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Du X, Tao C, Li X, Du J, Liao Y, Jin H. Predicting therapeutic efficacy of oral rehydration salts in children with vasovagal syncope. Front Pediatr 2023; 11:1164304. [PMID: 37124188 PMCID: PMC10133722 DOI: 10.3389/fped.2023.1164304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This study was designed to develop an easy-to-perform and inexpensive measure to predict efficacy of the oral rehydration salts (ORS) in children with vasovagal syncope (VVS). Materials and methods Children diagnosed with VVS and treated with ORS for a median of 3 months at the Peking University First Hospital, China, were enrolled and followed up. Demographic data, clinical hemodynamic parameters, and variables related to red blood cells were collected at the baseline. On the basis of changes in symptom scores after treatment, participants were divided into effective or ineffective groups at the end of the follow-up. Logistic regression analysis was used to investigate parameters related to therapeutic efficacy of ORS and a predictive model of ORS effectiveness was created. The predictive efficiency was evaluated using the receiver operating characteristic curve. The accuracy/consistency was evaluated by the Hosmer-Lemeshow test and calibration curve. Internal validation was done using the bootstrap approach. Results Totally 97 pediatric participants were included in the study and 4 (4.1%) were lost during the follow-up. ORS therapy was effective in 46 children and ineffective in 47 children. Children in the effective group had higher baseline red blood cell count, hemoglobin, and hematocrit than those in the ineffective group (p < 0.01). Through logistic regression analysis, the baseline hematocrit and body mass index (BMI) were included in predictive model for the response to ORS treatment. The predictive efficacy of the model showed an area under the curve of 0.77 (p < 0.01). The predicted probability cut-off value of 0.5 was found to be optimal, with a resulting sensitivity of 67.4% and specificity of 80.9%. In the Hosmer-Lemeshow test, p-value was 0.75, and the calibration plot showed a good model fitness. Internal validation was performed using the bootstrap approach (n = 1,000), showing 95% confidence interval of 0.67-0.86. Conclusion Hemoglobin combined with BMI was useful for predicting the therapeutic efficacy of ORS in children with VVS.
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Affiliation(s)
- Xiaojuan Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Correspondence: Ying Liao Hongfang Jin
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Correspondence: Ying Liao Hongfang Jin
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Yadav K, Singh A, Jaryal AK, Coshic P, Deepak KK. Temporal Analysis of Sequential Changes in Heart Rate Variability During Non-hypotensive Hypovolemia. High Blood Press Cardiovasc Prev 2022; 29:385-391. [PMID: 35670948 DOI: 10.1007/s40292-022-00525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Haemorrhage is associated with changes in the cardiac autonomic drive which begins during early stages of mild haemorrhage. The knowledge of chronology of the autonomic changes at smaller timescale during the period of haemorrhage can help identify the primary autonomic parameter which signals the institution of cardiovascular reflex mechanisms. AIM To evaluate the heart rate variability in 2-min sequential segments with one minute overlap during and after the period of mild haemorrhage (450 ml) using blood donation as a model of acute blood loss. METHODS 47 male blood donors who had volunteered for blood donation were recruited for the study. Continuous lead II ECG was recorded before the start of the blood donation (5 min), during the period of the blood donation (~ 5-7 min) and after blood donation (5 min). The parasympathetic and sympathetic drive to heart was estimated by measures of heart rate variability in time and frequency domain. RESULTS A significant decrease in the parameters assessing parasympathetic drive i.e., normalised High frequency (HFn) and NN50 (Number of pairs of adjacent NN intervals differing by more than 50 ms) and pNN50 (NN50 divided by the total number of all NN Intervals) was observed during blood donation at 3-5 min, as compared to baseline. An increase in parameters associated with sympathetic drive i.e., normalised low frequency (LFn) was observed only in the post donation period at 2-3 min. A significant rise in LF/HF ratio which is a marker of sympatho vagal balance was observed at 4-5 min during blood donation when compared to baseline. CONCLUSION The initial cardiac autonomic change during mild haemorrhage is withdrawal of parasympathetic drive, followed by an increase in sympathetic tone which occurs much later.
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Affiliation(s)
- Kavita Yadav
- Department of Physiology, Pt. BD Sharma Post graduate Institute of Medical Sciences, 1st Floor, Rohtak, India
| | - Akanksha Singh
- Department of Physiology, All India Institute of Medical Sciences, Room no. 2017, Teaching Block, Second Floor, Ansari Nagar, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, Room no. 2009, Teaching Block, Second Floor, Ansari Nagar, New Delhi, India.
| | - Poonam Coshic
- Department of Transfusion Medicine (Blood Bank), All India Institute of Medical Sciences, Ground Floor, Main Blood Bank Unit 1, Ansari Nagar, New Delhi, India
| | - K K Deepak
- Department of Physiology, All India Institute of Medical Sciences, Room no. 2009, Teaching Block, Second Floor, Ansari Nagar, New Delhi, India
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Frandsen MN, Mehlsen J, Foss NB, Kehlet H. Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis. J Clin Monit Comput 2022; 36:947-960. [PMID: 35092527 PMCID: PMC9293802 DOI: 10.1007/s10877-022-00819-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
Heart rate variability (HRV) is a predictor of mortality and morbidity after non-lethal cardiac ischemia, but the relation between preoperatively measured HRV and intra- and postoperative complications is sparsely studied and most recently reviewed in 2007. We, therefore, reviewed the literature regarding HRV as a predictor for intra- and postoperative complications and outcomes. We carried out a systematic review without meta-analysis. A PICO model was set up, and we searched PubMed, EMBASE, and CENTRAL. The screening was done by one author, but all authors performed detailed review of the included studies. We present data from studies on intraoperative and postoperative complications, which were too heterogeneous to warrant formal meta-analysis, and we provide a pragmatic review of HRV indices to facilitate understanding our findings. The review was registered in PROSPERO (CRD42021230641). We screened 2337 records for eligibility. 131 records went on to full-text assessment, 63 were included. In frequency analysis of HRV, low frequency to high frequency ratio could be a predictor for intraoperative hypotension in spinal anesthesia and lower total power could possibly predict intraoperative hypotension under general anesthesia. Detrended fluctuation analysis of HRV is a promising candidate for predicting postoperative atrial fibrillation. This updated review of the relation between preoperative HRV and surgical outcome suggests a clinically relevant role of HRV but calls for high quality studies due to methodological heterogeneity in the current literature. Areas for future research are suggested.
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Sun Y, Zhang L, Liu J, Zhang X, Su Y, Yin Q, He S. Effects of lunar dust simulant on cardiac function and fibrosis in rats. Toxicol Res (Camb) 2019; 8:499-508. [PMID: 31367333 PMCID: PMC6622043 DOI: 10.1039/c8tx00329g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/04/2019] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to investigate the effects of lunar dust simulant (LDS) on cardiac function and fibrosis. In an in vivo experiment, after 3 weeks of exposure, electrocardiography (ECG) and histopathological and immunohistochemical analyses of the cardiac tissue were performed. Systemic inflammatory markers and genes and proteins associated with cardiac tissue fibrosis were examined. In an in vitro experiment, fibrosis-related factors were detected in H9c2 cells by western blot and the mechanism of myocardial fibrosis by LDS exposure was explored. LDS exposure significantly altered heart rate indicators, implying altered cardiac and autonomic system functions. LDS dose-dependently increased the type and number of ECG abnormalities, and increased serum inflammatory factors. In addition, pathological changes in the myocardial tissue were observed through hematoxylin and eosin, Masson, and immunohistochemical staining; the expression of genes and proteins related to fibrosis in the myocardial tissue was also altered. These findings indicate that LDS exposure causes systemic inflammatory lesions that affect autonomic function, leading to inflammatory myocardial fibrosis. And its mechanisms involve the mediation of the nuclear factor-E2-related factor (Nrf2)/nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) redox balance.
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Affiliation(s)
- Yan Sun
- College of Basic Medical Sciences , Shenyang Medical College , Shenyang 110034 , China .
- Lunar and Planetary Science Laboratory , MUST-Partner Laboratory of Key Laboratory of Lunar and Deep Space Exploration , CAS , China
- State Key Laboratory of Robotics , Shenyang Institute of Automation , Chinese Academy of Sciences , Shenyang 110016 , China
| | - Lu Zhang
- Key Laboratory of Space Utilization , Technology and Engineering Center for Space Utilization , Chinese Academy of Sciences , Beijing 100094 , China
| | - Jinguo Liu
- State Key Laboratory of Robotics , Shenyang Institute of Automation , Chinese Academy of Sciences , Shenyang 110016 , China
| | - Xiaoping Zhang
- Lunar and Planetary Science Laboratory , MUST-Partner Laboratory of Key Laboratory of Lunar and Deep Space Exploration , CAS , China
- Lunar and Planetary Science Laboratory , Macau University of Science and Technology , Macau , China
| | - Yan Su
- College of Basic Medical Sciences , Shenyang Medical College , Shenyang 110034 , China .
| | - Quanling Yin
- College of Basic Medical Sciences , Shenyang Medical College , Shenyang 110034 , China .
| | - Shuangxi He
- China Astronaut Research and Training Center , Beijing 100094 , China
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5
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Colombo R, Wu MA, Catena E, Perotti A, Fossali T, Cioffi F, Rech R, Castelli A, Cicardi M. The Role of Failing Autonomic Nervous System on Life-Threatening Idiopathic Systemic Capillary Leak Syndrome. Front Med (Lausanne) 2018; 5:111. [PMID: 29732372 PMCID: PMC5919959 DOI: 10.3389/fmed.2018.00111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/04/2018] [Indexed: 11/20/2022] Open
Abstract
Idiopathic systemic capillary leak syndrome (ISCLS) is a rare disease that involves the endothelium and microcirculation, leading to an abrupt shift of fluids and proteins from the intravascular to the interstitial compartment. The consequence of the capillary leakage is a life-threatening hypovolemic shock that can lead to lethal multiple organ dysfunction. The autonomic nervous system (ANS) is central in regulating the cardiovascular response to hypovolemia, but ANS modulation in ISCLS has not yet been investigated. Here, we report ANS activity during acute phase and recovery from a severe ISCLS shock and speculate on the possibility that autonomic mechanisms underlie the pathogenesis of attacks.
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Affiliation(s)
- Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Emanuele Catena
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Andrea Perotti
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Federico Cioffi
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Roberto Rech
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Antonio Castelli
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
| | - Marco Cicardi
- Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo ospedaliero, University of Milan, Milan, Italy
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Hoogerwerf MD, Veldhuizen IJT, Tarvainen MP, Merz EM, Huis In 't Veld EMJ, de Kort WLAM, Sluiter JK, Frings-Dresen MHW. Physiological stress response patterns during a blood donation. Vox Sang 2018; 113:357-367. [PMID: 29574883 DOI: 10.1111/vox.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 01/31/2018] [Accepted: 02/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Donating blood is associated with increased psychological stress. This study investigates whether a blood donation induces physiological stress and if response patterns differ by gender, donation experience and non-acute stress. STUDY DESIGN AND METHODS In 372 donors, physiological stress [blood pressure, pulse rate, pulse rate variability (PRV)] was measured at seven moments during routine donation. PRV was assessed using time domain [root mean square of successive differences (RMSSD)] and frequency domain [high frequency (HF) and low frequency (LF) power] parameters. Non-acute stress was assessed by questionnaire. Shape and significance of time course patterns were assessed by fitting multilevel models for each stress measure and comparing men and women, first-time and experienced donors, and donors with high and low levels of non-acute stress. RESULTS Significant response patterns were found for all stress measures, where levels of systolic blood pressure (F(1,1315) = 24·2, P < 0·001), RMSSD (F(1,1315) = 24·2, P < 0·001), LF (F(1,1627) = 14·1, P < 0·001) and HF (F(1,1624) = 34·0, P < 0·001) increased towards needle insertion and then decreased to values lower than when arriving at the donation centre. Diastolic blood pressure (F(1,1326) = 50·9, P < 0·001) increased and pulse rate (F(1,1393) = 507·4, P < 0·001) showed a U-shaped curve. Significant group effects were found, that is, higher systolic blood pressure/pulse rate in women; higher pulse rate in first-time donors; higher RMSSD at arrival and from screening until leaving in first-time donors; and higher LF and HF in first-time donors. CONCLUSION This study shows an increase in physiological stress related to needle insertion, followed by a decrease when leaving the donation centre. Some group effects were also found.
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Affiliation(s)
- M D Hoogerwerf
- Department Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
| | - I J T Veldhuizen
- Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - E-M Merz
- Department Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - W L A M de Kort
- Department Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J K Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
| | - M H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
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Saugel B, Bendjelid K, Critchley LAH, Scheeren TWL. Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and hemodynamic monitoring. J Clin Monit Comput 2018; 32:189-196. [PMID: 29484529 DOI: 10.1007/s10877-018-0119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
Abstract
Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A H Critchley
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,The Belford Hospital, Fort William, The Highlands, Scotland, UK
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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