dementia patients to rule out critical causes that may mimic autonomic symptoms in patients with DUB.

Coronavirus disease-19 (COVID-19) is a predominantly respiratory syndrome. Growing reports about a SARS-CoV-2 neurological involvement, including autonomic dysfunction (AD), have been reported, mostly in critically-ill patients, or in the long-COVID syndrome. In this observational, cross-sectional study, we investigated the prevalence of AD in 20 non-critically-ill COVID-19 patients (COVID+ group) in the acute phase of the disease through a composite instrumental evaluation consisting of Sudoscan, automated pupillometry, heart rate variability (HRV), and pulse transit time (PTT). All the parameters were compared to a control group of 20 healthy volunteers (COVID- group). COVID+ group presented higher values of pupillary dilatation velocities, and baseline pupil diameter than COVID- subjects. Moreover, COVID+ patients presented a higher incidence of feet sudomotor dysfunction than COVID- group. No significant differences emerged in HRV and PTT parameters between groups. In this study we observed the occurrence of autonomic dysfunction in the early stage of the disease.

Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures., Peer Reviewed

Introduction Autonomic dysfunction has been reported as one of non-motor manifestations of both pre-symptomatic and manifest Huntington's Disease (HD). The aim of our study was to evaluate heart rate variability (HRV) during wake and sleep in a cohort of patients with manifest HD. Methods Thirty consecutive patients with manifest HD were enrolled, 14 men and 16 women, mean age 57.3±12.2 years. All patients underwent full-night attended video-polysomnography. HRV was analyzed during wake, NREM and REM sleep, in time and frequency domain. Results were compared with a control group of healthy volunteers matched for age and sex. Results During wake HD patients presented significantly higher mean heart rate than controls (72.4±9.6 vs 58.1±7.3 bpm; p<0.001). During NREM sleep, HD patients showed higher mean heart rate (65.6±11.1 vs 48.8±4.6 bpm; p<0.001) and greater Low Frequency (LF) component of HRV (52.9±22.6 vs 35.5±17.3 n.u.; p=0.004). During REM sleep, we observed lower standard deviation of the R-R interval (SDNN) in HD subjects (3.4±2.2 vs 3.7±1.3 ms; p=0.015). Conclusion Our results showed that HD patients have higher heart rate than controls, during wake and NREM, but not during REM sleep. Among HRV variability parameters, the most relevant difference regarded the LF component, which reflects, at least partially, the ortho-sympathetic output. Our results confirm the involvement of autonomic nervous system in HD and demonstrate that it is evident during both wake and sleep.

Background: Autonomic nervous system dysfunction (ANSD) is known to affect glucose metabolism in the mammalian body. Tradition holds that glucose homeostasis is regulated by the peripheral nervous system, and contemporary therapeutic intervention reflects this convention.Objectives: The present study tested the role of cerebral regulation of ANSD as consequence of novel understanding of glucose metabolism and treatment target in type 2 diabetes (T2D), suggested by the claim that the pressure pain sensitivity (PPS) of the chest bone periosteum may be a measure of cerebral ANSD.Design: In a randomized controlled trial of 144 patients with T2D, we tested the claim that 6 months of this treatment would reduce PPS and improve peripheral glucose metabolism.Results: In the active treatment group, mean glycated hemoglobin A1c (HbA1c) declined from 53.8 to 50.5 mmol/mol (intragroup p = 0.001), compared with the change from 53.8 to 53.4 mmol/mol in the control group, with the same level of diabetes treatment but not receiving the active treatment (between group p = 0.036). Mean PPS declined from 76.6 to 56.1 units (p <0.001) in the active treatment group and from 77.5 to 72.8 units (p = 0.02; between group p <0.001) in the control group. Changes of PPS and HbA1c were correlated (r = 0.37; p <0.001).Conclusion: We conclude that the proposed approach to treatment of T2D is a potential supplement to conventional therapy.

Background: Autonomic nervous system dysfunction (ANSD) is known to affect glucose metabolism in the mammalian body. Tradition holds that glucose homeostasis is regulated by the peripheral nervous system, and contemporary therapeutic intervention reflects this convention.Objectives: The present study tested the role of cerebral regulation of ANSD as consequence of novel understanding of glucose metabolism and treatment target in type 2 diabetes (T2D), suggested by the claim that the pressure pain sensitivity (PPS) of the chest bone periosteum may be a measure of cerebral ANSD.Design: In a randomized controlled trial of 144 patients with T2D, we tested the claim that 6 months of this treatment would reduce PPS and improve peripheral glucose metabolism.Results: In the active treatment group, mean glycated hemoglobin A1c (HbA1c) declined from 53.8 to 50.5 mmol/mol (intragroup p = 0.001), compared with the change from 53.8 to 53.4 mmol/mol in the control group, with the same level of diabetes treatment but not receiving the active treatment (between group p = 0.036). Mean PPS declined from 76.6 to 56.1 units (p <0.001) in the active treatment group and from 77.5 to 72.8 units (p = 0.02; between group p <0.001) in the control group. Changes of PPS and HbA1c were correlated (r = 0.37; p <0.001).Conclusion: We conclude that the proposed approach to treatment of T2D is a potential supplement to conventional therapy.

There is a dearth of information about cardiovascular problems in fragile X premutation carriers who have 55-200 CGG repeats in fragile X mental retardation 1 (FMR1) gene. The FMR1 expansion in the premutation range leads to toxic RNA gain-of-function resulting in cellular dysregulation. The mechanism of RNA toxicity underlies all of the premutation disorders including fragile X-associated tremor/ataxia syndrome, fragile X-associated primary ovarian insufficiency, and fragile X-associated neuropsychiatric disorder. Cardiovascular problems particularly autonomic dysfunction, hypertension, and cardiac arrhythmias are not uncommon in premutation carriers. Some arterial problems and valvular heart diseases have also been reported. This article reviews cardiovascular problems in premutation carriers and discusses possible contributing mechanisms including RNA toxicity and mild fragile X mental retardation protein deficiency. Further research studies are needed in order to prove a direct association of the cardiovascular problems in fragile X premutation carriers because such knowledge will lead to better preventative treatment.

Purpose: based on the generalization of the results of modern domestic and foreign scientific and methodological literature to develop a physical therapy program for adolescents with autonomic dysfunction. Material & Methods: under our supervision there were 30 children 15–17 years old with a diagnosis of vegetative-vascular dystonia. According to the purpose and objectives of the study, anthropometric methods were used, the condition of the musculoskeletal system was studied using the stoop index and REEDCO posture assessment, the static balancing was determined using the Bondarevsky test, the Kerdo index was calculated, and mathematical statistics methods were used. Results: a physical therapy program was developed, which included kinesiotherapy, elements of psychotherapy and auto-training, post-isometric relaxation. After applying the physical therapy program in adolescents, complaints of headache and dizziness decreased. The dynamics of the assessment of posture and stoop index indicated a significant improvement in all the studied parameters from the cardiovascular system; a decrease in the rate of cardiovascular contractions, an increase in the numbers of systolic blood pressure and the Kerdo index were observed. Conclusions: the physical therapy program was developed taking into account the principles of physical therapy, the effectiveness of the program is confirmed by improving empirical parameters, indicators of the musculoskeletal system, cardiovascular system and quality of life, reduced as a result of autonomic dysfunction.

There is a dearth of information about cardiovascular problems in fragile X premutation carriers who have 55-200 CGG repeats in fragile X mental retardation 1 (FMR1) gene. The FMR1 expansion in the premutation range leads to toxic RNA gain-of-function resulting in cellular dysregulation. The mechanism of RNA toxicity underlies all of the premutation disorders including fragile X-associated tremor/ataxia syndrome, fragile X-associated primary ovarian insufficiency, and fragile X-associated neuropsychiatric disorder. Cardiovascular problems particularly autonomic dysfunction, hypertension, and cardiac arrhythmias are not uncommon in premutation carriers. Some arterial problems and valvular heart diseases have also been reported. This article reviews cardiovascular problems in premutation carriers and discusses possible contributing mechanisms including RNA toxicity and mild fragile X mental retardation protein deficiency. Further research studies are needed in order to prove a direct association of the cardiovascular problems in fragile X premutation carriers because such knowledge will lead to better preventative treatment.

Physical culture at the university is carried out throughout the entire period of training of students and is carried out in various forms, which are interrelated and represent a single process of physical education of students. The learning process is organized depending on the state of health, the level of physical development and fitness of students, as well as taking into account the conditions and nature of the work of their future professional activity.

Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME., Peer Reviewed, Postprint (published version)

Objective: This study aimed to analyze the association of autonomic dysfunction with cognition, depression, apathy, and fatigue in Lewy body disease (LBD). Methods: We included 61 patients [49 with idiopathic Parkinson’s disease, 7 with dementia with Lewy bodies, and 5 E46K- SNCA mutation carriers] and 22 healthy controls. All participants underwent a comprehensive battery of neuropsychologi- cal and clinical measures, autonomic symptom assessment with the SCOPA-AUT, analysis of non-invasive hemodynamic parameters during deep breathing, the Valsalva maneuver, and a 20-min tilt test, and electrochemical skin conductance measurement at rest (Sudoscan). Student’s t tests were used to assess group diferences, and bivariate correlations and stepwise linear regressions to explore associations between autonomic function, cognition, depression, apathy, and fatigue. Results: Compared to controls, patients who had signifcant impairment (p<0.05) in cognition, higher depression, apathy, and fatigue, more autonomic symptoms and objective autonomic dysfunction, reduced deep breathing heart rate variability [expiratory-to-inspiratory (E/I) ratio], prolonged pressure recovery time, and lower blood pressure in Valsalva late phase II and phase IV, while 24.1% had orthostatic hypotension in the tilt test. Autonomic parameters signifcantly correlated with cognitive and neuropsychiatric outcomes, systolic blood pressure during the Valsalva maneuver predicting apathy and depres- sion. The E/I ratio was the main predictor of cognitive performance (17.6% for verbal fuency to 32.8% for visual memory). Conclusion: Cardiovascular autonomic dysfunction is associated with cognitive and neuropsychiatric impairment in LBD, heart rate variability during deep breathing and systolic blood pressure changes during the Valsalva procedure are the main predictors of neuropsychological performance and depression/apathy symptoms, respectively.

PurposeCardiac autonomic dysfunction manifests as reduced heart rate variability (HRV) in idiopathic Parkinson's disease (PD), but no significant reduction has been found in PD patients who carry the LRRK2 mutation. Novel HRV features have not been investigated in these individuals. We aimed to assess cardiac autonomic modulation through standard and novel approaches to HRV analysis in individuals who carry the LRRK2 G2019S mutation.MethodsShort-term electrocardiograms were recorded in 14 LRRK2-associated PD patients, 25 LRRK2-non-manifesting carriers, 32 related non-carriers, 20 idiopathic PD patients, and 27 healthy controls. HRV measures were compared using regression modeling, controlling for age, sex, mean heart rate, and disease duration. Discriminant analysis highlighted the feature combination that best distinguished LRRK2-associated PD from controls.ResultsBeat-to-beat and global HRV measures were significantly increased in LRRK2-associated PD patients compared with controls (e.g., deceleration capacity of heart rate: p = 0.006) and idiopathic PD patients (e.g., 8th standardized moment of the interbeat interval distribution: p = 0.0003), respectively. LRRK2-associated PD patients also showed significantly increased irregularity of heart rate dynamics, as quantified by Rényi entropy, when compared with controls (p = 0.002) and idiopathic PD patients (p = 0.0004). Ordinal pattern statistics permitted the identification of LRRK2-associated PD individuals with 93% sensitivity and 93% specificity. Consistent results were found in a subgroup of LRRK2-non-manifesting carriers when compared with controls.ConclusionsIncreased beat-to-beat HRV in LRRK2 G2019S mutation carriers compared with controls and idiopathic PD patients may indicate augmented cardiac autonomic cholinergic activity, suggesting early impairment of central vagal feedback loops in LRRK2-associated PD.

Background. There are multifunctional researches for better understanding the effect of cognitive disorders on treatment, mobility, mortality of patients, especially persons with multimorbid pathology. The purpose was to study the features of cognitive and neurovegetative dysfunction in patients with different forms of non-alcoholic fatty liver disease (NAFLD) (non-alcoholic fatty hepatosis (NAFH) and non-alcoholic steatohepatitis (NASH)) and type 2 diabetes mellitus (T2DM). Materials and methods. Fifty patients with NAFLD (24 — with NAFH and 26 — with NASH) were examined. The comparison group included 22 patients with T2DM. Dysfunction of central and autonomic nervous system was evaluated with the help of neuropsychometric testing. Results. The analysis of conducted research indicates autonomic dysfunction in the surveyed patients. Cognitive impairment (mostly mild and moderate) was detected in all persons in both groups. The most pronounced disturbances were determined in the areas of attention and concentration, memory, less pronounced — in visually constructive area, especially in patients with NASH combined with type 2 diabetes. Stressful situations have a significant impact on the lives of these persons, but they are not critical enough to any issues. Patients with NASH associated with type 2 diabetes have the lowest level of resistance to stress — (56.7 ± 3.1) points; p < 0.01. They experienced a slight vulnerability even from minor impacts. Conclusions. According to neuropsychometric testing, cognitive impairment and autonomic dysfunction were found in patients with NAFLD and type 2 diabetes. The most pronounced cognitive impairment was found in patients with NASH combined with type 2 diabetes and obesity class I, according to the results of the Montreal Cognitive Assessment (r = 0.90; p < 0.01), the Boston test (r = 0.94; p < 0.01) and the Wisconsin Card Sorting Test (r = 0.92; p < 0.01)., Актуальность. Проводятся разнонаправленные исследования для лучшего понимания влияния когнитивных нарушений на лечение, мобильность, смертность пациентов, особенно лиц с полиморбидной патологией. Цель: изучить особенности когнитивных и нейровегетативных нарушений у пациентов с различными формами неалкогольной жировой болезни печени (НАЖБП) (неалкогольный жировой гепатоз (НАЖГ) и неалкогольный стеатогепатит (НАСГ)) и сахарным диабетом (СД) 2 типа. Материалы и методы. Обследовано 50 пациентов с НАЖБП (24 — с НАЖГ и 26 — с НАСГ). Группа сравнения включала 22 человека с СД 2 типа. Нарушения функций центральной и вегетативной нервной системы определяли с помощью нейропсихометрических тестов. Результаты. У обследованных пациентов по результатам анкетирования установлена вегетативная дисфункция. Когнитивные нарушения (преимущественно легкие и умеренные) выявлены в обеих группах больных. Максимально выраженные нарушения определялись в сфере внимания и концентрации, памяти, менее выраженные — в зрительно-конструктивной сфере, особенно у больных с НАСГ в сочетании с СД 2 типа. Стрессовые ситуации негативно влияют на жизнь этих пациентов, при этом они недостаточно критически реагируют на обнаруженные проблемы. У больных НАСГ в сочетании с СД 2 типа установлен наименьший уровень сопротивляемости стрессу — (56,7 ± 3,1) балла; p < 0,01. У них определяется легкая уязвимость даже при незначительном негативном влиянии. Выводы. У пациентов с НАЖБП и СД 2 типа выявлены когнитивные нарушения и вегетативная дисфункция по результатам нейропсихометрического тестирования. Наиболее выраженными когнитивные нарушения были у больных НАСГ в сочетании с СД 2 типа и ожирением I степени по результатам Монреальской шкалы оценки когнитивных функций (r = 0,90; р < 0,01), Бостонского теста (r = 0,94; р < 0,01) и Висконсинского теста сортировки карточек (r = 0,92, р < 0,01)., Актуальність. Проводяться різноспрямовані дослідження для кращого розуміння впливу когнітивних порушень на лікування, мобільність, смертність пацієнтів, особливо осіб iз поліморбідною патологією. Мета: вивчити особливості когнітивних i нейровегетативних порушень у пацієнтів iз різними формами неалкогольної жирової хвороби печінки (НАЖХП) (неалкогольний жировий гепатоз (НАЖГ) та неалкогольний стеатогепатит (НАСГ)) та цукровим діабетом 2 типу. Матеріали та методи. Обстежено 50 пацієнтів iз НАЖХП (24 — з НАЖГ та 26 — з НАСГ). Група порівняння включала 22 людини з ЦД 2 типу. Порушення функцій центральної та вегетативної нервової системи визначали за допомогою нейропсихометричних тестів. Результати. В обстежених пацієнтів за результатами анкетування встановлено вегетативну дисфункцію. Когнітивні порушення (переважно легкі та помірні) виявлено в обох групах хворих. Максимально виражені порушення визначались у сфері уваги і концентрації, пам’яті, менш виражені — у зорово-конструктивній сфері, особливо у хворих iз НАСГ у поєднанні з ЦД 2 типу. Стресові ситуації мають виражений вплив на життя цих пацієнтів, при цьому вони не досить критично реагують на виявлені проблеми. У хворих iз НАСГ у поєднанні з ЦД 2 типу встановлено найнижчий рівень опірності стресу — (56.7 ± 3.1) бала; p < 0,01. У них виявлена легка вразливість навіть за незначного негативного впливу. Висновки. У пацієнтів iз НАЖХП та ЦД 2 типу виявлено когнітивні порушення та вегетативну дисфункцію за результатами нейропсихометричного тестування. Найбільш вираженими когнітивні порушення були у хворих iз НАСГ у поєднанні з ЦД 2 типу та ожирінням І ступеня за результатами Монреальської шкали оцінки когнітивних функцій (r = 0,90; р < 0,01), Бостонського тесту (r = 0,94; р < 0,01) та Вісконсинського тесту сортування карток (r = 0,92; р < 0,01).

Objective: To perform a systematic review of the current scientific literature in order to identify variables associated with patient prognosis in autoimmune encephalitis. Method(s): We performed a systematic literature search using MEDLINE, Embase, PubMed and PsychInfo databases. We selected studies that explored the correlation between early clinical and paraclinical findings, and patient outcomes. Data was extracted, analyzed and recorded in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Result(s): Forty four publications detailing 2823 subjects matched our inclusion criteria. There was considerable heterogeneity in methodology, patient profile, investigation results and clinical outcome measures. Findings were often discrepant for cases of anti-NMDAR encephalitis when compared with other causes of autoimmune encephalitis. Delay in immunotherapy contributed to a variety of worse outcomes for patients with different subsets of autoimmune encephalitis. Altered consciousness, ICU admission and no use of immunotherapy were variables associated with poor prognosis in anti-NMDAR encephalitis. Older age, sex, the presence of status epilepticus, CSF abnormalities and MRI changes were unlikely to have significant prognostic value. The influence of antibody titers, autonomic dysfunction and underlying malignancy was unclear. Conclusion(s): A number of variables were identified to have potential predictive value for outcomes in autoimmune encephalitis. Heterogeneous study design, size and quality were major limiting factors in this review.Copyright © 2018 Elsevier Ltd

PurposeCardiac autonomic dysfunction manifests as reduced heart rate variability (HRV) in idiopathic Parkinson's disease (PD), but no significant reduction has been found in PD patients who carry the LRRK2 mutation. Novel HRV features have not been investigated in these individuals. We aimed to assess cardiac autonomic modulation through standard and novel approaches to HRV analysis in individuals who carry the LRRK2 G2019S mutation.MethodsShort-term electrocardiograms were recorded in 14 LRRK2-associated PD patients, 25 LRRK2-non-manifesting carriers, 32 related non-carriers, 20 idiopathic PD patients, and 27 healthy controls. HRV measures were compared using regression modeling, controlling for age, sex, mean heart rate, and disease duration. Discriminant analysis highlighted the feature combination that best distinguished LRRK2-associated PD from controls.ResultsBeat-to-beat and global HRV measures were significantly increased in LRRK2-associated PD patients compared with controls (e.g., deceleration capacity of heart rate: p = 0.006) and idiopathic PD patients (e.g., 8th standardized moment of the interbeat interval distribution: p = 0.0003), respectively. LRRK2-associated PD patients also showed significantly increased irregularity of heart rate dynamics, as quantified by Rényi entropy, when compared with controls (p = 0.002) and idiopathic PD patients (p = 0.0004). Ordinal pattern statistics permitted the identification of LRRK2-associated PD individuals with 93% sensitivity and 93% specificity. Consistent results were found in a subgroup of LRRK2-non-manifesting carriers when compared with controls.ConclusionsIncreased beat-to-beat HRV in LRRK2 G2019S mutation carriers compared with controls and idiopathic PD patients may indicate augmented cardiac autonomic cholinergic activity, suggesting early impairment of central vagal feedback loops in LRRK2-associated PD.

Pitt-Hopkins syndrome (PTHS) is a neurodevelopmental disorder characterized by intellectual disability, specific facial features, and marked autonomic nervous system dysfunction, especially with disturbances of regulating respiration and intestinal mobility. It is caused by variants in the transcription factor TCF4. Heterogeneity in the clinical and molecular diagnostic criteria and care practices has prompted a group of international experts to establish guidelines for diagnostics and care. For issues, for which there was limited information available in international literature, we collaborated with national support groups and the participants of a syndrome specific international conference to obtain further information. Here, we discuss the resultant consensus, including the clinical definition of PTHS and a molecular diagnostic pathway. Recommendations for managing particular health problems such as dysregulated respiration are provided. We emphasize the need for integration of care for physical and behavioral issues. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimization of diagnostics and care.

The study examined the effects of short-term field-based military training with partial sleep deprivation on whole-body endurance performance in well-trained individuals. Before and after a 2-day sustained operations (SUSOPS), 14 cadets performed a 15-min constant-load cycling at 65% of peak power output (PPO; CLT65), followed by an exhaustive constant-load trial at 85% of PPO (CLT85). Physiological [oxygen uptake (O-2), heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and regional oxygenation (TOI) in the frontal cerebral cortex and vastus lateralis muscle] and psychological [effort perception (RPE), affective valence (FS), and perceived activation (FAS)] variables were monitored during exercise. SUSOPS reduced time to exhaustion in CLT85 by 29.1% (p = 0.01). During the CLT65 trial, SUSOPS potentiated the exercise-induced elevations in O-2 and HR (p < 0.05), and blunted MAP (p = 0.001). CO did not differ between trials. Yet, towards the end of both CLT85 trials, CO tended to decline (p 0.08); a response that occurred at an earlier stage in the SUSOPS trial. During CLT65, SUSOPS altered neither cerebral nor muscle TOI. The SUSOPS CLT85 trial, however, was terminated at similar leg-muscle deoxygenation (p > 0.05) and lower prefrontal cortex deoxygenation (p < 0.01). SUSOPS increased RPE at submaximal intensities (p = 0.05), and suppressed FAS and FS throughout (p < 0.01). The present findings indicate, therefore, that a brief period of military sustained operations with partial sleep deprivation augment cardiorespiratory and psychological strain, limiting high-intensity endurance capacity., QC 20180720

Актуальність. Тріметабол — комплексний препарат, що стимулює апетит, чинить кардіопротекторну, нейротропну й антиоксидантну дію. Мета: оцінити ефективність метаболічної терапії із застосуванням препарату Тріметабол у дітей із синдромом вегетативної дисфункції за гіпотензивним типом. Матеріали та методи. Обстежено 45 дітей віком 9–17 років із вегетативною дисфункцією за гіпотензивним типом. Усіх дітей було розподілено на дві групи: основна група (30 дітей) отримувала Тріметабол, група порівняння (15 дітей) — полівітамінні комплекси. Курс лікування становив 1 місяць. Результати. На тлі прийому Тріметаболу в дітей відбувалося зменшення скарг на головний біль, запаморочення, кардіалгії, покращився апетит, нормалізувалися серцевий ритм і провідність. На відміну від групи порівняння в дітей основної групи спостерігалася краща динаміка показників добового моніторингу артеріального тиску (ДМАТ) і варіабельності серцевого ритму. За даними ДМАТ, середньодобовий систолічний артеріальний тиск (САТ) збільшився в них із 107,4 ± 1,0 мм рт.ст. до 110,8 ± 1,1 мм рт.ст., р < 0,05 (у групі порівняння вірогідно не змінився), індекс часу гіпотензії САТ зменшився з 36,3 ± 2,9 % до 25,4 ± 2 ,6 %, р < 0,01 (у групі порівняння зменшився з 40,7 ± 4,7 % до 26,8 ± 4,6 %, р < 0,05). Зменшення загальної потужності спектра спостерігалося в обох групах, проте в основній групі воно було більш виражене й відбувалося як за рахунок зменшення VLF% (з 75,82 ± 1,63 % до 69,5 ± 1,7 %, р < 0,05) , так і за рахунок збільшення питомої ваги LF (з 8,78 ± 0,43 % до 10,20 ± 0,37 %, р < 0,05) і HF% (з 11,31 ± 0,46 % до 13,9 ± 0,8 %, р < 0,05). Ці дані вказують на те, що під впливом Тріметаболу відбувався перерозподіл активності центральних і автономних контурів регуляції зі зменшенням активності центральних контурів (VLF%) і відносним підвищенням активності автономних (LF%, HF%). Висновки. Тріметабол є ефективним препаратом у лікуванні вегетативної дисфункції за гіпотензивним типом. Застосування, Background. Trimetabol is a combined appetite stimulant that has cardioprotective, neurotropic and antioxidant effects. The purpose was to evaluate the effectiveness of metabolic therapy with the use of Trimetabol in children with hypotensive type of autonomic dysfunction syndrome. Materials and methods. Forty five children aged 9–17 years with autonomic hypotensive dysfunction were examined. All children were divided into two groups: the main group (n = 30) received Trimetabol, the comparison group (n = 15) — multivitamins. The course of treatment was 1 month. Results. Against the background of treatment with Trimetabol, headache, dizziness, heart pain decreased, appetite, heart rhythm and conduction normalized. Unlike the comparison group, the children of the main group experienced better dynamics of ambulatory blood pressure monitoring (ABPM) and heart rate variability. According to ABPM, average daily systolic blood pressure (SBP) increased from 107.4 ± 1.0 mmHg to 110.8 ± 1.1 mmHg, p < 0.05 (in the comparison group, it has not changed significantly), the time index of hypotension of SBP decreased from 36.3 ± 2.9 % to 25.4 ± 2.6 %, p < 0.01 (in the comparison group — from 40.7 ± 4.7 % to 26.8 ± 4.6 %, p < 0.05). Reduction in total spectrum power was observed in both groups, but in the main group, it was more significant and occurred as a result of a decrease in VLF% (from 75.82 ± 1.63 % to 69.50 ± 1.70 %, p < 0.05), and due to an increase in the specific gravity of LF (from 8.78 ± 0.43 % to 10.20 ± 0.37 %, p < 0.05) and HF% (from 11.31 ± 0.46 % to 13.90 ± 0.80 %, p < 0.05). These data indicate that under the influence of Trimetabol, the central and autonomic regulation circuit activity was redistributed from the decrease in the activity of the central circuits (VLF%) and the relative increase in the activity of autonomic circuits (LF%, HF%). Conclusions. Trimetabol is an effective drug for the treatment of hypotensive type of autonomic dysfunct, Актуальность. Триметабол — комплексный препарат, который стимулирует аппетит, оказывает кардиопротекторное, нейротропное и антиоксидантное действие. Цель: оценить эффективность метаболической терапии с применением препарата Триметабол у детей с синдромом вегетативной дисфункции по гипотензивному типу. Материалы и методы. Обследовано 45 детей 9–17 лет с вегетативной дисфункцией по гипотензивному типу. Все дети были разделены на две группы: основная группа (30 детей) получала Триметабол, группа сравнения (15 детей) — поливитаминные комплексы. Курс лечения составил 1 месяц. Результаты. На фоне приема Триметабола у детей уменьшались жалобы на головную боль, головокружение, кардиалгии, улучшился аппетит, нормализовались сердечный ритм и проводимость. В отличие от группы сравнения у детей основной группы наблюдалась лучшая динамика показателей суточного мониторинга артериального давления (СМАД) и вариабельности сердечного ритма. По данным СМАД, среднесуточное систолическое артериальное давление (САД) увеличилось с 107,4 ± 1,0 мм рт.ст. до 110,8 ± 1,1 мм рт.ст., р < 0,05 (в группе сравнения достоверно не изменилось), индекс времени гипотензии САД уменьшился с 36,3 ± 2,9 % до 25,4 ± 2,6 %, р < 0,01 (в группе сравнения уменьшился с 40,7 ± 4,7 % до 26,8 ± 4,6 %, р < 0,05). Уменьшение общей мощности спектра наблюдалось в обеих группах, однако в основной группе оно было более выраженным и происходило как за счет уменьшения VLF% (с 75,82 ± 1,63 % до 69,5 ± 1,7 %, р < 0,05), так и за счет увеличения удельного веса LF (с 8,78 ± 0,43 % до 10,20 ± 0,37 %, р < 0,05) и HF% (с 11,31 ± 0,46 % до 13,9 ± 0,8 %, р < 0,05). Эти данные указывают на то, что под влиянием Триметабола происходило перераспределение активности центральных и автономных контуров регуляции с уменьшением активности центральных контуров (VLF%) и относительным повышением активности автономных (LF%, HF%). Выводы. Триметабол является эффективным препаратом в лечении вегетативной дисфункции по гипотензивн

Короткий опис роботи. Доведено, що вегетативна дисфункція, яка виникла в дитячому чи підлітковому віці, стає несприятливим фоном та передвісником багатьох захворювань, зокрема хронічних. У зв’язку зі зростанням частоти вегетативної дисфункції у дітей за останні роки виникає необхідність вивчати цю проблему.Мета роботи. Дослідити стан вегетативної нервової системи в дітей із хронічною гастродуоденальною патологією.Матеріали та методи. Обстежено 120 дітей шкільного віку, які перебували на стаціонарному лікуванні в гастроентерологічному відділенні міської дитячої клінічної лікарні м. Чернівці. Дітей розподілено на дві групи: основну - (60 осіб із хронічною гастродуоденальною патологією), та контрольну – (60 осіб із функціональними захворюваннями органів травного каналу). Під час анкетування дітей за допомою опитувальника Вейна оцінили стан вегетативної нервової системи. Для визначення характеру вегетативної дисфункції із переважанням симпатичного чи парасимпатичного відділів використовували вегетативний індекс Кердо. Усім дітям також проводили електрокардіографічне обстеження.Результати. У дітей із хронічною гастродуоденальною патологією у двічі частіше виявляли вегетативну дисфункцію, ніж у групі порівняння. Оцінивши індекс Кердо у дітей із основної групи вірогідно частіше спостерігалося переважання симпатичного тонусу вегетативної системи 85,6±0,2 %, проти 50,8±0,3% у контрольній групі та вірогідно рідше виявлено в них еутонію – 4,4±0,4 %, проти 41,0±0,2 % у контрольній групі, р<0,05.Висновки. Переважання частоти вегетативної дисфункції у дітей основної групи можна пояснити наслідком вегетативної дизрегуляції та органічного ураження гастродуоденальної ділянки у них., Резюме. Доказано, что вегетативная дисфункция, которая возникла в детском или подростковом возрасте, становится неблагоприятным фоном и предвестником многих заболеваний, в том числе хронических. В связи с ростом частоты вегетативной дисфункции у детей за последние годы возникает необходимость изучать эту проблему.Цель работы. Исследовать состояние вегетативной нервной системы у детей с хронической гастродуоденальной патологией.Материалы и методы. Обследовано 120 детей школьного возраста, которые находились на стационарном лечении в гастроэнтерологическом отделении городской детской клинической больницы г.Черновцы. Дети разделены на две группы: основную - (60 человек с хронической гастродуоденальной патологией), и контрольную - (60 человек с функциональными заболеваниями органов желудочно-кишечного тракта).Во время анкетирования детей при помощи опросника Вейна оценили состояние вегетативной нервной системы. Для определения характера вегетативной дисфункции с преобладанием симпатического или парасимпатического отделов использовали вегетативный индекс Кердо. Всем детям также проводили электрокардиографическое обследование.Результаты. У детей с хронической гастродуоденальной патологией в два раза чаще определяли вегетативную дисфункцию, чем в группе сравнения. Оценив индекс Кердо у детей из основной группы достоверно чаще наблюдалось преобладание симпатического тонуса вегетативной системы 85,6 ± 0,2%, против 50,8 ± 0,3% в контрольной группе и достоверно реже обнаружено в них еутонию - 4,4 ± 0 4%, против 41,0 ± 0,2% в контрольной группе, р <0,05.Выводы. Преобладание частоты вегетативной дисфункции у детей основной группы можно объяснить следствием вегетативной дизрегуляции и органического поражения гастродуоденальной зоны у них., Summary. It is proved that the vegetative dysfunction, which originated in childhood or adolescence, becomes an unfavorable background and a harbinger of many diseases, including chronic ones. In connection with the increase in the frequency of autonomic dysfunction in children, there is a need in recent years to study this problem. Objective. To study the state of the autonomic nervous system in children with chronic gastroduodenal pathology.Materials and methods. 120 school-age children were examined, who were hospitalized in the gastroenterological department of the city children's clinical hospital in Chernivtsi. Children are divided into two groups: the main one (60 people with chronic gastroduodenal pathology), and the control group (60 people with functional diseases of the gastrointestinal tract).During the questioning of children, using the questionnaire ofWayne, the state of the vegetative nervous system was evaluated. To determine the nature of autonomic dysfunction with a predominance of sympathetic or parasympathetic departments, the vegetative Kerdo index was used. All children were also electrocardiographically examined.Results. Children with chronic gastroduodenal pathology were twice as likely to have autonomic dysfunction as compared to the comparison group. Estimating the Curdo index in children from the main group, the prevalence of the sympathetic tone of the vegetative system was significantly higher (85.6 ± 0.2%, vs. 50.8 ± 0.3% in the control group and significantly less pronounced in them eutonia - 4.4 ± 0 4%, against 41.0 ± 0.2% in the control group, p <0.05.Conclusions. The predominance of the frequency of autonomic dysfunction in children of the main group can be explained by the effect of autonomic dysregulation and organic lesions of the gastroduodenal zone in them.

We examined 40 children aged 10–18 years, who were diagnosed with gastroesophageal reflux disease (GERD). According to a survey by O.M. Vein, all patients had manifestations of autonomic dysfunction. The children were divided into 2 groups. The control group consisted of 20 patients, who received standard antisecretory therapy. The main group consisted of 20 children, who received standard antisecretory therapy and phenibut (Noofen®, OlainFarm, Latvia) at a dose of 250 mg 2 times a day for 21 days. After 1 month of starting the treatment, an evaluation of its efficacy was conducted. Clinical evaluation of the dynamics of autonomic nervous system status in schoolchildren with GERD suggests that inclusion of Noofen into the complex of therapy for this disease provides good stabilizing effect, which manifests by a restoration of autonomic nervous system balance in schoolchildren., Нами обследованы 40 детей в возрасте 10–18 лет с диагнозом гастроэзофагеальной рефлюксной болезни (ГЭРБ). По данным опроса по А.М. Вейну, у всех детей были проявления вегетативной дисфункции. Дети были разделены на 2 группы. Контрольную группу составили 20 детей, получавших лечение по стандартной схеме. Основную группу — 20 детей, получавших, кроме стандартной терапии, гидрохлорид бета-фенил-гамма-аминомасляную кислоту — фенибут (Ноофен®, Olain Farma, Латвия) в дозе 250 мг 2 раза в сутки в течение 21 дня. Через 1 месяц после начала лечения проводилась оценка его эффективности. Клиническая оценка динамики вегетативного статуса школьников с ГЭРБ позволяет утверждать, что включение в комплекс терапии этой патологии препарата Ноофен обеспечивает хороший вегетостабилизирующий эффект, что проявляется восстановлением вегетативного баланса у детей., Нами обстежені 40 дітей віком 10–18 років із діагнозом гастроезофагеальної рефлюксної хвороби (ГЕРХ). За даними опитування за А.М. Вейном, в усіх дітей були прояви вегетативної дисфункції. Діти були розподілені на 2 групи. Контрольну групу становили 20 дітей, які одержували лікування за стандартною схемою. Основну групу — 20 дітей, які, крім стандартної терапії, отримували гідрохлорид бета-феніл-гамма-аміномасляну кислоту — фенібут (Ноофен®, Olain Farma, Латвія) у дозі 250 мг 2 рази на добу протягом 21 дня. Через 1 місяць після початку лікування проводилась оцінка його ефективності. Клінічна оцінка динаміки вегетативного статусу школярів із ГЕРХ дозволяє стверджувати, що включення в комплекс терапії цієї патології препарату Ноофен забезпечує добрий вегетостабілізуючий ефект, що проявляється відновленням вегетативного балансу в дітей.

Distribution entropy (DistEn) is a recently developed measure of complexity that is used to analyse heart rate variability (HRV) data. Its calculation requires two input parameters-the embedding dimension m, and the number of bins M which replaces the tolerance parameter r that is used by the existing approximation entropy (ApEn) and sample entropy (SampEn) measures. The performance of DistEn can also be affected by the data length N. In our previous studies, we have analyzed stability and performance of DistEn with respect to one parameter (m or M) or combination of two parameters (N and M). However, impact of varying all the three input parameters on DistEn is not yet studied. Since DistEn is predominantly aimed at analysing short length heart rate variability (HRV) signal, it is important to comprehensively study the stability, consistency and performance of the measure using multiple case studies. In this study, we examined the impact of changing input parameters on DistEn for synthetic and physiological signals. We also compared the variations of DistEn and performance in distinguishing physiological (Elderly from Young) and pathological (Healthy from Arrhythmia) conditions with ApEn and SampEn. The results showed that DistEn values are minimally affected by the variations of input parameters compared to ApEn and SampEn. DistEn also showed the most consistent and the best performance in differentiating physiological and pathological conditions with various of input parameters among reported complexity measures. In conclusion, DistEn is found to be the best measure for analysing short length HRV time series.