Afferent vagal stimulation via gastric electrical stimulation alters sympathetic-vagal balance in domestic pigs - a pilot trial.

The disturbance of the sympathetic-vagal balance with increasing sympathetic activity and consecutive increase in cytokine release is a major threat in numerous hyperinflammatory syndromes. Therapeutic interventions that modulate the activity in the sympathetic-vagal system are suggested as an effective treatment in these incidences. The purpose of this pilot study was to investigate the effect of electrical stimulation of the gastric wall on sympathetic-vagal balance. German domestic pigs (n=5) were prepared with a modified gastric tube (mGT) for repetitive gastric electrical stimulation (GES). Electrocardiogram was recorded continuously and heart rate variability (HRV) as measure of sympathetic-vagal activity was calculated for three-minute epochs at baseline condition before GES and during GES condition. In comparison to baseline, activity of the autonomic nervous system (ANS) shifted significantly toward increased dominance of vagal activity during GES with a decrease of normalized low frequency (nLF from 58.00 to 25.52) as marker of sympathetic dominance and parallel increase of normalized high frequency (nHF from 41.48 to 74.16) as marker of vagal dominance. During GES, compared to baseline, no difference in heart rate was found. These results indicate that electrical stimulation of the gastric wall may result in shifting the sympathetic-vagal balance toward a parasympathetic predominance.

Autonomic balance determines the severity of COVID-19 courses.

COVID-19 has left mankind desperately seeking how to manage dramatically rising infection rates associated with severe disease progressions. COVID-19 courses range from mild symptoms up to multiple organ failure and death, triggered by excessively high serum cytokine levels (IL 1ß, IL 6, TNF α, IL 8). The vagally driven cholinergic anti-inflammatory pathway (CAP) stops the action of nuclear factor κB (NF-κB), the transcriptional factor of pro-inflammatory cytokines. Thus, well-balanced cytokine release depends on adequate vagal signaling. Coronaviruses replicate using NF-κB transcriptional factor as well. By degrading the cytoplasmatic inhibitor of NF-κB subunits (IκB), coronaviruses induce unrestricted NF-κB expression accelerating both, virus replication and cytokine transcription.We hypothesize that CAP detriment due to depressed vagal tone critically determines the severity of COVID-19.

The association between an anxiety disorder and cancer in medical history.

BACKGROUND: Cancer patients can feel depression and anxiety any time after a cancer diagnosis. The Generalized Anxiety Disorder Scale (GAD-7) is an instrument for the assessment of anxiety. The main objective of this work was to compare general anxiety levels between cancer survivors and individuals without a history of cancer in a population-based study (LIFE-ADULT) with 10,000 participants. METHODS: All participants (18-80 years) completed the GAD-7 and other psychological and medical questionnaires. A score of 10 or greater for GAD-7 (of total 21) indicates a probable generalized anxiety disorder. RESULTS: 954 participants reported a diagnosis of cancer in their medical history. In the multivariate analysis an anxiety disorder was associated with prior cancer diagnosis (OR: 1.8; 95% CI [1.4-2.4]), age -every additional year- (OR: 0.983; [0.976-0.991]), female gender (OR: 1.8; [1.5-2.2]) and low socioeconomic status (OR: 2.0; [1.7-2.5]) all p < 0.001. There were no significant associations between general anxiety and other comorbidities, such as myocardial infarction (OR: 1.0; p = 0.948), stroke (OR: 1.4; p = 0.237) or diabetes (OR: 1.0; p = 0.326). There was also no significant difference in anxiety disorder among cancer survivors regarding the time passed since the initial cancer diagnosis (OR: 1.1; [0.6-1.9], p = 0.804 comparing 5-10 years after a diagnosis of cancer vs. ≤5 years and OR: 0.6; [0.4-1.1], p = 0.107 comparing >10 vs. ≤5 years). LIMITATIONS: This study has a cross-sectional character, therefore, causal conclusions cannot be drawn. CONCLUSION: Cancer survivors may require screening for anxiety disorders and long-term professional psychosocial support.

[How to distinguish between autosomal dominant optic atrophy and Leber's hereditary optic neuropathy]. / Autosomal-dominant erbliche Optikusatrophie vs. Lebersche Optikusneuropathie. Wie kann man sie unterscheiden?

BACKGROUND: Patients with long-lasting bilateral optic atrophy showed typical clinical features of autosomal dominant optic atrophy (ADOA). Molecular genetic analysis identified them as atypical cases of Leber's hereditary optic neuropathy (LHON). METHOD: Three patients with bilateral optic atrophy and central scotomas of their visual fields were clinically diagnosed with ADOA. Samples of lymphocytic genomic DNA were amplified with polymerase chain reaction, and analysis of the coding exons including the flanking intron/UTR sequences of the OPA-1 gene was performed. However, no ADOA-associated mutations were found. We therefore analysed the total lymphocyte mitochondrial DNA for all common LHON mutations in these patients. RESULTS: Three patients from three unrelated pedigrees (two men, one woman) who were clinically diagnosed as suffering from ADOA did not harbor any typical mutation of the OPA-1 gene. However, analysis of their mitochondrial DNA showed that they harbored the 3460, 11778, and 14484 LHON mutations. The patients were identified as atypical cases of LHON. The pedigrees of the patients fulfilled the criteria for both dominant and mitochondrial-maternal transmission in all cases. The clinical picture of LHON differed remarkably from the classic course of LHON. CONCLUSIONS: To identify atypical LHON patients with bilateral optic atrophy and central scotomas in the visual field and to distinguish them from ADOA patients, careful molecular genetic analysis is necessary. In these rare cases, only double examinations of both the genomic and the mitochondrial DNA will allow these patients to be adequately advised.

Coronary arterial stent patency: assessment with electron-beam CT.

PURPOSE: To evaluate electron-beam computed tomography (CT) for stent localization and noninvasive assessment of stent patency in patients with coronary arterial stents and coronary bypass stents. MATERIALS AND METHODS: CT in the single-section volume mode was performed in 202 patients with 321 coronary arterial stents in 221 vessels to localize the stents. Patency was evaluated in the multisection flow mode with an intravenous bolus injection of contrast material. All electron-beam CT images were reviewed by an observer who had no knowledge of the coronary angiographic results. Electron-beam CT findings were then compared with coronary angiographic findings. RESULTS: The stents could be visualized and related to the coronary arterial segments in 216 of 221 vessels with electron-beam CT. Of the 221 vessels, 207 were correctly evaluated with electron-beam CT. Compared with coronary angiography, electron-beam CT permitted the detection of 18 of 23 high-grade stenoses (sensitivity, 78%) and correctly depicted the absence of high-grade stenoses in 189 of 193 vessels with stents (specificity, 98%). Altogether, 18 stenoses were detected correctly at electron-beam CT; the interpretation was false-positive in four vessels (positive predictive value, 82% [18/22 vessels]) and false-negative in five (negative predictive value, 97% [189/194 vessels]). CONCLUSION: Electron-beam CT may be helpful in localizing intracoronary stents and assessing stent patency noninvasively to delay the intervals between catheterizations in an increasing number of patients.

Electron-beam CT in the noninvasive assessment of coronary stent patency.

RATIONALE AND OBJECTIVES: Coronary artery stents reduce the rate of restenosis in patients who have undergone balloon angioplasty; therefore, the implantation of coronary stents represents an important method in the treatment of coronary stenoses. The authors' purpose was to investigate the usefulness of electron-beam computed tomography (CT) as a noninvasive means of assessing the patency of coronary artery stents in patients who had undergone balloon angioplasty and stent placement. MATERIALS AND METHODS: Electron-beam CT was used to assess stent patency in 177 patients with 285 stents. Contrast material-enhanced multisection flow studies were performed, and the images were evaluated by three investigators and compared with the findings of coronary angiography. RESULTS: Cine loop evaluations and time-attenuation curve analysis led to the correct diagnosis in 167 (94.3%) patients, as confirmed with coronary angiography. Stenoses had occurred in 18 of the 194 vessels with stents, and 14 of these were detected with electron-beam CT. CONCLUSION: Electron-beam CT appears to be a valuable imaging modality in the noninvasive assessment of stent patency in coronary arteries.

[Brief scale for assessment of need for care and provision of care]. / Kurzskala zur Erfassung der Pflegebedürftigkeit und Pflegeversorgung (PBV-Skala).

In accordance with the German law on care for helpless persons, an observer rating scale has been developed to allow a staging of need of care. Construction of the scale, item descriptions, definitions, algorithms for sum score and inter-rater reliability data are reported. The scale can reliably measure the need of care, quality of care, and who is the care provider.