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1.
Int Heart J ; 62(2): 298-304, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731524

RESUMO

Radiofrequency and cryoballoon applications around the pulmonary veins (PVs) could provoke a vagal reflex (VR) by modulating the intrinsic cardiac autonomic nervous system (ICANS).This study aimed to investigate the incidence, timing, and clinical impact of a VR provoked by a laser balloon application for a PV isolation (PVI).A total of 92 consecutive paroxysmal atrial fibrillation (PAF) patients underwent a laser balloon PVI of PAF. Acute changes in the heart rate and blood pressure were recorded. The heart rate variability (HRV) was tested by Holter ECGs before and at three months following the ablation. Three hundred forty-five out of 363 PVs were successfully isolated (97%) with laser balloon applications. A VR such as sinus bradycardia (26.1%), transient sinus arrest (9.8%), transient atrioventricular block (1.1%), or a blood pressure reduction (8.7%) was observed during the laser balloon applications for the PVI. The follow-up ended at 12 months. The HRV attenuation was comparable before and at three months after the ablation procedure between that with and without a VR (P = 0.14). The PAF recurrence rate was also comparable between the two groups (P = 0.882).The laser balloon PVI often provoked a VR, however, the modulation of the ICANS was temporary and for up to three months as measured by the HRV changes after the ablation, and the freedom from any atrial fibrillation recurrence was comparable regardless of the occurrence of a VR.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Frequência Cardíaca/fisiologia , Terapia a Laser/métodos , Taquicardia Paroxística/cirurgia , Nervo Vago/fisiopatologia , Idoso , Fibrilação Atrial/fisiopatologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taquicardia Paroxística/fisiopatologia , Fatores de Tempo
2.
Nat Metab ; 3(4): 530-545, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33767443

RESUMO

The brainstem dorsal vagal complex (DVC) is known to regulate energy balance and is the target of appetite-suppressing hormones, such as glucagon-like peptide 1 (GLP-1). Here we provide a comprehensive genetic map of the DVC and identify neuronal populations that control feeding. Combining bulk and single-nucleus gene expression and chromatin profiling of DVC cells, we reveal 25 neuronal populations with unique transcriptional and chromatin accessibility landscapes and peptide receptor expression profiles. GLP-1 receptor (GLP-1R) agonist administration induces gene expression alterations specific to two distinct sets of Glp1r neurons-one population in the area postrema and one in the nucleus of the solitary tract that also expresses calcitonin receptor (Calcr). Transcripts and regions of accessible chromatin near obesity-associated genetic variants are enriched in the area postrema and the nucleus of the solitary tract neurons that express Glp1r and/or Calcr, and activating several of these neuronal populations decreases feeding in rodents. Thus, DVC neuronal populations associated with obesity predisposition suppress feeding and may represent therapeutic targets for obesity.


Assuntos
Mapeamento Cromossômico , Obesidade/genética , Obesidade/fisiopatologia , Nervo Vago/fisiopatologia , Animais , Apetite/genética , Peso Corporal/genética , Tronco Encefálico/fisiopatologia , Proteína Semelhante a Receptor de Calcitonina/genética , Núcleo Celular/genética , Cromatina/genética , Cromatina/metabolismo , Expressão Gênica , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Neurônios , Núcleo Solitário/fisiologia
3.
Am J Physiol Lung Cell Mol Physiol ; 320(4): L545-L556, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33501891

RESUMO

Obesity increases incidence and severity of asthma but the molecular mechanisms are not completely understood. Hyperinsulinemia potentiates vagally induced bronchoconstriction in obese rats. Since bronchoconstriction results from airway smooth muscle contraction, we tested whether insulin changed agonist-induced airway smooth muscle contraction. Obesity-prone and resistant rats were fed a low-fat diet for 5 wk and treated with insulin (Lantus, 3 units/rat sc) 16 h before vagally induced bronchoconstriction was measured. Ex vivo, contractile responses to methacholine were measured in isolated rat tracheal rings and human airway smooth muscle strips before and after incubation (0.5-2 h) with 100 nM insulin or 13.1 nM insulin like growth factor-1 (IGF-1). M2 and M3 muscarinic receptor mRNA expression was quantified by qRT-PCR and changes in intracellular calcium were measured in response to methacholine or serotonin in isolated rat tracheal smooth muscle cells treated with 1 µM insulin. Insulin, administered to animals 16 h prior, potentiated vagally induced bronchoconstriction in both obese-prone and resistant rats. Insulin, not IGF-1, significantly increased methacholine-induced contraction of rat and human isolated airway smooth muscle. In cultured rat tracheal smooth muscle cells, insulin significantly increased M2, not M3, mRNA expression and enhanced methacholine- and serotonin-induced increase in intracellular calcium. Insulin alone did not cause an immediate increase in intracellular calcium. Thus, insulin acutely potentiated agonist-induced increase in intracellular calcium and airway smooth muscle contraction. These findings may explain why obese individuals with hyperinsulinemia are prone to airway hyperreactivity and give insights into future targets for asthma treatment.


Assuntos
Hiper-Reatividade Brônquica/patologia , Broncoconstrição , Hiperinsulinismo/complicações , Insulina/efeitos adversos , Cloreto de Metacolina/farmacologia , Contração Muscular , Músculo Liso/patologia , Animais , Hiper-Reatividade Brônquica/etiologia , Hiper-Reatividade Brônquica/metabolismo , Cálcio/metabolismo , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Agonistas Muscarínicos/farmacologia , Músculo Liso/efeitos dos fármacos , Músculo Liso/metabolismo , Obesidade/complicações , Ratos , Ratos Sprague-Dawley , Receptores Muscarínicos/metabolismo , Traqueia/efeitos dos fármacos , Traqueia/patologia , Nervo Vago/fisiopatologia
4.
Sci Rep ; 10(1): 21810, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33311648

RESUMO

Long-duration Antarctic expeditions are characterized by isolation, confinement, and extreme environments. Here we describe the time course of cardiac autonomic modulation assessed by heart rate variability (HRV) during 14-month expeditions at the German Neumayer III station in Antarctica. Heart rate recordings were acquired in supine position in the morning at rest once before the expedition (baseline) and monthly during the expedition from February to October. The total set comprised twenty-five healthy crewmembers (n = 15 men, 38 ± 6 yrs, n = 10 women, 32 ± 6 yrs, mean ± SD). High frequency (HF) power and the ratio of low to high frequency power (LF/HF) were used as indices of vagal modulation and sympathovagal balance. HF power adjusted for baseline differences decreased significantly during the expedition, indicating a gradual reduction in vagal tone. LF/HF powers ratio progressively shifted toward a sympathetic predominance reaching statistical significance in the final trimester (August to October) relative to the first trimester (February to April). This effect  was particularly pronounced in women. The depression of cardio-vagal tone and the shift toward a sympathetic predominance observed throughout the overwintering suggest a long-term cardiac autonomic modulation in response to isolation and confinement during Antartic overwintering.


Assuntos
Eletrocardiografia , Frequência Cardíaca , Coração/fisiopatologia , Nervo Vago/fisiopatologia , Adulto , Regiões Antárticas , Feminino , Humanos , Masculino
5.
Nat Commun ; 11(1): 5555, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33144559

RESUMO

It is highly debated how cyclic adenosine monophosphate-dependent regulation (CDR) of the major pacemaker channel HCN4 in the sinoatrial node (SAN) is involved in heart rate regulation by the autonomic nervous system. We addressed this question using a knockin mouse line expressing cyclic adenosine monophosphate-insensitive HCN4 channels. This mouse line displayed a complex cardiac phenotype characterized by sinus dysrhythmia, severe sinus bradycardia, sinus pauses and chronotropic incompetence. Furthermore, the absence of CDR leads to inappropriately enhanced heart rate responses of the SAN to vagal nerve activity in vivo. The mechanism underlying these symptoms can be explained by the presence of nonfiring pacemaker cells. We provide evidence that a tonic and mutual interaction process (tonic entrainment) between firing and nonfiring cells slows down the overall rhythm of the SAN. Most importantly, we show that the proportion of firing cells can be increased by CDR of HCN4 to efficiently oppose enhanced responses to vagal activity. In conclusion, we provide evidence for a novel role of CDR of HCN4 for the central pacemaker process in the sinoatrial node.


Assuntos
Relógios Biológicos , AMP Cíclico/metabolismo , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/metabolismo , Nó Sinoatrial/patologia , Potenciais de Ação/efeitos dos fármacos , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Relógios Biológicos/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Bradicardia/complicações , Bradicardia/patologia , Carbacol/farmacologia , Eletrocardiografia , Feminino , Células HEK293 , Coração/efeitos dos fármacos , Coração/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Camundongos Endogâmicos C57BL , Subunidades Proteicas/metabolismo , Reprodutibilidade dos Testes , Nó Sinoatrial/fisiopatologia , Nervo Vago/efeitos dos fármacos , Nervo Vago/fisiopatologia
6.
Am J Gastroenterol ; 115(9): 1534-1538, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732620

RESUMO

INTRODUCTION: To determine whether pretreatment vagal efficiency (VE), respiratory sinus arrhythmia, and heart period can predict pain improvement with auricular neurostimulation in pediatric functional abdominal pain disorders. METHODS: A total of 92 adolescents with functional abdominal pain disorders underwent a 4-week randomized, double-blinded, sham-controlled auricular neurostimulation trial. Electrocardiogram-derived variables at baseline were used to predict pain using mixed effects modeling. RESULTS: A 3-way interaction (95% confidence intervals: 0.004-0.494) showed that the treatment group subjects with low baseline VE had lower pain scores at week 3. There was no substantial change in the placebo or high VE treatment group subjects. This effect was supported by a significant correlation between baseline VE and degree of pain reduction only in the treatment group. DISCUSSION: Impaired cardiac vagal regulation measured by VE predicts pain improvement with auricular neurostimulation.


Assuntos
Dor Abdominal/terapia , Terapia por Estimulação Elétrica/métodos , Gastroenteropatias/terapia , Nervo Vago/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Criança , Método Duplo-Cego , Feminino , Gastroenteropatias/fisiopatologia , Humanos , Masculino , Manejo da Dor , Medição da Dor , Resultado do Tratamento
7.
Exp Psychol ; 67(2): 150-159, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32729407

RESUMO

Cognition is affected by psychophysiological states. While the influence of stress on cognition has been investigated intensively, less studies have addressed how the opposite of stress, a state of relaxation, affects cognition. We investigated whether the extent of parasympathetic activation is positively related to divergent thinking. Sixty healthy female participants were randomly allocated to a standardized vagus nerve massage (n = 19), a standardized soft shoulder massage (n = 22), or a resting control group (n = 19). Subsequently, participants completed the Alternative Uses Test (AUT), a measure of divergent thinking. Respiratory sinus arrhythmia (RSA), a vagally mediated heart rate variability component, was monitored throughout the experiment. The area under the curve with respect to the increase was calculated for RSA trajectories as an indicator of vagal tone during the relaxing intervention. Regressions tested the effect of vagal tone on AUT outcomes. We found an association between vagal tone and subsequent AUT outcomes. Yet, this association was no longer significant when controlling for the effect of the creative potential of an individual, which was strongly related to AUT outcomes. Being exploratory, we found a positive association between creative potential and vagal tone. These results imply that creative potential might be related to the capacity to relax.


Assuntos
Cognição/fisiologia , Criatividade , Estresse Psicológico/psicologia , Nervo Vago/fisiopatologia , Adulto , Feminino , Humanos , Masculino
8.
Am J Physiol Regul Integr Comp Physiol ; 319(1): R106-R113, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32493036

RESUMO

Electroacupuncture (EA) is widely used as an effective method to treat stress-related disorders. However, its mechanisms remain largely unknown. The aim of this study was to investigate the effects and mechanisms of EA on gastric slow wave (GSW) dysrhythmia and c-Fos expression in the nucleus of the solitary tract (NTS) induced by stress in a rodent model of functional dyspepsia (FD). Rats in the neonatal stage were treated using intragastric iodoacetamide. Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of GSW and electrodes into accupoints ST36 for EA. Autonomic functions were assessed by spectral analysis of heart rate variability. Rats were placed for 30 min in a cylindrical plastic tube for acute restraint stress. The involvement of a central afferent pathway was assessed by measuring c-Fos-immunoreactive cells in the NTS. 1) EA normalized restraint stress-induced impairment of GSW in FD rats. 2) EA significantly increased vagal activity (P = 0.002) and improved sympathovagal balance (P = 0.004) under stress in FD rats. 3) In FD rats under restraint stress, plasma norepinephrine concentration was increased substantially (P < 0.01), which was suppressed with EA. 4) The EA group showed increased c-Fos-positive cell counts in the NTS compared with the sham EA group (P < 0.05) in FD rats. Acute restraint stress induces gastric dysrhythmia in a rodent model of FD. EA at ST36 improves GSW under stress in FD rats mediated via the central and autonomic pathways, involving the NTS and vagal efferent pathway.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Dispepsia/fisiopatologia , Dispepsia/terapia , Eletroacupuntura , Gastropatias/terapia , Estresse Psicológico/complicações , Vias Aferentes/fisiopatologia , Animais , Animais Recém-Nascidos , Esvaziamento Gástrico , Iodoacetamida , Masculino , Norepinefrina/sangue , Proteínas Proto-Oncogênicas c-fos/biossíntese , Ratos , Ratos Sprague-Dawley , Restrição Física , Núcleo Solitário/metabolismo , Gastropatias/induzido quimicamente , Nervo Vago/fisiopatologia
9.
Sci Rep ; 10(1): 9472, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32528023

RESUMO

The efficacy of prior activation of an anti-inflammatory pathway called the cholinergic anti-inflammatory pathway (CAP) through vagus nerve stimulation (VNS) has been reported in renal ischemia-reperfusion injury models. However, there have been no reports that have demonstrated the effectiveness of VNS after injury. We investigated the renoprotective effect of VNS in a cisplatin-induced nephropathy model. C57BL/6 mice were injected with cisplatin, and VNS was conducted 24 hours later. Kidney function, histology, and a kidney injury marker (Kim-1) were evaluated 72 hours after cisplatin administration. To further explore the role of the spleen and splenic macrophages, key players in the CAP, splenectomy, and adoptive transfer of macrophages treated with the selective α7 nicotinic acetylcholine receptor agonist GTS-21 were conducted. VNS treatment significantly suppressed cisplatin-induced kidney injury. This effect was abolished by splenectomy, while adoptive transfer of GTS-21-treated macrophages improved renal outcomes. VNS also reduced the expression of cytokines and chemokines, including CCL2, which is a potent chemokine attracting monocytes/macrophages, accompanied by a decline in the number of infiltrating macrophages. Taken together, stimulation of the CAP protected the kidney even after injury in a cisplatin-induced nephropathy model. Considering the feasibility and anti-inflammatory effects of VNS, the findings suggest that VNS may be a promising therapeutic tool for acute kidney injury.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/fisiopatologia , Cisplatino/farmacologia , Macrófagos/fisiologia , Nervo Vago/fisiopatologia , Injúria Renal Aguda/metabolismo , Animais , Anti-Inflamatórios/farmacologia , Compostos de Benzilideno/farmacologia , Citocinas/metabolismo , Inflamação/metabolismo , Inflamação/fisiopatologia , Rim/efeitos dos fármacos , Rim/metabolismo , Rim/fisiopatologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Piridinas/farmacologia , Traumatismo por Reperfusão/induzido quimicamente , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/fisiopatologia , Baço/efeitos dos fármacos , Baço/metabolismo , Baço/fisiopatologia , Nervo Vago/metabolismo , Estimulação do Nervo Vago/métodos , Receptor Nicotínico de Acetilcolina alfa7/metabolismo
10.
Am J Cardiol ; 125(11): 1751-1752, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32279837

RESUMO

In a 27-year-old man the electrocardiogram suggests increased vagal tone, and not intrinsic atrioventricular nodal disease, as the cause of transient atrioventricular block.


Assuntos
Bloqueio Atrioventricular/fisiopatologia , Nervo Vago/fisiopatologia , Adulto , Nó Atrioventricular/fisiopatologia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Masculino , Esforço Físico/fisiologia , Síncope
12.
Circ Arrhythm Electrophysiol ; 13(3): e007471, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32063070

RESUMO

BACKGROUND: Risk stratification in catecholaminergic polymorphic ventricular tachycardia remains ill defined. Heart rate recovery (HRR) immediately after exercise is regulated by autonomic reflexes, particularly vagal tone, and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Our objective was to evaluate whether HRR after maximal exercise on the exercise stress test (EST) is associated with symptoms and ventricular arrhythmias. METHODS: In this retrospective observational study, we included patients ≤65 years of age with an EST without antiarrhythmic drugs who attained at least 80% of their age- and sex-predicted maximal HR. HRR in the recovery phase was calculated as the difference in heart rate (HR) at maximal exercise and at 1 minute in the recovery phase (ΔHRR1'). RESULTS: We included 187 patients (median age, 36 years; 68 [36%] symptomatic before diagnosis). Pre-EST HR and maximal HR were equal among symptomatic and asymptomatic patients. Patients who were symptomatic before diagnosis had a greater ΔHRR1' after maximal exercise (43 [interquartile range, 25-58] versus 25 [interquartile range, 19-34] beats/min; P<0.001). Corrected for age, sex, and relatedness, patients in the upper tertile for ΔHRR1' had an odds ratio of 3.4 (95% CI, 1.6-7.4) of being symptomatic before diagnosis (P<0.001). In addition, ΔHRR1' was higher in patients with complex ventricular arrhythmias at EST off antiarrhythmic drugs (33 [interquartile range, 22-48] versus 27 [interquartile range, 20-36] beats/min; P=0.01). After diagnosis, patients with a ΔHRR1' in the upper tertile of its distribution had significantly more arrhythmic events as compared with patients in the other tertiles (P=0.045). CONCLUSIONS: Catecholaminergic polymorphic ventricular tachycardia patients with a larger HRR following exercise are more likely to be symptomatic and have complex ventricular arrhythmias during the first EST off antiarrhythmic drug.


Assuntos
Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Recuperação de Função Fisiológica/fisiologia , Taquicardia Ventricular/fisiopatologia , Adulto , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Nervo Vago/fisiopatologia , Adulto Jovem
13.
J Abnorm Psychol ; 129(3): 237-247, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32077707

RESUMO

The valine66methionine (Val66Met) polymorphism (rs6265) of the brain-derived neurotrophic factor (BDNF) gene has been shown to influence autonomic arousal pathways, which in turn predict elevated syndromal anxiety in healthy humans. We examined whether the BDNF variant is associated with an increased risk of generalized anxiety disorder (GAD), one of the most prevalent anxiety disorders, through altering parasympathetic stress/relaxation reactivity. A total of 2,250 Han Chinese adults (750 GAD patients and 1,500 healthy controls) were included in the genotyping. High-frequency heart rate variability, an index of vagal (parasympathetic) activity, was measured during the supine-standing-supine test (5 min in each position); vagal withdrawal and vagal activation were calculated as baseline supine minus standing and recovery supine minus standing, respectively. Analysis of healthy participants indicated that Val/Val homozygotes displayed significantly blunted vagal withdrawal and vagal activation compared with Met allele carriers. After analyzing the entire sample, these effects remained significant. Furthermore, both attenuated vagal response patterns were found to be significantly associated with a higher incidence of GAD. Lastly, the path analysis identified a significant indirect effect of BDNF on the risk of GAD via diminishing vagal response to either orthostatic stress or supine relaxation. Even when further testing the subsample comprising only comorbidity- and medication-free GAD patients and healthy controls to minimize the confounding bias, the results still remained. Our findings demonstrate that individuals carrying the BDNF Val/Val genotype, compared to Met-carriers, may be at higher risk of GAD due to blunted vagal reactivity in response to both stress and relaxation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/genética , Ansiedade/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Genótipo , Sistema Nervoso Parassimpático/fisiopatologia , Polimorfismo de Nucleotídeo Único , Adulto , Alelos , Ansiedade/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Nível de Alerta/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Vago/fisiopatologia
14.
Medicine (Baltimore) ; 99(4): e18961, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977913

RESUMO

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection.In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups.Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990-0.999) and LF/HF (OR = 0.494; 95% CI, 0.423-0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685-0.797) and 0.930 (95% CI, 0.900-0.960), respectively, in identifying sepsis in patients with suspected infection.Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.


Assuntos
Frequência Cardíaca , Sepse/diagnóstico , Nervo Vago/fisiopatologia , Idoso , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Prospectivos , Sensibilidade e Especificidade , Sepse/fisiopatologia
15.
Brain Stimul ; 13(1): 1-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31668983

RESUMO

Major Depressive Disorder (MDD) is a psychiatric disorder characterized by high comorbidity with cardiovascular disease. Furthermore, a combination of high heart rate (HR) and low heart rate variability (HRV) has been frequently reported in depressed patients. The present review proposes a frontal-vagal (brain-heart) network that overlaps with functional nodes of the depression network. Moreover, we summarize neuromodulation studies that have targeted key nodes in this depression network, with subsequent impact on heart rate (HR) or heart-rate-variability (HRV), such as the dorsolateral prefrontal cortex (DLPFC), subgenual anterior cingulate cortex (sgACC), and the vagus nerve (VN). Based on the interplay of this frontal-vagal network, we emphasize the importance of including HR and HRV measurements in human depression studies, in particular those that conduct neuromodulation, in order to obtain a better understanding of the pathways that are affected, and we explore the possibilities of using this frontal-vagal interplay as a method for target engagement in neuromodulation treatments. This frontal-vagal network theory opens-up the possibility for individualizing neuromodulation treatments such as rTMS. A recent development called Neuro-Cardiac-Guided TMS (NCG-TMS), was developed based on this theory, and an individual-participant meta-analysis is presented. Four studies provide consistent and replicable support for NCG-TMS as a target engagement method, with consistent HR deceleration during frontal TMS and HR acceleration during motor strip TMS.


Assuntos
Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Frequência Cardíaca/fisiologia , Córtex Pré-Frontal/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Nervo Vago/fisiopatologia , Giro do Cíngulo/fisiopatologia , Humanos , Córtex Motor/fisiopatologia
16.
Exp Neurol ; 323: 113092, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31697943

RESUMO

Dramatic impairment of gastrointestinal (GI) function accompanies high-thoracic spinal cord injury (T3-SCI). The vagus nerve contains mechano- and chemosensory fibers as well as the motor fibers necessary for the central nervous system (CNS) control of GI reflexes. Cell bodies for the vagal afferent fibers are located within the nodose gangla (NG) and the majority of vagal afferent axons are unmyelinated C fibers that are sensitive to capsaicin through activation of transient receptor potential vanilloid-1 (TRPV1) channels. Vagal afferent fibers also express receptors for GI hormones, including cholecystokinin (CCK). Previously, T3-SCI provokes a transient GI inflammatory response as well as a reduction of both gastric emptying and centrally-mediated vagal responses to GI peptides, including CCK. TRPV1 channels and CCK-A receptors (CCKar) expressed in vagal afferents are upregulated in models of visceral inflammation. The present study investigated whether T3-SCI attenuates peripheral vagal afferent sensitivity through plasticity of TRPV1 and CCK receptors. Vagal afferent response to graded mechanical stimulation of the stomach was significantly attenuated by T3-SCI at 3-day and 3-week recovery. Immunocytochemical labeling for CCKar and TRPV1 demonstrated expression on dissociated gastric-projecting NG neurons. Quantitative assessment of mRNA expression by qRT-PCR revealed significant elevation of CCKar and TRPV1 in the whole NG following T3-SCI in 3-day recovery, but levels returned to normal after 3-weeks. Three days after injury, systemic administration of CCK-8 s showed a significantly diminished gastric vagal afferent response in T3-SCI rats compared to control rats while systemic capsaicin infusion revealed a significant elevation of vagal response in T3-SCI vs control rats. These findings demonstrate that T3-SCI provokes peripheral remodeling and prolonged alterations in the response of vagal afferent fibers to the physiological signals associated with digestion.


Assuntos
Neurônios Aferentes/metabolismo , Receptores da Colecistocinina/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Canais de Cátion TRPV/metabolismo , Nervo Vago/fisiopatologia , Animais , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Masculino , Plasticidade Neuronal/fisiologia , Ratos , Ratos Wistar , Traumatismos da Medula Espinal/complicações , Estômago/inervação , Vértebras Torácicas , Nervo Vago/metabolismo
17.
Anesth Analg ; 130(4): 1054-1062, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30346356

RESUMO

BACKGROUND: Organ ischemia-reperfusion injury often induces local and systemic inflammatory responses, which in turn worsen organ injury. These inflammatory responses can be regulated by the central nervous system, particularly by the vagal nerve and nicotinic acetylcholine receptors, which are the key components of cholinergic anti-inflammatory pathway. Activation of the cholinergic anti-inflammatory pathway can suppress excessive inflammatory responses and be a potential strategy for prevention of ischemia-reperfusion injury of organs including the kidney. METHODS: Vagal nerve activity, plasma acetylcholine, catecholamine and inflammatory mediators, renal tissue injury, and cell death were measured in mice with bilateral renal ischemia/reperfusion with or without treatment with dexmedetomidine (Dex), an α2-adrenergic receptor agonist. RESULTS: Dex significantly increased the discharge frequency of the cervical vagal nerve by up to 142 Hz (mean) (P < .001), and preserved kidney gross morphology and structure and attenuated cell apoptosis after ischemia-reperfusion. Furthermore, Dex also significantly increased acetylcholine release to 135.8 pmol/L (median) when compared to that (84.7 pmol/L) in the sham group (P < .001) and reduced the levels of several inflammatory mediators induced by renal ischemia/reperfusion. All the effects were abolished by vagotomy, splenectomy, or combinative administration of atipamezole, an α2-adrenergic receptor antagonist. CONCLUSIONS: Our findings suggest that Dex provides renoprotection, at least in part, through anti-inflammatory effects of the parasympathetic nervous system activation in addition to its direct actions on α2-adrenergic receptors.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Anti-Inflamatórios/farmacologia , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Nefropatias/prevenção & controle , Sistema Nervoso Parassimpático/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , Acetilcolina/sangue , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Apoptose/efeitos dos fármacos , Catecolaminas/sangue , Imidazóis/farmacologia , Mediadores da Inflamação/metabolismo , Rim/patologia , Nefropatias/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Nervo Vago/fisiopatologia
18.
Acta Diabetol ; 57(2): 141-150, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31367992

RESUMO

AIMS: Present study observed the impact of blood glucose control on sympathetic and vagus functional status in type 2 diabetes mellitus (DM) patients through observing the association between glycosylated hemoglobin (HbA1c) level and sympathetic and vagus functional status detected by heart rate recovery (HRR) and heart rate variability (HRV) assessments. METHODS: Consecutive hospitalized DM patients were divided into well glycemic control group (HbA1c < 7.0%, group WGC, n = 100) and poor glycemic control group (HbA1c ≥ 7.0%, group PGC, n = 100), 100 hospitalized patients without DM served as control group (group C). All subjects underwent blood biochemistry test, treadmill exercise testing and 24-h Holter monitoring. RESULTS: HRR and HRV parameters were significantly lower in group WGC and PGC than in group C. Standard deviation of NN intervals (SDNN), standard deviation of all 5-min average NN intervals (SDANN), very low frequency (VLF) values were significantly lower in group PGC than in group WGC. HbA1c level was negatively correlated with HRR1, SDNN, SDANN, VLF, low frequency and high frequency. Logistic regression analysis showed that lower SDNN, SDANN and VLF values were risk factors for high HbA1c levels in DM patients after adjusting for gender, age and beta-blocker use in the model 1, and for gender, age, beta-blocker use, coronary artery disease and hypertension in the model 2. CONCLUSIONS: Present results indicate that sympathetic and vagal functional status are impaired independent of HbA1c level, while poor glycemic control is related to more significant neurocardiac dysfunction in DM patients.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Sistema Nervoso Simpático/fisiopatologia , Nervo Vago/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/fisiopatologia , Eletrocardiografia Ambulatorial , Teste de Esforço , Feminino , Hemoglobina A Glicada/metabolismo , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Med Sci Sports Exerc ; 52(2): 362-369, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31469711

RESUMO

PURPOSE: Sweat-induced fluid loss during prolonged exercise-heat stress can compromise cardiovascular and thermoregulatory function, although its effects on cardiac autonomic modulation remain unclear. We therefore examined heart rate variability (HRV) and recovery (HRRec), as surrogates of cardiac autonomic modulation, during and after prolonged exercise in the heat with and without fluid replacement. METHODS: Eleven young and healthy men performed 90 min of semi-recumbent cycling in dry heat (40°C; 20% relative humidity) at a fixed rate of metabolic heat production (600 W; ~46% V˙O2peak) followed by 40-min resting recovery without fluid replacement (No-FR; ~3.4% reduction in body mass). On a separate day, participants completed the same protocol with fluid replacement (FR; 500-700 mL timed boluses) to offset sweat losses. Esophageal temperature and ECG were recorded throughout, with measurements analyzed over 10-min averaged epochs during baseline, each 30-min interval during exercise and 20-min interval during recovery. RESULTS: Esophageal temperature and heart rate were elevated in No-FR relative to FR throughout exercise (all P ≤ 0.02). The HRV indices reflecting vagal influence of heart rate including the cardiac vagal index (CVI = log10[16 × SD1 × SD2]) and root-mean-square of successive differences were attenuated throughout exercise relative to baseline in both conditions (all P < 0.05), with the magnitude of the reduction greater in the No-FR condition (all P < 0.05). Further, sample entropy was reduced throughout all time points measured during exercise in the No-FR relative to FR condition (all P ≤ 0.03). CONCLUSIONS: Our unique observations indicate that while prolonged exercise heat stress attenuates the vagal influence and complexity of cardiac rhythms, that reduction is further exacerbated by fluid loss, highlighting the importance of fluid replacement in such conditions.


Assuntos
Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Transtornos de Estresse por Calor/fisiopatologia , Sudorese/fisiologia , Nervo Vago/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Temperatura Corporal/fisiologia , Eletrocardiografia , Hidratação , Transtornos de Estresse por Calor/terapia , Temperatura Alta , Humanos , Masculino , Fatores de Tempo
20.
Circ Arrhythm Electrophysiol ; 12(12): e007811, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31760820

RESUMO

BACKGROUND: Circumferential pulmonary vein isolation (CPVI) often cause unavoidable vagal reflexes during procedure due to the coincidental modification of ganglionated plexus which are located on pulmonary vein (PV) antrum. The right anterior ganglionated plexi (RAGP) which located at superoanterior area of right superior PV antrum is an essential station to regulate the cardiac autonomic nerve activities and is easily coincidentally ablated during CPVI. The aim of this study is to assess the effect of RAGP ablation on vagal response (VR) during CPVI. METHODS: A total of 80 patients with paroxysmal atrial fibrillation who underwent the first time CPVI were prospectively enrolled and randomly assigned to 2 groups: group A (n=40), CPVI started with right PVs at RAGP site; group B (n=40): CPVI started with left PVs first, and the last ablation site is RAGP. Electrophysiological parameters include basal cycle length, A-H interval, H-V interval, sinus node recovery time, and atrioventricular node Wenckebach point were recorded before and after CPVI procedure. RESULTS: During CPVI, the positive VR were only observed on 1 patient in group A and 25 patients in group B (P<0.001). A total of 21 patients with positive VR in group B needed for temporary ventricular pacing during procedure, while the only patient with positive VR in group A did not need for temporary ventricular pacing (P<0.001). Compared with baseline, basal cycle length, sinus node recovery time, and atrioventricular node Wenckebach point were decreased significantly after CPVI procedure in both groups (all P<0.05) and without differences between 2 groups. CONCLUSIONS: Circumferential PV isolation initiated from RAGP could effectively inhibit VR occurrence and significantly increase heart rate during procedure.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Gânglios Parassimpáticos/cirurgia , Ganglionectomia , Frequência Cardíaca , Veias Pulmonares/cirurgia , Reflexo , Nervo Vago/fisiopatologia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Pequim , Ablação por Cateter/efeitos adversos , Feminino , Gânglios Parassimpáticos/fisiopatologia , Ganglionectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/inervação , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
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