An optimal control approach for blood pressure regulation during head-up tilt

Postural orthostatic tachycardia syndrome explained using a baroreflex response model

Patients with postural orthostatic tachycardia syndrome (POTS) experience an excessive increase in heart rate (HR) and low-frequency (∼0.1 Hz) blood pressure (BP) and HR oscillations upon head-up tilt (HUT). These responses are attributed to increased baroreflex (BR) responses modulating sympathetic and parasympathetic signalling. This study uses a closed-loop cardiovascular compartment model controlled by the BR to predict BP and HR dynamics in response to HUT. The cardiovascular model predicts these quantities in the left ventricle, upper and lower body arteries and veins. HUT is simulated by letting gravity shift blood volume (BV) from the upper to the lower body compartments, and the BR control is modelled using set-point functions modulating peripheral vascular resistance, compliance, and cardiac contractility in response to changes in mean carotid BP. We demonstrate that modulation of parameters characterizing BR sensitivity allows us to predict the persistent increase in HR and the low-frequency BP and HR oscillations observed in POTS patients. Moreover, by increasing BR sensitivity, inhibiting BR control of the lower body vasculature, and decreasing central BV, we demonstrate that it is possible to simulate patients with neuropathic and hyperadrenergic POTS.

Dynamical consequences of sensory feedback in a half-center oscillator coupled to a simple motor system

We investigate a simple model for motor pattern generation that combines central pattern generator (CPG) dynamics with a sensory feedback (FB) mechanism. Our CPG comprises a half-center oscillator with conductance-based Morris-Lecar model neurons. Output from the CPG drives a push-pull motor system with biomechanics based on experimental data. A sensory feedback conductance from the muscles allows modulation of the CPG activity. We consider parameters under which the isolated CPG system has either "escape" or "release" dynamics, and we study both inhibitory and excitatory feedback conductances. We find that increasing the FB conductance relative to the CPG conductance makes the system more robust against external perturbations, but more susceptible to internal noise. Conversely, increasing the CPG conductance relative to the FB conductance has the opposite effects. We find that the "closed-loop" system, with sensory feedback in place, exhibits a richer repertoire of behaviors than the "open-loop" system, with motion determined entirely by the CPG dynamics. Moreover, we find that purely feedback-driven motor patterns, analogous to a chain reflex, occur only in the inhibition-mediated system. Finally, for pattern generation systems with inhibition-mediated sensory feedback, we find that the distinction between escape- and release-mediated CPG mechanisms is diminished in the presence of internal noise. Our observations support an anti-reductionist view of neuromotor physiology: Understanding mechanisms of robust motor control requires studying not only the central pattern generator circuit in isolation, but the intact closed-loop system as a whole.

Control theory in biology and medicine : Introduction to the special issue

From September-December 2017, the Mathematical Biosciences Institute at Ohio State University hosted a series of workshops on control theory in biology and medicine, including workshops on control and modulation of neuronal and motor systems, control of cellular and molecular systems, control of disease / personalized medicine across heterogeneous populations, and sensorimotor control of animals and robots. This special issue presents tutorials and research articles by several of the participants in the MBI workshops.

Hemodynamic Response to the Head-Up Tilt Test in Patients With Syncope as a Predictor of the Test Outcome: A Meta-Analysis Approach

Aim: The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and stroke volume (SV) measured during head-up tilt table test (HUTT) in patients with positive and negative HUT test outcome. Methods: Pubmed and Clinical Key databases were searched for English-only articles presenting results of biosignals measurements during tilt test in patients suffering from syncope. From 3,289 articles 13 articles published between 1997 and 2015 investigating 892 patients (467 with positive HUTT outcome and 401 with negative one) were selected. Results: There were not statistically significant differences observed between the parameters measured in supine position in patients with positive and negative test outcome [HR (p = 0.86), sBP (p = 0.32), dBP (p = 0.21), SV (p = 0.71)]. In tilt position the parameters HR and SV were significantly different when compared between the two groups of patients [HR (p = 0.02), sBP (p = 0.10), dBP (p = 0.59), SV (p = 0.0004)]. Conclusions: Changes in HR and SV parameters in response to tilt test turned out to be statistically significant. In supine position the differences between patients with positive and negative test outcome were not significant, hence tilt test can be considered as necessary in the diagnosis of vasovagal syndrome.