The Reciprocal Effect on the Subject and Therapist by the Abdominal Therapeutic Touch / 日本補完代替医療学会誌

The therapeutic touch therapists would recognize the physical variability of themselves, mainly on the increase fever of their palms, and the continuous responses of the physical variability of the patients, such as the stable breath, the decreasing respiration, the fever of the touched parts, through their daily therapy processes. But there is actually little study that would evaluate the therapeutic touch therapy effect between the therapists and the subjects.Previous studies have reported that the effects on the subjects, but these authors did not discuss about the therapists and the interactions between the therapists and subjects. Therefore, we examined to measure the continuous physical variability both of the therapist and the subjects, the same time and parts, before and after the abdominal therapeutic touch. And we intended to clarify the relationship and the interaction between the therapist and the subjects.We enrolled the female and male therapists, and each of them performed the therapeutic touch to six subjects. Each of the test was separated to three parts, before therapy (30min), therapy (10min) and after therapy (10min) period. We designed that the therapeutic touch therapy part of the subjects was on the abdomen, there would be considered empirically the sensitive point. The subjects were asked to rest supine and the measurement were the electrocardiogram R-R interval and the epidermal temperatures of the four Meridian points (ST9, HT7, CV7, LR3). The therapist was sitting on chair beside the subject during the experiment and the measurements were carried out the same time and method as the subjects.The results showed that the abdominal therapeutic touch (1) decrease the R-R interval of the therapist, that would indicate to increase the sympathetic activity, (2) increase the R-R interval of the subject, that would indicate to increase the parasympathetic activity, (3) increase the epidermal temperature of therapeutic touch related parts of the therapist, HT7, CV7, and ST9, (4) increase the epidermal temperature of therapeutic touch related parts of the subject, CV7 and LR3. That is to say that the R-R interval variability of the therapist against the subject were inverse, and according to the abdominal therapeutic touch process, the epidermal temperature of the upper regions, above the abdomen, neck and wrist belong to the therapist would increase, while these of under regions, below the abdomen and the instep belong to subjects would increase. More detail, during the experiments, both of the therapist totally showed the similar therapeutic touch effects, but also suggested the characteristics of their performance to the subjects.Under these designed experiments, especially the same time continuous measurement of the variability, both of the therapist and the subjects, we could reveal that the rapid interaction and the dynamic relationship between the therapist and the subjects.

Support Vector Machine-based Multi-scale Entropy of Curves Recognition for Electrocardiogram Data.

Objective: Multiscale entropy (MSE) analysis has been widely used to analyze the physiological signals in the frequency domain. Higher complexities of MSE curve present in the physiological system have the better ability to adapt under environmental change. Most people use the subjective experience to distinguish different complexity groups of MSE curves. When the difference between curves is hard to distinguish, the results are often misinterpreted. Methodology: In this study, four features were designed for the purpose to use the support vector machine technique to develop an automatic recognition procedure for the MSE curve. Results: A dataset of the electrocardiogram was used to illustrate the proposed analytical process. The results show that AUC is not the only MSE curve feature that should be employed, and new design features may increase recognition ability of MSE curves for electrocardiogram data. Conclusion: The study results imply that the proposed process can facilitate MSE recognition among nonprofessionals.

Heart Rate Variability in Hyperthyroidism.

Background: Hyperthyroidism is associated with altered cardiac autonomic nervous activity (CANA). Heart Rate Variability (HRV) analysis is a promising technique to quantify CANA and therefore can be done in hyperthyroidism. Objective: To observe the HRV parameters in patients with hyperthyroidism to find out the influence of excess thyroid hormone on cardiac autonomic nervous activities. Method: The cross sectional study was carried out on 60 hyperthyroid patients (groupB)aged 30-50 years in the Department of Physiology, BSMMU, Dhaka from 1st July 2007 to 30th June 2008. Age and sex matched 20 apparently healthy euthyroids were also studied for comparison (group A). On the basis of treatment, they were further divided into group B1 consisting of 30 untreated newly diagnosed patients and group B2 consisting of 30 hyperthyroid patients treated with antithyroid drugs for at least 2 months. The patients were selected from the Out Patient Department of Endocrinology, BSMMU, Dhaka. To assess thyroid status, serum TSH and serum FT4 levels were measured by AxSym system and time domain measures of HRV such as mean R-R interval, mean heart rate, SDNN and RMSSD were assessed from 5minute(short term) ECG recording by a polygraph. For statistical analysis Mann-Whitney U test was done. Results: Mean R-R interval was significantly (P<0.001) lower but mean heart rate was significantly (P<0.001) higher in untreated patients than those of treated and euthyroids subjects. These values were found almost similar when compared between euthyroids and treated hyperthyroids. Similarly SDNN and RMSSD were significantly lower in untreated hyperthyroids than both euthyroids (P<0.001) and treated hyperthyroids (P<0.01). Conclusion: This study concluded that decreased vagal modulation on heart rate may occur in hyperthyroidism, which may be restored following adequate treatment of the disease.

Electrophysiological Characteristics of Autonomic Nervous System Function in Post-Stroke Patients

OBJECTIVE: To evaluate the autonomic nervous function in post-stroke patients. METHOD: A total of 58 subjects, 34 post-stroke patients (mean age of 61.35 years) and 24 healthy subjects (mean age of 34.42 years) were included. The sympathetic skin response (SSR), the R-R interval variation (RRIV) and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response including no response. The R-R interval variations were estimated during rest, deep breathing and Valsalva maneuver respectively. RESULTS: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR on affected side (81.6%, 111 of 136 waves) was significantly higher than unaffected side (69.1%, 94 of 136 waves) (p0.05). The RRIV of stroke patients with OH (1.09+/-0.06) was significantly lower than in control (1.14+/-0.05) during rest (p<0.01), and in stroke patients without OH, the RRIV (1.13+/-0.06) was also significantly lower than in control (1.27+/-0.22) during Valsalva maneuver (p<0.01). CONCLUSION: Evaluation of SSR and RRIV could be helpful in detecting dysfunction of autonomic nervous system in post-stroke patients.

Training-related changes in the R-R interval at the onset of passive movements in humans

The aim of the present study was to determine whether training-related alterations in muscle mechanoreflex activation affect cardiac vagal withdrawal at the onset of exercise. Eighteen male volunteers divided into 9 controls (26 ± 1.9 years) and 9 racket players (25 ± 1.9 years) performed 10 s of voluntary and passive movement characterized by the wrist flexion of their dominant and non-dominant limbs. The respiratory cycle was divided into four phases and the phase 4 R-R interval was measured before and immediately following the initiation of either voluntary or passive movement. At the onset of voluntary exercise, the decrease in R-R interval was similar between dominant and non-dominant forearms in both controls (166 ± 20 vs 180 ± 34 ms, respectively; P > 0.05) and racket players (202 ± 29 vs 201 ± 31 ms, respectively; P > 0.05). Following passive movement, the non-dominant forearm of racket players elicited greater changes than the dominant forearm (129 ± 30 vs 77 ± 17 ms; P < 0.05), as well as both the dominant (54 ± 20 ms; P < 0.05) and non-dominant (59 ± 14 ms; P < 0.05) forearms of control subjects. In contrast, changes in R-R interval elicited by the racket players' dominant forearm were similar to that observed in the control group, indicating that changes in R-R interval at the onset of passive exercise were not attenuated in the dominant forearm of racket players. In summary, cardiac vagal withdrawal induced by muscle mechanoreflex stimulation is well-maintained, despite long-term exposure to training.

R-R interval variation in healthy subjects.

This study was performed to establish normal data for R-R interval variation in order to study parasympathetic heart rate control in subject with autonomic neuropathy. R-R interval variation or heart rate change was measured in 50 healthy subjects aged 16-53 (30.52 + 8.8) years using electromyographic equipment. The studies were performed at rest and deep breathing was 19.34 + 7.26 and 39.18 + 14.14 respectively. The difference between maximal and minimal heart rate at rest and deep breathing was 14.56 + 5.38 and 29.38 + 10.06 beat per minute respectively.

effects of various degrees of coronary stenosis on Lyapunov exponents of ECG and R-R interval time series / 中国医学物理学杂志

Purpose:It has been shown that the heart is a chaotic oscillator. So it is appropriiate to use the Lyapunov exponent, an important parameter to identify the nature of non-linear dynamical systems, for identifying the state of human heart. Methods:Preliminary results are obtained in this paper using Wolf's algorithm for 8 normal and 107 abnormal ECG recordings. Results:Significant differences are found between the Lyapunov exponents of normal ECG and ECG with obvious coronary stenosis (OCS), but there is no significant difference between the Lyapunov exponents of normal ECG and ECG with mild coronary stenosis (MCS);Significant differences are also found between the Lyapunov exponents of R-R interval series of normal ECG、ECG with MCS and ECG with OCS. Conclusions:It is apparent that the R-R interval series can give us more messages about human heart, and the Lyapunov exponents of ECG and R-R interval series are the appropriate parameters for the identification of the physiological states of human heart. It is possible to use Lyapunov exponent for early diagnosis of Coronary Heart Disease.

Assessment of Autonomic Function in Diabetic Patients

Dysfunction of the autonomic nervous system is reported to occur at an incidence of 20% to 40% in diabetes. The clinical symptoms include orthostatic hypotension, vomiting, diarrhea, bladder dysfunction, male impotence, sweating, etc. Two simple noninvasive tests, sympathetic skin response (SSR) and R-R interval variation (RRIV), were used to assess autonomic functions. We performed SSR and RRIV on the diabetic patients and controls. The patients were classified into 4 groups (group I: without peripheral neuropathy or dysautonomia, group II: with dysautonomia only, group III: with peripheral neuropathy only, group IV: with both peripheral neuropathy and dysautonomia). We also tried to correlate their clinical dysautonomic symptoms and the results of nerve conduction studies (NCS) and of SSR and RRIV. The subjects of this study were 82 diabetic patients, 20 to 73 years old with the mean age of 53, and 12 controls. Latency, amplitude, and loss of SSR all showed a significant difference in relation to the dysautonomic symptoms. The loss of SSR in the foot showed a remarkable difference in group I. In groups III and IV, three RRIVs (Valsalva ratio, E:I ratio, 30 : 15 ratio) showed a significant decrease compared with the control group, and in group II, only the 30:15 ratio showed a statistically significant decrease. In conclusion, the changes in SSR and RRIV were significantly associated with the dysautonomia. Among these, loss of SSR in the foot and decrease in the 30 : 15 ratio were useful parameters for early detection of diabetic autonomic neuropathy without peripheral neuropathy.

Sympathetic Skin Response and Heart Rate Variation in Spinal Cord Injured Patients

OBJECTIVE: Most spinal cord injured patients suffered form various autonomic dysfunction. The purpose of this study is evaluation of sympathetic skin response (SSR) and R-R interval variability (RRIV) as a method of autonomic function test in spinal cord injured patients. METHOD: Thirty-six spinal cord injured patients were enrolled in this study. SSR was recorded in the palm and sole by electrical stimulation of right median nerve and RRIV during rest, deep breathing and Valsalva maneuver for 1 minute. RESULTS: The higher level of spinal cord injury, the higher rate of the abnormal sympathetic skin response in the palm and sole and more reduced values of Valsalva ratio (p<0.05). The parameters of sympathetic skin response and R-R interval variability were not correlated with injury severity of spinal cord and their autonomic symptoms. CONCLUSION: Evaluation of SSR and RRIV could be helpful methods to evaluate autonomic function in the spinal cord injured patients.

Effects of maximal running exercise on heart rate responses after standing up in adult men / 体力科学

The change in R-R interval (RRI) induced by rapid postural change from a squat posture to standing was analyzed in 8 healthy male students (20.3±1.2 years of age) before and immediately after maximal running exercise. We instructed subjects to stand up as quickly as possible, and to repeat the standing-up movement three times at intervals of 2 min. Heart rate responses and heart rate variability were analyzed by the change in RRI induced by standing up. Heart rate (HR) increased quickly at the onset of standing up. The time (T) until the maximal HR (Hmax) was reached 9.79±1.44 s after standing up, and then the HR after Hmax decreased rapidly with time. The maximal HR was 1.20 times higher while standing up than in the squat position. Maximal running exercise significantly delayed the time taken to reach Hmax after standing up, and significantly diminished the increased HR to 1.15 times. The Hmax/Hmin ratio, which expressed the magnitude of autonomic activity during standing up, was significantly lower following maximal exercise, indicating that the cardiac sympathetic nervous system seems to be in a state of hyperfunction immediately after maximal running exercise. These findings suggest that disturbance in the postural adjustment of the cardiovascular system immediately after intense exercise may be induced by the delayed response and decreased amplitude of the HR.

Preoperative Evaluation of Diabetic Autonomic Neuropathy by Power Spectral Analysis / 대한마취과학회지

Background: The aim of this study is to investigate the changes in the patterns of power spectra of R-R interval variability of diabetic patients who are subject to autonomic neuropathy. Methods: The changes in power spectra of eight diabetic patients were compared with those of eight normal persons while changing positions from supine to Trendelenburg and from supine to standing each. Results: Low, high and total frequency power densities of diabetic patient group were significantly lower than those of control group in resting supine position. Low frequency power density and ratio of low frequency power to high frequency power of control group increased significantly while changing position from supine to standing compared with those of diabetic patient group. And low frequency power density of control group decreased significantly compared with that of diabetic patient group while changing position from supine to Trendelenburg. Conclusions: The decrease in power densities of low, high and total frequency suggest depressed overall autonomic activities in diabetic patient group and significantly decreased changes in low frequency power and ratio of low frequency power to high frequency power while changing positions from supine to standing suggest attenuated sympathetic activity in diabetic patient group, reflecting autonomic changes in diabetic group rapidly.

Changes in Power Spectrum of R-R Interval Variability According to the Changes in End Tidal Concentration of Inhalation Anesthetics / 대한마취과학회지

BACKGROUND: Heart rate variability provides us with many informations of autonomic activities of cardiovascular system. Among the many methods of analyzing R-R variability, power spectral analysis is understood to be the most useful, quantitative, and noninvasive method which represents the changes of frequency. And the power spectral density is composed of three components in power, a high frequency at 0.15~0.5Hz, a middle frequency at 0.10-0.15 Hz, and a low frequency at 0.04~0.08Hz. METHODS: The each frequency power of the R-R interval variability was checked in the 8 mongorean dogs according to the changes in end tidal concentration of halothane, enflurane and isoflurane, and the relationship was measured. RESULTS: The power of three frequency bands decreased at 1.0 and 1.5MAC and increased at 2.0MAC halothane compared with previous MAC respectively. The power increased at 1.0 and 1.5MAC and decreased at 2.0MAC enflurane compared with previous MAC respectively. There was no correlation between the power of three frequency bands and the changes of end tidal concentration of isoflurane. The low/high ratio associated with the changes of end tidal concentration of inhalation anesthetics increased at 1.0 and 1.5MAC and decreased at 2.0MAC compared with previous MAC respectively. CONCLUSIONS: In our study we confirmed that spectral analysis of R-R interval variability might reflect the balance between sympathetic and parasympathetic activity and low/high ratio would be a convenient index of such interaction during anesthesia within the clinical range of end tidal concentration of inhalation anesthetics.

Brain Stem Auditory Evoked Potential and R-R interval Analysis of the Workers Exposed to Trichloroethylene / 대한산업의학회지

In order to evaluate the effects of trichloroethylene (TCE) on the central and autonomic nervous system, the brain stem auditory evoked potentials (BAEPs) and the electrocardiographic R-R interval variability (CV(rr)) were measured in three groups of workers (11) working in TCE degreasing process, workers (4) exposed to lead and two groups of workers (12) not exposed to any kinds of neurotoxicants. Two components of the CVrr reflecting parasympathetic activity (C-CV(rsa)) and sympathetic and parasympathetic activities (CCV(mwsa)) were examined. The TCE workers were exposed to TCE at the level of less than 1 hour per week while the degreasing material was changed. There were no differences in the latencies of BAEPS and CV(rr) and the components of the CV(rr) between control and TCE and lead groups. However, two lead workers had the blood lead level of less than 60 g/dl recommended as present biological guideline by the Ministry of Labor, showed the delayed latencies of V5 and I-V in BAEP. This results suggested that intermittent TCE erposure didn't affect the auditory nervous pathway and the autonomic nervous system, however, lead exposure might affect the central nervous system at the level of less than 60 g/dl in blood lead.

Changes in Power Spectum of R-R Interval Variability during General Anesthesia: Real Time Analysis and Monitoring / 대한마취과학회지

In general, anesthetic depth is evaluated by experience of anesthesiologist based on the changes of blood pressure and pulse rate. So it is difficult to guarantee the accuracy in evaluation of anesthetic depth. The efforts to develop the objective index for evaluation of anesthetic depth were continued but there was ression in this area. In recent EEG, evoked potential and law esophageal pressure are testad as monitoring tools of anesthetic depth. Heaut rate variabilty provides much infarmation of autonomic activity of cardiovascular system and almost all anesthetics depress the autonamic activity. Novel monitoring system which can simply and exactly analyze the autonomic activity of cardiovascular system will provide important information for evaluation of anesthetic depth. In this aspect, development of real time R-R interval variability analysis system and evaluation of its efficacy for evaluation of anesthetic depth were performed. Newly developed real time R-R interval variability analysis system works by simple adaptation to EKG monitor, displays the color power spectrum every 30 seconds for at least 4 hours. So users can easily understand the whole trends during anesthesia and check the changes of short duration. And for the cutting expenditure of memory of personal computer this system is programmed to discard the calculated data of power spectrum after display on screen and saves only R-R interal of heart rate for off-line analysis. At first, function of real time R-R interval variability analysis system was tested with EKG simulator. Our system was well functioned in getting the signals from EKG, analyzing, displaying and saving the data. In animal experiment the changes in power of high frequency band assaciated with the changes of end tidal concentration of halothane (p<0.05). And during intravenous infusion of propofol the changes of infusion amount induced the changes in power spectrum of each frequency band. After animal experiment clinical application was tried. During induction of N2O-O2-enflurane anesthesia and recovery, power of each frequency band was decreased and increased in trend. Endotracheal intubation and skin incision induced high peak of power of each frequency band. Standard score of power and trend curve using 3RSSH was used for the analysis of trend of power change and provide meaningful information of R-R interval variability.

Develpement of Program for On - line Power Spectral Analysis of R-R Interval Variability / 대한마취과학회지

Analysis of R-R interal variability is a useful method of obtaining many information about cardiovascular control mechanisms. Among the many methods of analyzing R-R variability, power spectral analysis(PSA) is said to be the most powerful and acurate tool. Although application of computer techniques in analysing R-R interval variability were introduced, as most of the studies on the R-R interval variability have been off-line and invasively, they were not suitable for practical use. So we prepared a program for non-invasive on-line perioperative assessment of R-R interval variability. We used Turbo C++(ver 1.0, Borland International, USA) and Turbo Assembler(ver 2.0, Borland International, USA) for programing. Data were collected by A/D converter(PCL 718,, Taiwan) by interrupt mode and transferred to TBM386 compatibie computer with VGA color monitor. By applying PSA to R-R interval variation, we can get an almost as confident information about the cardiovascular system as analysis of arterial waveform, In addition to this we can get data that requires very reduced momory size, and get them non-invasively. So analysing R- R interval variability may be the most suitable method for on-line continuous assessment of cardiac parameters.

Changes of Power Spectrum of R-R Interval Variability during Recovery from Anesthesia - Preliminary report / 대한마취과학회지

Changes of power spectrum of R-R interval variabilty during recovery from N2O-O2 - halothane anesthesia have been studied in 20 patients. Power spectral analysis of R-R intervals during awake period and recovery period have been performed with newly developed R-R interval variability, we compared the power of each frequency range(low: 0.04-0.08 Hz, middle 0.10-0.15 Hz, high: above 0.3 Hz) between awake period and recovery period. There was no difference between awake period and recovery period in the power of low and high frequency ranges, but there was remarkable difference in power of midfrequency range. During awake period the power of midfrequency range changed with cyclic pattern, but there was no cyclic change during recovery period even after the regain of consciounss(30+/-3.2 min.). The power of midfrequency range during recovery period began to change with cyclic pattern only after 45 minutes. It is concluded that the power of midfrequency range is useful index of recovery from N2O-O2 -halothane anesthesia.

Effects of electrical acupuncture to the stellate ganglion on R-R intervals in electrocardiogram / 全日本鍼灸学会雑誌

Previously we reported that acupuncture to the stellate ganglion stimulates sympathetic nervous system while it decreases heart rate.<br>As it is said that R-R intervals in electrocardiogram (ECG) reflect functions of parasympathetic nervous system, we measured effects of electrical acupuncture to the stellate ganglion (SG) or traditional acupuncture points (AP) on the meridians (H7: SHENMEN and P4: HSIMEN) on R-R intervals in ECG by using 24 patients; 12 each in SG-group and AP-group.<br>Results are as follows; (1) Means of heart rate (HR) decreased with 1-3bpm in the both groups; (2) Coefficients of variation (CV) of HR increased with 1-2% in the both groups; (3) Means of R-R intervals prolonged with 39-47msec in the SG-group and 20-44msec in the AP-group, respectively; (4) CV of R-R intervals increased with 1% in the SG-group only.<br>It is suggested that acupuncture stimulates not only sympathetic nervous system, but also parasympathetic nervous system.

Effect of Acupuncture on Mean and C V of R-R interval in ECG / 全日本鍼灸学会雑誌

Many patients who receive general acupuncture treatment have many complaints concerning their autonomic nervous systems. Applying CMI and CMI type classification (Abe method-a variation of CMI) to 100 new patients who came to our clinic last year, we found vegetative dystonia in half of them. Upon this finding, the following examinations were carried out by means of an function test of autonomic nervous system developed by Kageyama et al.: the coefficient of variation (CV) of R-R interval in ECG obtained through the function test is regarded as an expression of vagal function.<br>(1) Using this test, the participation of the autonomic nervous system in the condition of those patients who visited our clinic was examined.<br>(2) Effects of acupuncture treatment on the autonomic nervous system were examined.<br>(3) Acupuncture stimulation was separately applied to S36 (Zusanli), P4 (Ximen) and Liv3 (Taichong) to examine the influence of the acupuncture point location on the CV obtained through the test.<br>Results:<br>(1) 15 new patients (25%-comparatively high rate) showed low CV (less than 2%) of R-R interval in ECG.<br>(2) In some cases, acupuncture treatment caused an increase in CV.<br>(3) Acupuncture caused pulse infrequens: R-R interval showed a tendency toward prolongation during <i>the in situ needle technique</i> and after <i>withdrawing the needle</i> on each of the three points (S36, P4 and Liv3). CV increased after <i>withdrawing the needle</i> on either S36 or Liv3 and shortly after <i>needle insertion</i> and after <i>withdrawing the needle</i> on P4.<br>These result suggest that many patients who receive acupuncture treatment have additional disorder in parasympathetic nervous system which can be improved through acupuncture.