Randomized Pilot Trial Using External Yarrow Liver Compress Applications With Metastatic Cancer Patients Suffering From Fatigue: Evaluation of Sympathetic Modulation by Heart Rate Variability Analysis.

BACKGROUND: Liver compresses are commonly applied in complementary medicine during cancer treatment and are believed to have an energizing effect. We conducted a pilot study to investigate the influence of external application of yarrow liver compresses on the autonomous nervous system by analyzing the heart rate variability (HRV) in metastatic cancer patients undergoing radiation therapy and suffering from cancer-related fatigue (CRF). METHODS: A randomized pilot trial was undertaken with patients suffering from CRF receiving palliative radiation therapy for bone or brain metastasis over 2 weeks. CRF patients were randomized into an intervention group receiving yarrow liver compresses and a control group receiving no external application. HRV was analyzed at the beginning (T1) and end (T2) period of the study during daytime (d) and nighttime (n) in both groups and quantified using time-, frequency-, and nonlinear dynamics domains. RESULTS: A total of 39 patients were randomized between September 2017 and August 2019 and a total of 20 patients (10 per group) were available for analysis. For both groups, significant differences in HRV analyses were found in the comparison over the timeline between the first and second measurement (T1d→T2d) during daytime. Specifically, the intervention group showed decreased HRV and complexity of heart rate regulation, indicating increased sympathetic activity at time T2d, whereas the control group showed increased HRV and complexity of heart rate regulation, indicating increased vagal activity at time T2d. Furthermore, the observed HRV analyses showed almost no significant differences between the 2 groups in a direct comparison at the beginning and the end of the study (exception: T2d). CONCLUSIONS: Yarrow liver compresses led to increased sympathetic activity during daytime in the intervention group, whereas in the control group, which did not receive any external application, increased parasympathetic activity was observed.

Quantification of Cardiovascular Regulation Applying Heart Rate Variability Analyses for Different Warm and Moist Chest Compresses in Healthy Subjects.

Background: In integrative medicine, complementary healing methods, such as external applications (massages, rhythmic rubs, and compresses), are part of the practice and clinical application and have proven their therapeutic effect in various fields. Objective: Aim of this exploratory, controlled, single-blinded study was to investigate the effects of three different warming chest compresses on cardiovascular regulation by analyzing heart rate variability (HRV) in healthy subjects. Methods: Over a period of 4 weeks, three different warming chest compresses (a hot water compress, a ginger powder compress, and a mustard flour compress) in 30 healthy subjects were analyzed. For all subjects, 48-h long-term electrocardiograms were recorded, and afterward, epochs of 5 min length extracted and analyzed by different linear and nonlinear HRV indices. Results: A moist chest compress did not result in any significant short- and long-term stimulation of the autonomic regulation, except for a short-term significant decrease in heart rate (meanNN, p < 0.05). Warm and moist chest compresses with ginger flour led to significantly increased HRV (sdNN, p < 0.05; symbolic dynamics2, p < 0.05) and its complexity (renyi4 entropy, p < 0.05) and a significant decrease in heart rate (meanNN, p < 0.00036), and thus to a short-term relaxation effect. In contrast, warm and moist chest compresses with mustard flour led to significantly decreased HRV and their complexity (time-, frequency-, and nonlinear dynamics domain, p < 0.00036), which can be interpreted as a stress reaction of the autonomous nervous system. Conclusions: The application of chest compresses led to short-term relaxation effects (ginger) as well as short-term stress effects (mustard) but not to any significant longer-term effect on HRV in healthy subjects.

Effects of yoga and mindfulness practices on the autonomous nervous system in primary school children: A non-randomised controlled study.

OBJECTIVES: The present study examined the effects of a yoga and mindfulness-based programme on the autonomic nervous system of primary school children by using heart rate variability parameters. DESIGN: A two-arm non-randomised controlled trial compared an integrated yoga and mindfulness-based programme (16 weeks) to conventional primary school lessons. SETTING: Primary school classrooms and conference rooms. INTERVENTIONS: Participants were allocated to a 16-week integrated yoga-based programme or conventional school lessons. A subgroup was randomised to receive 24h electrocardiogram-recordings. MAIN OUTCOME MEASURES: Heart rate variability indices were measured, both linear (time and frequency domain) and non-linear (symbolic dynamics, compression entropy), calculated from 30-minute extracts of Holter-electrocardiogram-recordings. Assessments were conducted at baseline and at the end of intervention. RESULTS: 40 participants (42.5% female) were included into the analysis of HRV. No significant changes in heart rate variability parameters were observed between the groups after 16 weeks. In the intervention group, a trend towards increased parasympathetic activity could be seen over time, although not significantly enhanced compared to the control group. CONCLUSION: Results obtained here do not clearly show that children in German primary school settings benefit from an integrated yoga-based intervention. However, exploratory post-hoc analyses point interestingly to an increased nocturnal parasympathetic activity in the intervention group. Further studies are required with high-quality study designs, larger sample sizes and longer-term follow-ups.

Adenosine A1 receptor-mediated suppression of carbamazepine-resistant seizure-like events in human neocortical slices.

OBJECTIVE: The need for alternative pharmacologic strategies in treatment of epilepsies is pressing for about 30% of patients with epilepsy who do not experience satisfactory seizure control with present treatments. In temporal lobe epilepsy (TLE) even up to 80% of patients are pharmacoresistant, and surgical resection of the ictogenic tissue is only possible for a minority of TLE patients. In this study we investigate purinergic modulation of drug-resistant seizure-like events (SLEs) in human temporal cortex slices. METHODS: Layer V/VI field potentials from a total of 77 neocortical slices from 17 pharmacoresistant patients were recorded to monitor SLEs induced by application of 8 mM [K(+) ] and 50 µm bicuculline. RESULTS: Activating A1 receptors with a specific agonist completely suppressed SLEs in 73% of human temporal cortex slices. In the remaining slices, incidence of SLEs was markedly reduced. Because a subportion of slices can be pharmacosensitive, we tested effects of an A1 agonist, in slices insensitive to a high dose of carbamazepine (50 µm). Also in these cases the A1 agonist was equally efficient. Moreover, ATP and adenosine blocked or modulated SLEs, an effect mediated not by P2 receptors but rather by adenosine A1 receptors. SIGNIFICANCE: Selective activation of A1 receptors mediates a strong anticonvulsant action in human neocortical slices from pharmacoresistant patients. We propose that our human slice model of seizure-like activity is a feasible option for future studies investigating new antiepileptic drug (AED) candidates.

Increased QT variability in patients with anorexia nervosa--an indicator for increased cardiac mortality?

OBJECTIVE: Increased mortality in anorexia nervosa is associated with autonomic dysfunction and prolongation of the QT interval. In this study, we examined the relative importance of repolarization abnormalities and vagal modulation of heart rate. In particular, we hypothesized that patients with anorexia nervosa show increased QT interval variability, particularly since this measure has been shown to correlate with serious cardiac arrhythmias. METHOD: We assessed linear and nonlinear heart rate variability (HRV) parameters as well as measures of QT variability in 20 female patients with anorexia nervosa and 20 controls. In patients, parameters were correlated with serum electrolytes. RESULTS: QT variability was significantly increased in the patient group and correlated negatively with serum potassium concentrations. HRV measures showed a shift of autonomic balance towards vagal predominance. DISCUSSION: The increase in QT variability might at least in part account for the higher risk of cardiac arrhythmias in patients with anorexia nervosa. Once validated in a prospective study design, parameters of QT variability might serve as surrogate markers for arrhythmia risk stratification in anorexia nervosa. Supplementation with potassium might normalize QT variability abnormalities.