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Background and Objective@#Premature ventricular complex (PVC) burden exhibits one of three circadian types, classified as fast-type, slow-type, and independent-type PVC. It is unknown whether PVC circadian types have different heart rate variability (HRV) parameter values. Therefore, this study aimed to evaluate differences in HRV circadian rhythm among fast-, slow-, and independent-type PVC. @*Methods@#This cross-sectional observational study consecutively recruited 65 idiopathic PVC subjects (23 fast-, 20 slow-, and 22 independent-type) as well as five control subjects. Each subject underwent a 24-hour Holter to examine PVC burden and HRV. HRV analysis included components that primarily reflect global, parasympathetic, and sympathetic activities. Repeated measures analysis of variance was used to compare differences in HRV circadian rhythm by PVC type. Results. The average PVC burden was 15.7%, 8.4%, and 13.6% in fast-, slow-, and independent-type idiopathic PVC subjects, respectively. Global, parasympathetic nervous system, and sympathetic nervous system HRV parameters were significantly lower in independenttype PVC versus fast- and slow-type PVC throughout the day and night. Furthermore, we unexpectedly found that tendency towards sympathetic activity dominance during nighttime was only in independent-type PVC.@*Conclusion@#The HRV parameters are reduced in patients with independent-type PVC compared to fast- and slowtype PVC. Future research is warranted to determine possible differences in the prognosis between the three PVC types.
Subject(s)
Ventricular Premature Complexes , Circadian Rhythm , Autonomic Nervous SystemABSTRACT
@#Objective To explore the predictive value of systolic pulmonary artery pressure (SPAP) on autonomic nerve excitation in patients with valvular disease, so as to provide reference for the formulation of clinical intervention plans. Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28, 2020 to February 3, 2021 were prospectively collected. According to the standard deviation of normal-to-normal R-R intervals (SDNN) of the heart rate variability (HRV) of the long-range dynamic electrocardiogram (ECG) 7 days before the operation, the patients were divided into three groups: a sympathetic dominant (SE) group (SDNN≤50 ms), a balance group (50 ms<SDNN<100 ms) and a parasympathetic dominant (PSE) group (SDNN≥100 ms). The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed. Results A total of 186 patients were enrolled, including 108 males and 78 females aged 55.92±11.99 years. There were 26 patients in the SE group, 104 patients in the balance group, and 56 patients in the PSE group. The left anteroposterior diameter (LAD), left ventricular end diastolic inner diameter, ratio of peak E to peak A of mitral valve (Em/Am), left ventricular end diastolic volume, left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group (P<0.05), while peak A of tricuspid valve (At) and left ventricular ejection fraction (LVEF) were lower than those in the balance group (P<0.05). The LAD and Em/Am in the balance group were significantly higher than those in the PSE group (P<0.05). Multivariate analysis showed that patients in the SE group had lower At (right atrial systolic function declines), lower LVEF and higher SPAP than those in the balance group (P=0.04, 0.04 and 0.00). When HRV increased and parasympathetic nerve was excited in patients with valvular disease, Em/Am decreased (left atrial function and/or left ventricular diastolic function declined) with a normal LAD. Pearson analysis showed that there was a linear negative correlation between SPAP and SDNN, with a coefficient of −0.348, indicating that the higher SPAP, the lower HRV and the more excited sympathetic nerve. Receiver operating characteristic curve showed that when SPAP≥45.50 mm Hg (1 mm Hg=0.133 kPa), the sensitivity and specificity of sympathetic excitation in patients with valvular disease were 84.60% and 63.70%, respectively. Conclusion Parasympathetic excitation is an early manifestation of the disease, often accompanied by decreased left atrial function and/or left ventricular diastolic function. Sympathetic nerve excitation can be accompanied by the increase of SPAP and the decrease of left ventricular and right atrial systolic function. SPAP has a unique predictive value for the prediction of autonomic nerve excitation in patients with valvular disease.
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ObjectiveTo explore the impact of autonomic nerve function on motor function in patients with post-stroke depression (PSD) from the perspective of regional homogeneity (ReHo). MethodsFrom January to December, 2020, a total of 60 inpatients and outpatients with cerebral infarction in the Affiliated Brain Hospital of Nanjing Medical University were divided into control group (n = 30) and PSD group (n = 30). Two groups were assessed using Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Heart rate variability (HRV) was measured. Ten patients in each group were selected randomly to undergo resting state functional magnetic resonance imaging (rs-fMRI) to calculate ReHo. ResultsAll HRV indices were lower in PSD group than in the control group (|t| > 2.092, P < 0.05). In PSD group, FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals (SDNN), the root mean square of successive differences between normal heartbeats over 24 hours (RMSSD), the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms (PNN50), total power (TP), very low frequency power (VLF) and low frequency power (LF) (r > 0.394, P < 0.05), and showed negative correlations with HAMD scores (|r| > 0.919, P < 0.001). HAMD scores in PSD group were negatively correlated with SDNN, RMSSD, PNN50, TP and VLF (|r| > 0.769, P < 0.001). Compared with the control group, the ReHo increased in PSD group in the right rectus gyrus (142 voxels, t = 6.575), the left medial and paracingulate gyri (204 voxels, t = 4.925) (GRF correction, P-Voxel < 0.005，P-Cluster < 0.05); and reduced in the right cerebellum (191 voxels, t = -6.487), the left middle temporal gyrus (140 voxels, t = -5.516), and the left precentral gyrus (119 voxels, t = -4.764) (GRF correction, P-Voxel < 0.005，P-Cluster < 0.05) in PSD group. ConclusionAutonomic nerve function is related to motor dysfunction in patients with PSD. The modulation of emotional, cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the motor function in patients with PSD.
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Abstract Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.
Resumo A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.
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ABSTRACT BACKGROUND: There are several illness-specific cultural and system-based barriers to palliative care (PC) integration and end-of-life (EOL) care in the field of oncohematology. OBJECTIVES: This study aimed to investigate the variability in the perceptions of PC and EOL care. DESIGN AND SETTING: A cross-sectional study was conducted in the Hematology Division of our University Hospital in Salvador, Bahia, Brazil. METHODS: Twenty physicians responded to a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies from October to December 2022. RESULTS: The median age of the participants was 44 years, 80% of the participants identified as female, and 75% were hematologists. Participants faced a hypothetical scenario involving the treatment of a 65-year-old female with a poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of the participants chose to follow other chemotherapy regimens, whereas 40% opted for PC. Next, participants considered case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct, and the conduct they thought would be better for the patient. Even though participants were from the same center, we found a divergence from the most probable conduct among 40% of the participants, which was due to personal convictions, legal aspects, and other physicians' reactions. CONCLUSIONS: We found considerable differences in the perception of PC and EOL care among professionals, despite following the same protocols. The study also demonstrated variations between healthcare professionals' beliefs and practices and persistent historical tendencies to prioritize aggressive interventions.
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Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.
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Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.
A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.
Subject(s)
Phosphorus , Genetic Variation , Hydroponics , Sorghum/growth & developmentABSTRACT
Resumen La variabilidad de la frecuencia cardiaca (VFC) se utiliza como una señal fisiológica para evaluar la reactividad psicofisiológica al estrés. El análisis en el dominio de la frecuencia de esta señal se ha usado para describir el papel del sistema nervioso autónomo en los procesos de adaptación al estrés. Sin embargo, el uso de medidas de tendencia central para reportar los resultados de distintas poblaciones desestima las diferencias individuales en la reacción frente al estrés. El objetivo de esta investigación fue caracterizar la reactividad cardiaca ante la evocación de eventos estresantes en población universitaria. Participaron 94 estudiantes de nuevo ingreso a la carrera de psicología, de dos universidades de México. Los resultados indican un decremento consistente en la banda de alta frecuencia ante la evocación de eventos estresantes, en comparación con la banda de baja frecuencia. La caracterización de la respuesta autonómica al estrés presenta dos subgrupos acoplados (co-activación y co-inhibición); y uno desacoplado. Nuestros hallazgos, ratifican la viabilidad de la banda de frecuencia alta de la VFC como un indicador estable de reactividad al estrés, y resaltan la importancia de las diferencias específicas de la actividad autonómica en la caracterización de la respuesta fisiológica al estrés.
Abstract Heart rate variability (HRV) is used as a reliable physiological signal to assess psychophysiological reactivity to stress. Frequency-domain mathematical analysis of the HRV signal provides metrics that are associated with the performance of the autonomic nervous system. However, the use of measures of central tendency to report global results in different populations underestimates individual differences in the way people react to stress and the clinical importance of this response. The objective of this research was to characterize cardiac reactivity to the evocation of stressful events in a university population. The participants were 94 new psychology students from two universities in Mexico. A psychophysiological stress assessment was performed to estimate cardiac reactivity; the evaluation consisted of the following conditions: 1) Baseline; 2) Evocation of stress; and 3) Recovery. The participants were sitting with their eyes closed and without moving during every single one of the conditions. Four subgroups were created depending on the type of cardiac reactivity to stress. The results indicate a significant consistent decrease in the high-frequency band when evoking stressful events, compared to the low-frequency band. Similar responses were observed between the low-frequency band and the high-frequency band in 60.6% of the cases, suggesting that the antagonistic autonomic balance between the two divisions of the ANS was scarce. According to the autonomic space model and the type of stress reactivity of each student, there were two subgroups characterized by co-activation and co-inhibition modes; and one subgroup characterized by uncoupled response mode. Our findings confirm the viability of the high-frequency band of HRV as a stable indicator of stress reactivity. Likewise, evidence is generated in favor of using evocative stress stimuli to assess physiological reactivity like more personal stressors. Lastly, the importance of specific differences in autonomic activity to characterize the physiological response to stress and its possible clinical utility to propose interventions and select techniques that most effectively benefit vulnerable populations are highlighted.
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Con el objetivo de evaluar la diversidad fenotípica de ocho cultivares de arroz (Oryza sativa L.) procedentes de Vietnam, para su introducción en los programas de mejora y en la producción en Cuba, apoyados en caracteres morfoagronómicos y técnicas de análisis multivariado, fue desarrollado este trabajo en la Unidad Científico Tecnológica de Base "Los Palacios", perteneciente al Instituto Nacional de Ciencias Agrícolas de Cuba. Los cultivares vietnamitas se sembraron en campo junto a los comerciales INCA LP-5 e INCA LP-7, para ser caracterizados agronómicamente con la utilización de 29 descriptores cualitativos y 22 cuantitativos. Los resultados mostraron que 16 caracteres cualitativos resultaron homogéneos para los ocho cultivares procedentes de Vietnam y los dos cultivares comerciales cubanos, la asociación entre varios caracteres cuantitativos reafirma la influencia que ejercen algunos componentes sobre el rendimiento, los que son considerados como marcadores para la selección, tres cultivares de procedencia vietnamita (GL301, LCG3-4 y DS1) no pueden ser utilizados en la producción arrocera en Cuba, por su susceptibilidad a Tagosodes. Todos los cultivares mostraron resistencia a Rhizoctonia solani y Sarocladium oryzae y dos (GL 301 y LTH 31) fueron susceptibles a Pyricularia grisea. Los cultivares OM6976, OM5451 y OM8087 alcanzaron valores altos de rendimiento, por lo que pudieran ser utilizados, como progenitores en los programas de mejora, así como cultivares comerciales.
With the objective of evaluating the phenotypic diversity of eight rice cultivars (Oryza sativa L.) from Vietnam, for their introduction in breeding programs and production in Cuba, supported by morphoagronomic characters and multivariate analysis techniques, this work was developed in Scientific and Technological Base Unit belonging to the National Agricultural Sciences Institute of Cuba. The Vietnamese cultivars were planted in the field together with the commercial cultivars INCA LP-5 and INCA LP-7, to be characterized agronomically with the use of 29 qualitative and 22 quantitative descriptors. The results showed that 16 qualitative characters were homogeneous for the eight cultivars from Vietnam and the two Cuban commercial cultivars, the association between various quantitative characters reaffirms the influence exerted by some components on yield, which are considered as markers for selection. Three cultivars of Vietnamese origin (GL301, LCG3-4 and DS1) cannot be used in Cuban rice production, due to their susceptibility to Tagosodes. All cultivars showed resistance to Rhizoctonia solani and Sarocladium oryzae and two (GL 301 and LTH 31) were susceptible to Pyricularia grisea. The OM6976, OM5451 and OM8087 cultivars reached high yield values, so they could be used as parents in breeding programs, as well as commercial cultivars.
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Background: The brain-computer interface (BCI) is gaining much attention to treat neurological disorders and improve brain-dependent functions. Significant achievements over the last decade have focused on engineering and computation technology to enhance the recording of signals and the generation of output stimuli. Nevertheless, many challenges remain for the translation of BCIs to clinical applications. Methods: We review the relevant data on the four significant gaps in enhancing BCI's clinical implementation and effectiveness. Results: The paper describes three methods to bridge the current gaps in the clinical application of BCI. The first is using a brain-directed adjuvant with a high safety profile, which can improve the accuracy of brain signaling, summing of information, and production of stimuli. The second is implementing a second-generation artificial intelligence system that is outcome-oriented for improving data streaming, recording individualized brain-variability patterns into the algorithm, and improving closed-loop learning at the level of the brain and with the target organ. The system overcomes the compensatory mechanisms that underlie the loss of stimuli' effectiveness for ensuring sustainable effects. Finally, we use inherent brain parameters relevant to consciousness and brain function to bridge some of the described gaps. Conclusions: Combined with the currently developed techniques for enhancing effectiveness and ensuring a sustainable response, these methods can potentially improve the clinical outcome of BCI techniques.
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Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.
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Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023. Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP. Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ??and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.
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Background: Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, representing up to 80–90% of all malignant neoplasms of the oral cavity. The increasing cases of oral cancer are the most important concern for community health. Defects of mitosis result in various nuclear abnormalities namely micronuclei, binucleation, broken egg appearance, pyknotic nuclei, and increased numbers of mitotic figures. The rationale for mitotic counting is that it is frequently used for classification and grading of tumors, prediction of prognosis of tumors and even advocated as a decision point for treatment. Reproducibility of the mitotic counting is paramount for the assessment of malignancy on a histologic scale. Considering this, we decided to assess the inter-observer variability in mitotic figure counting in various grades of oral squamous cell carcinoma. Material & Methods: A retrospective study was carried out on 48 formalin fixed paraffin embedded tissue blocks of the confirmed cases of Oral squamous cell carcinoma in the archives of department of oral pathology, Govt. Dental College & Hospital, Srinagar. Mitotic figure counting was done by two independent, mutually blind observers. The data was assessed for inter-observer variability in counting of figures. Results: Least difference was seen in cases of WDSCC up to the maximum difference of 3 mitoses. MDSCC showed modest differences in observations, with a maximum difference of 4 mitoses. PDSCC cases had the highest inter-observer variability, with a maximum difference of 5 mitoses. Conclusion: Mitosis counting has been shown most convincingly to provide independent prognostic value and is the most well established component of the histological grading systems of OSCC. Reproducibility of the mitotic counting is paramount for the assessment of malignancy on a histologic scale.
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Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.
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Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than >50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2 ), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2 , P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.
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Background: Liraglutide, glucagon-like peptide-1 (GLP-1) receptor agonist, has been investigated for safety and effectiveness for blood glucose (BG) control in a surgical setting. However, there are only a few studies specific to cardiac surgery patients. Aims: To primarily compare perioperative 1) BG and 2) glycemic variability (GV) between added liraglutide and only insulin infusion in diabetes mellitus (DM) patients undergoing cardiac surgery. Setting and Design: A randomized control trial was conducted in DM patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Inclusion criteria were age 20� years and DM Type 2. Material and Methods: The recruited patients were randomly assigned to Group 1 (added liraglutide with insulin infusion) and Group 2 (insulin infusion). Insulin infusion was based on institutional protocol. Point of care testing (POCT) glucose was used for the adjustment of insulin and BG analysis. Continuous glucose monitor (CGM) was for GV analysis (using Standard deviation: SD). Statistics: t?test, Chi?square or Fisher?exact test, or Mann朩hitney U test. Results: Finally, 60 patients were in our study (Group 1 = 32 vs Group 2 = 28). Perioperative mean BG levels of Group 1 were significantly lower than Group 2 with a mean difference of 15.9 mg/dL. Nine patients (18.7% vs 10.7%, P = 0.384) had BG of 60� with mean BGs (109.1 vs 147.9, P = 0.001) in the morning. Thirteen patients (9.4% vs 35.7%, P = 0.025) had BG >180 mg/dL at the 1st operative hour. SDs were increasing, but lower SD of Group 1 were observed at the postoperative period. Mean of SDs at postoperative day 2 were 23.65 vs 32.79 mg/dL, P = 0.018. Conclusions: Liraglutide added with insulin infusion can attenuate perioperative BG and is beneficial in the aspect of lowering GV together with BG at the postoperative period in DM patients. Liraglutide can be applied in cardiac surgery but a rearrangement of time and dosage should be further investigated.
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Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality throughout the world. COPD and its complications also lead to a large number of deaths every year in our country. Cardiac arrhythmias and sudden cardiac death are the major complications of COPD leading to death and disability. Such cardiac complications are often a result of autonomic dysfunction. Aims and Objectives: This study aims to find out the autonomic dysfunction in moderate COPD patients by comparing their heart rate variability (HRV) parameters with age and sex matched healthy controls. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, 48 patients of moderate COPD and 54 healthy subjects were assessed and compared with respect to their HRV parameters which included Mean RR, Mean HR, SDNN, NN50, pNN50, root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), LF/HF ratio, and SD2/SD1 ratio. Results: It was found that in comparison to healthy controls, patients of moderate COPD had significant alteration in the following HRV parameters – Mean HR (P: 0.001), RMSSD (P: 0.002), SDNN (P: 0.015), NN50 (P: 0.001), pNN50 (P: 0.000), HF (NU/normalized unit) [P: 0.033], HF (%) [P: 0.002], LF (NU/normalized unit) [P: 0.033], LF (%) [P: 0.012], and LF/HF (P: 0.033). Conclusion: As there is a significant alteration of several HRV parameters in moderate COPD patients, we conclude that HRV measurement may subserve as a simple and non-invasive tool to assess autonomic dysfunction in patients of COPD at the earliest.
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Objective:This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods:A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University. And these patients all received insulin injection more than six months. Lipohypertrophy was assessed by ultrasound scanning, and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM). Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results:Compared with patients without lipohypertrophy, patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE), coefficient of variation(CV), mean of daily differences(MODD), standard deviation(SD) of blood glucose, time above range(TAR), and high blood glucose index(HBGI; all P<0.05), while time in range(TIR) of glucose markedly become lower( P<0.01). Moreover, multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR( β=-9.423, P=0.032), MAGE( β=1.114, P=0.039), CV( β=4.304, P=0.041), MODD( β=0.717, P=0.046) after adjusting for age at diagnosis, duration of insulin injection, fasting C-peptide, and daily dose of insulin per unit weight. Conclusion:Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.
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Objective:To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD).Methods:In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD-Q9 questionnaire was used to self-evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow-up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow-up and were included in this study. According to the MoCA score at the end of follow-up (<26 or ≥26), the patients were divided into progression group (39 cases) and non-progression group (44 cases). The difference of MoCA score between baseline and last follow-up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD-Q9 score in the progression group were tested by multiple linear regression analysis. Results:The 4-year progression rate of SCD patients was 46.99% (39/83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD-Q9 score and MoCA score between the progressive group and the non-progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non-progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P=0.016]. There was no significant difference in 24 h DCV between the two groups ( P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference ( r=-0.368, P=0.021). Conclusion:There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value.
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Heart rate variability is one of the methods to evaluate cardiac autonomic nervous function. It is widely used because of its non-invasive, convenient, fast and other advantages. Various heart diseases, including cardiovascular disease, arrhythmia and myocardial disease, are closely related to autonomic dysfunction, so heart rate variability has also become one of the important indicators to predict the prognosis of heart disease. This article reviews the research status of heart rate variability and its application in heart disease.