Autonomic Neuroscience-Basic & Clinical最新文献

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Functional and 123I-MIBG scintigraphy assessment of cardiac adrenergic dysfunction in diabetes 糖尿病患者心脏肾上腺素能功能障碍的功能和 123I-MIBG 闪烁扫描评估
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2024-02-07 DOI: 10.1016/j.autneu.2024.103155
Thorsten K. Rasmussen , Per Borghammer , Nanna B. Finnerup , Troels S. Jensen , John Hansen , Karoline Knudsen , Wolfgang Singer , Guillaume Lamotte , Astrid J. Terkelsen
{"title":"Functional and 123I-MIBG scintigraphy assessment of cardiac adrenergic dysfunction in diabetes","authors":"Thorsten K. Rasmussen ,&nbsp;Per Borghammer ,&nbsp;Nanna B. Finnerup ,&nbsp;Troels S. Jensen ,&nbsp;John Hansen ,&nbsp;Karoline Knudsen ,&nbsp;Wolfgang Singer ,&nbsp;Guillaume Lamotte ,&nbsp;Astrid J. Terkelsen","doi":"10.1016/j.autneu.2024.103155","DOIUrl":"https://doi.org/10.1016/j.autneu.2024.103155","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the agreement between clinical cardiovascular adrenergic function and cardiac adrenergic innervation in type 2 diabetes patients (T2D).</p></div><div><h3>Methods</h3><p>Thirty-three patients with T2D were investigated bimodally through (1) a standardized clinical cardiovascular adrenergic assessment, evaluating adequacy of blood pressure responses to the Valsalva maneuver and (2) <sup>123</sup>I-meta-iodobenzylguanidine (MIBG) scintigraphy assessing myocardial adrenergic innervation measured as early and delayed heart heart/mediastinum (H/M) ratio, and washout rate (WR).</p></div><div><h3>Results</h3><p>T2D patients had significantly lower early and delayed H/M-ratios, and lower WR, compared to laboratory specific reference values. Thirteen patients had an abnormal adrenergic composite autonomic severity score (CASS &gt; 0). Patients with abnormal CASS scores had significantly higher early H/M ratios (1.76 [1.66–1.88] vs. 1.57 [1.49–1.63], <em>p</em> &lt; 0.001), higher delayed H/M ratios (1.64 [1.51:1.73] vs. 1.51 [1.40:1.61] (<em>p</em> = 0.02)), and lower WR (−0.13(0.10) vs −0.05(0.07), <em>p</em> = 0.01). Lower Total Recovery and shorter Pressure Recovery Time responses from the Valsalva maneuver was significantly correlated to lower H/M early (<em>r</em> = 0.55, <em>p</em> = 0.001 and r = 0.5, <em>p</em> = 0.003, respectively) and lower WR for Total Recovery (<em>r</em> = −0.44, <em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>The present study found impairment of sympathetic innervation in T2D patients based on parameters derived from MIBG cardiac scintigraphy (low early H/M, delayed H/M, and WR). These results confirm prior studies. We found a mechanistically inverted relationship with favourable adrenergic cardiovascular responses being significantly associated unfavourable MIBG indices for H/M early and delayed. This paradoxical relationship needs to be further explored but could indicate adrenergic hypersensitivity in cardiac sympathetic denervated T2D patients.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1566070224000092/pdfft?md5=5da3b0719cffb69fbb2126a873752793&pid=1-s2.0-S1566070224000092-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139733023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mechanistic involvement of noradrenergic neuronal neurotransmitter release in cutaneous vasoconstriction during autonomic dysreflexia in persons with spinal cord injury 脊髓损伤患者自主反射障碍时,去甲肾上腺素能神经元神经递质释放参与皮肤血管收缩的机制
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2024-01-27 DOI: 10.1016/j.autneu.2024.103154
Michelle Trbovich , Yubo Wu , Terry Romo , Wouker Koek , Dean Kellogg
{"title":"Mechanistic involvement of noradrenergic neuronal neurotransmitter release in cutaneous vasoconstriction during autonomic dysreflexia in persons with spinal cord injury","authors":"Michelle Trbovich ,&nbsp;Yubo Wu ,&nbsp;Terry Romo ,&nbsp;Wouker Koek ,&nbsp;Dean Kellogg","doi":"10.1016/j.autneu.2024.103154","DOIUrl":"10.1016/j.autneu.2024.103154","url":null,"abstract":"<div><h3>Introduction</h3><p>Autonomic dysreflexia (AD) is a potentially life-threatening consequence in high (above T6) spinal cord injury that involves multiple incompletely understood mechanisms. While peripheral arteriolar vasoconstriction, which controls systemic vascular resistance, is documented to be pronounced during AD, the pathophysiological neurovascular junction mechanisms of this vasoconstriction are undefined. One hypothesized mechanism is increased neuronal release of norepinephrine and co-transmitters. We tested this by examining the effects of blockade of pre-synaptic neural release of norepinephrine and co-transmitters on cutaneous vasoconstriction during AD, using a novel non-invasive technique; bretylium (BT) iontophoresis followed by skin blood flow measurements via laser doppler flowmetry (LDF).</p></div><div><h3>Methods</h3><p>Bretylium, a sympathetic neuronal blocking agent (blocks release of norepinephrine and co-transmitters) was applied iontophoretically to the skin of a sensate (arm) and insensate (leg) area in 8 males with motor complete tetraplegia. An nearby untreated site served as control (CON). Cutaneous vascular conductance (CVC) was measured (CVC = LDF/mean arterial pressure) at normotension before AD was elicited by bladder stimulation. The percent drop in CVC values from pre-AD vs. AD was compared among BT and CON sites in sensate and insensate areas.</p></div><div><h3>Results</h3><p>There was a significant effect of treatment but no significant effect of limb/sensation or interaction of limb x treatment on CVC. The percent drop in CVC between BT and CON treated sites was 25.7±1.75 vs. 39.4±0.87, respectively (<em>P</em> = 0.004).</p></div><div><h3>Conclusion</h3><p>Bretylium attenuates, but does not fully abolish vasoconstriction during AD. This suggests release of norepinephrine and cotransmitters from cutaneous sympathetic nerves is involved in cutaneous vasoconstriction during AD.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139588323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Limb-specific muscle sympathetic nerve activity responses to the cold pressor test 肢体肌肉交感神经活动对冷压试验的反应
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-29 DOI: 10.1016/j.autneu.2023.103146
Yasmine Coovadia , Brittany K. Schwende , Chloe E. Taylor , Charlotte W. Usselman
{"title":"Limb-specific muscle sympathetic nerve activity responses to the cold pressor test","authors":"Yasmine Coovadia ,&nbsp;Brittany K. Schwende ,&nbsp;Chloe E. Taylor ,&nbsp;Charlotte W. Usselman","doi":"10.1016/j.autneu.2023.103146","DOIUrl":"10.1016/j.autneu.2023.103146","url":null,"abstract":"<div><p><span>Recent studies have demonstrated that muscle sympathetic nerve activity<span><span><span> (MSNA) responses to isometric exercise differs between active and inactive limbs. Whether limb-dependent responses are characteristic of responses to the </span>cold pressor test (CPT) remains to be established. Therefore, we tested the hypothesis that CPT-induced MSNA responses differ between affected and unaffected limbs such that MSNA in the affected lower limb is greater than MSNA responses in the </span>contralateral lower limb and the upper limb. Integrated peroneal MSNA (microneurography) was measured in young healthy individuals (</span></span><em>n</em><span> = 10) at rest and during three separate 3-min CPTs: the microneurography foot</span><em>,</em> opposite foot<em>,</em><span> and opposite hand. Peak MSNA responses were extracted for further analysis, as well as corresponding hemodynamic<span> outcomes including mean arterial pressure (MAP; Finometer). MSNA responses were greater when the microneurography foot was immersed in ice water than when the opposite foot was immersed (38 ± 18 </span></span><em>vs</em> 28 ± 16 bursts/100hb: <em>P</em> &lt; 0.01). MSNA responses when the opposite hand was immersed were greater than both the microneurography foot (46 ± 22 <em>vs</em> 38 ± 18 bursts/100hb: <em>P</em> &lt; 0.01) and opposite foot (46 ± 22 <em>vs</em> 28 ± 16 bursts/100hb: <em>P</em> ≤0.01). Likewise, MAP responses were greater during the hand CPT than the microneurography foot (99 ± 9 <em>vs</em> 96 ± 8 mmHg: <em>P</em> &lt; 0.01) and opposite foot CPT (99 ± 9 <em>vs</em> 96 ± 9 mmHg: P &lt; 0.01). These data indicate that (a) upper limbs and (b) immersed limbs elicit greater MSNA responses to the CPT than lower and/or non-immersed limbs.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139068311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Maladaptive cardiac and behavioral reactivity to repeated vicarious stress exposure in socially bonded male prairie vole siblings 有社会关系的雄性草原田鼠兄弟姐妹对重复替代压力暴露的不良心脏和行为反应
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-27 DOI: 10.1016/j.autneu.2023.103145
Angela J. Grippo, Oreoluwa I. Akinbo, Alex Amidei, Joshua Wardwell, Marigny C. Normann, Sarah Ciosek, Dmitry Kovalev
{"title":"Maladaptive cardiac and behavioral reactivity to repeated vicarious stress exposure in socially bonded male prairie vole siblings","authors":"Angela J. Grippo,&nbsp;Oreoluwa I. Akinbo,&nbsp;Alex Amidei,&nbsp;Joshua Wardwell,&nbsp;Marigny C. Normann,&nbsp;Sarah Ciosek,&nbsp;Dmitry Kovalev","doi":"10.1016/j.autneu.2023.103145","DOIUrl":"10.1016/j.autneu.2023.103145","url":null,"abstract":"<div><p><span>Behaviors, emotions, and </span>cardiovascular functions<span> are influenced by stress. But these detrimental effects are not exclusive to an individual that directly experiences stress. Stress is also experienced vicariously through observation of another individual undergoing stress. The current study used the strong social bonds in socially monogamous prairie voles to determine effects of repeated vicarious stress on cardiac and behavioral outcomes. Male prairie voles were exposed to either a 5-minute open field chamber alone [separate (control)] or while concurrently witnessing their sibling undergo a tail-suspension stressor [concurrent (experimental)], repeated across 4 sessions. Cardiac responses in animals in the open field were evaluated for heart rate and heart rate variability prior to, during, and after each test session, and behaviors were evaluated for motion, exploration, stress reactivity, and anxiety-relevant behaviors during each test session. The concurrent condition (versus separate) displayed increased heart rate and reduced heart rate variability during repeated test sessions, and impaired recovery of these parameters following the test sessions. The pattern of disturbances suggests that both increased sympathetic and reduced parasympathetic influence contributed to the cardiac responses. Animals in the concurrent condition (versus separate) displayed disrupted rearing, grooming, and motion; reduced duration of center section exploration; and increased freezing responses across repeated test sessions. Collectively, cardiac and behavioral stress reactivity are increased as a function of vicarious stress in prairie voles, which are evident across repeated experiences of stress. These results inform our understanding of the experience of vicarious stress in social species, including humans.</span></p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139051429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis 非药物和非起搏疗法对预防血管迷走性晕厥的疗效:倾斜训练、物理反压法和瑜伽 - 系统回顾和荟萃分析
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-26 DOI: 10.1016/j.autneu.2023.103144
Abdulmajeed Alharbi , Momin Shah , Monik Gupta , Kassidy Rejent , Mona Mahmoud , Anas Alsughayer , Ahmad Alryheal , Wasef Sayeh , Rabbia Siddiqi , Abed Jabr , Eun Seo Kwak , Sadik Khuder , Ragheb Assaly , Blair Grubb
{"title":"The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis","authors":"Abdulmajeed Alharbi ,&nbsp;Momin Shah ,&nbsp;Monik Gupta ,&nbsp;Kassidy Rejent ,&nbsp;Mona Mahmoud ,&nbsp;Anas Alsughayer ,&nbsp;Ahmad Alryheal ,&nbsp;Wasef Sayeh ,&nbsp;Rabbia Siddiqi ,&nbsp;Abed Jabr ,&nbsp;Eun Seo Kwak ,&nbsp;Sadik Khuder ,&nbsp;Ragheb Assaly ,&nbsp;Blair Grubb","doi":"10.1016/j.autneu.2023.103144","DOIUrl":"10.1016/j.autneu.2023.103144","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and </span>postural control. Recurrent episodes of VVS significantly impact the </span>quality of life<span> and are a common reason for emergency department<span> visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain.</span></span></p></div><div><h3>Methods</h3><p>A systematic review<span> and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes.</span></p></div><div><h3>Results</h3><p>A total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128–0.471, <em>p</em>-value &lt;0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018–0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171–0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165–0.524) compared to control.</p></div><div><h3>Conclusion</h3><p>Non-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139051562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inflammation of some visceral sensory systems and autonomic dysfunction in cardiovascular disease 心血管疾病中某些内脏感觉系统的炎症和自律神经功能紊乱
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-07 DOI: 10.1016/j.autneu.2023.103137
R.M. Lataro , F. Brognara , R. Iturriaga , J.F.R. Paton
{"title":"Inflammation of some visceral sensory systems and autonomic dysfunction in cardiovascular disease","authors":"R.M. Lataro ,&nbsp;F. Brognara ,&nbsp;R. Iturriaga ,&nbsp;J.F.R. Paton","doi":"10.1016/j.autneu.2023.103137","DOIUrl":"10.1016/j.autneu.2023.103137","url":null,"abstract":"<div><p><span><span>The sensitization and hypertonicity of </span>visceral afferents<span><span> are highly relevant to the development and progression of cardiovascular and respiratory disease states. In this review, we described the evidence that the inflammatory process regulates visceral afferent sensitivity and tonicity, affecting the control of the cardiovascular and respiratory system. Some </span>inflammatory mediators like </span></span>nitric oxide<span><span><span><span><span>, angiotensin II<span>, endothelin-1, and arginine vasopressin<span> may inhibit baroreceptor afferents and contribute to the </span></span></span>baroreflex impairment observed in cardiovascular diseases. Cytokines may act directly on peripheral afferent terminals that transmit information to the </span>central nervous system (CNS). TLR-4 receptors, which recognize </span>lipopolysaccharide<span>, were identified in the nodose and petrosal ganglion<span> and have been implicated in disrupting the blood-brain barrier, which can potentiate the inflammatory process. For example, cytokines may cross the blood-brain barrier to access the CNS. Additionally, pro-inflammatory cytokines such as IL-1β, IL-6, TNF-α and some of their receptors have been identified in the nodose ganglion and </span></span></span>carotid body<span><span>. These pro-inflammatory cytokines also sensitize the dorsal root ganglion or are released in the nucleus of the </span>solitary tract<span>. In cardiovascular disease, pro-inflammatory mediators increase in the brain, heart, vessels, and plasma and may act locally or systemically to activate/sensitize afferent nervous terminals. Recent evidence demonstrated that the carotid body chemoreceptor cells<span><span> might sense systemic pro-inflammatory molecules, supporting the novel proposal that the carotid body is part of the afferent pathway in the central anti-inflammatory reflexes. The exact mechanisms of how pro-inflammatory mediators affects visceral afferent signals and contribute to the </span>pathophysiology of cardiovascular diseases awaits future research.</span></span></span></span></p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138552143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unraveling the lost balance: Adrenergic dysfunction in cancer cachexia 打破失去的平衡癌症恶病质中的肾上腺素能功能障碍
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-06 DOI: 10.1016/j.autneu.2023.103136
Parham Diba , Ariana L. Sattler , Tetiana Korzun , Beth A. Habecker , Daniel L. Marks
{"title":"Unraveling the lost balance: Adrenergic dysfunction in cancer cachexia","authors":"Parham Diba ,&nbsp;Ariana L. Sattler ,&nbsp;Tetiana Korzun ,&nbsp;Beth A. Habecker ,&nbsp;Daniel L. Marks","doi":"10.1016/j.autneu.2023.103136","DOIUrl":"10.1016/j.autneu.2023.103136","url":null,"abstract":"<div><p><span><span>Cancer cachexia, characterized by </span>muscle wasting and widespread inflammation, poses a significant challenge for patients with cancer, profoundly impacting both their </span>quality of life<span><span><span><span> and treatment management. However, existing treatment modalities remain very limited, accentuating the necessity for innovative therapeutic interventions. Many recent studies demonstrated that changes in autonomic balance is a key driver of cancer cachexia. This review consolidates research findings from investigations into </span>autonomic dysfunction<span> across cancer cachexia, spanning animal models and patient cohorts. Moreover, we explore therapeutic strategies involving adrenergic receptor modulation through </span></span>receptor blockers and agonists. Mechanisms underlying adrenergic hyperactivity in cardiac and </span>adipose tissues, influencing tissue remodeling, are also examined. Looking ahead, we present a perspective for future research that delves into autonomic dysregulation in cancer cachexia. This comprehensive review highlights the urgency of advancing research to unveil innovative avenues for combatting cancer cachexia and improving patient well-being.</span></p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138547803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A retrospective analysis of neurogenic orthostatic hypotension in long-term care facility residents with recurrent falls 长期护理机构住院患者复发性跌倒的神经源性直立性低血压回顾性分析
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-05 DOI: 10.1016/j.autneu.2023.103135
Mehdi Shadmand , Brian Elliott , Jacob Lautze , Ali Mehdirad
{"title":"A retrospective analysis of neurogenic orthostatic hypotension in long-term care facility residents with recurrent falls","authors":"Mehdi Shadmand ,&nbsp;Brian Elliott ,&nbsp;Jacob Lautze ,&nbsp;Ali Mehdirad","doi":"10.1016/j.autneu.2023.103135","DOIUrl":"10.1016/j.autneu.2023.103135","url":null,"abstract":"<div><h3>Introduction</h3><p>Approximately 50 % of residents in long-term care facilities fall yearly and orthostatic hypotension accounts for a significant portion of them. Neurogenic orthostatic hypotension - a subtype of orthostatic hypotension – is important to be recognized as its management is far more complex; undertreatment of these older adults can lead to recurrent falls, high healthcare cost burden, and increased morbidity and mortality. The primary purpose of our study was to describe the rate of neurogenic orthostatic hypotension in older adults in a long-term care facility, with a secondary purpose to describe risk factors for neurogenic orthostatic hypotension in this population.</p></div><div><h3>Methods</h3><p>We conducted a retrospective case-control study of residents with recurrent falls at the Dayton Veteran's Affairs long-term care facility. Charts were manually reviewed. Inclusion criterion was three or more falls and age 65 or greater; we did not have exclusion criteria.</p><p>ICD10 codes and most recent primary care physician notes were used to identify comorbidity diagnoses. Recent orthostatic vitals were used to assess orthostatic hypotension or neurogenic orthostatic hypotension diagnoses.</p></div><div><h3>Results</h3><p><span>Of our sample of 224 residents, we observed a prevalence of 20.5 % for neurogenic orthostatic hypotension and 32.1 % for orthostatic hypotension. Neither of them had diagnosis of neurogenic orthostatic hypotension documented. Parkinson's disease was associated with neurogenic orthostatic hypotension (OR-4.3; </span><em>p</em> = 0.002). Hypertension was prevalent in 69.6 % of residents with orthostatic vitals suggestive of neurogenic orthostatic hypotension.</p></div><div><h3>Conclusion</h3><p>Older adults with recurrent falls at a long-term care facility meet criteria for neurogenic orthostatic hypotension diagnosis far more often than is documented. Common comorbidities associated with neurogenic orthostatic hypotension in this population include Parkinson's disease.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neuroimmune interplay in kidney health and disease: Role of renal nerves 肾脏健康和疾病中的神经免疫相互作用:肾神经的作用
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-01 DOI: 10.1016/j.autneu.2023.103133
Madeline M. Gauthier, Sebastien Hayoz, Christopher T. Banek
{"title":"Neuroimmune interplay in kidney health and disease: Role of renal nerves","authors":"Madeline M. Gauthier,&nbsp;Sebastien Hayoz,&nbsp;Christopher T. Banek","doi":"10.1016/j.autneu.2023.103133","DOIUrl":"https://doi.org/10.1016/j.autneu.2023.103133","url":null,"abstract":"<div><p><span><span><span>Renal nerves and their role in physiology and disease have been a topic of increasing interest in the past few decades. Renal inflammation contributes to many cardiorenal disease conditions, including hypertension, </span>chronic kidney disease, and polycystic kidney disease. Much is known about the role of renal sympathetic nerves in physiology – they contribute to the regulation of </span>sodium reabsorption<span>, renin release, and </span></span>renal vascular resistance<span>. In contrast, far less is known about afferent, or “sensory,” renal nerves, which convey signals from the kidney to the brain. While much remains unknown about these nerves in the context of normal physiology, even less is known about their contribution to disease states. Furthermore, it has become apparent that the crosstalk between renal nerves and the immune system may augment or modulate disease. Research from other fields, especially pain research, has provided critical insight into neuroimmune crosstalk. Sympathetic renal nerve activity<span><span> may increase immune cell recruitment, but far less work has been done investigating the interplay between afferent renal nerves and the immune system. Evidence from other fields suggests that inflammation may augment afferent renal nerve activity. Furthermore, these nerves may exacerbate renal inflammation through the release of afferent-specific </span>neurotransmitters.</span></span></p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138501028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sympathetic remodeling and altered angiotensin-converting enzyme 2 localization occur in patients with cardiac disease but are not exacerbated by severe COVID-19 交感神经重构和血管紧张素转换酶定位改变发生在心脏病患者中,但不会因严重的COVID-19而加重
IF 2.7 4区 医学
Autonomic Neuroscience-Basic & Clinical Pub Date : 2023-12-01 DOI: 10.1016/j.autneu.2023.103134
Creighton L. Kellum , Logan G. Kirkland , Tasha K. Nelson , Seth M. Jewett , Eric Rytkin , Igor R. Efimov , Donald B. Hoover , Paul V. Benson , Brant M. Wagener
{"title":"Sympathetic remodeling and altered angiotensin-converting enzyme 2 localization occur in patients with cardiac disease but are not exacerbated by severe COVID-19","authors":"Creighton L. Kellum ,&nbsp;Logan G. Kirkland ,&nbsp;Tasha K. Nelson ,&nbsp;Seth M. Jewett ,&nbsp;Eric Rytkin ,&nbsp;Igor R. Efimov ,&nbsp;Donald B. Hoover ,&nbsp;Paul V. Benson ,&nbsp;Brant M. Wagener","doi":"10.1016/j.autneu.2023.103134","DOIUrl":"10.1016/j.autneu.2023.103134","url":null,"abstract":"<div><h3>Purpose</h3><p><span>Remodeling of sympathetic nerves and ACE2 has been implicated in cardiac pathology, and ACE2 also serves as a receptor for SARS-CoV-2. However, there is limited histological knowledge about the transmural distribution of sympathetic nerves and the cellular localization and distribution of ACE2 in human </span>left ventricles from normal or diseased hearts. Goals of this study were to establish the normal pattern for these parameters and determine changes that occurred in decedents with cardiovascular disease alone compared to those with cardiac pathology and severe COVID-19.</p></div><div><h3>Methods</h3><p>We performed immunohistochemical analysis on sections of left ventricular wall from twenty autopsied human hearts consisting of a control group, a cardiovascular disease group, and COVID-19 ARDS, and COVID-19 non-ARDS groups.</p></div><div><h3>Results</h3><p><span><span>Using tyrosine hydroxylase as a noradrenergic marker, we found substantial sympathetic nerve loss in cardiovascular disease samples compared to controls. Additionally, we found heterogeneous nerve loss in both COVID-19 groups. Using an ACE2 antibody, we observed robust transmural </span>staining localized to </span>pericytes<span><span> in the control group. The cardiovascular disease hearts displayed regional loss of ACE2 in pericytes and regional increases in staining of </span>cardiomyocytes for ACE2. Similar changes were observed in both COVID-19 groups.</span></p></div><div><h3>Conclusions</h3><p><span><span>Heterogeneity of sympathetic innervation, which occurs in cardiac disease and is not increased by severe COVID-19, could contribute to </span>arrhythmogenesis. The dominant localization of ACE2 to pericytes suggests that these cells would be the primary target for potential </span>cardiac infection<span><span> by SARS-CoV-2. Regional changes in ACE2 staining by myocytes and pericytes could have complex effects on cardiac </span>pathophysiology.</span></p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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