Impact of Air Pollutant on Heart Rate Variability in Healthy Young Adults

Abstract Background: Air pollution and sex independently affect cardiac autonomic control, which can be assessed by heart rate variability (HRV). The research hypothesis is that individuals exposed to low concentrations of pollution have higher cardiac autonomic modulation compared to those exposed to high concentrations and that women have better cardiac autonomic control than men. Objective: To analyze the impact of exposure to air pollutants, specifically smoke, and sex on HRV in healthy young people exposed to different concentrations of pollution over an average period of 22 years. Methods: From April to September 2011, 36 participants of both sexes (20-30 years old) were selected, grouped by levels of air pollution exposure according to indices provided by the Environmental Company of São Paulo State. The R-R intervals (R-Ri) of the electrocardiogram were captured using a heart rate monitor during supine rest. HRV was analyzed by spectral analysis and conditional entropy. The Queen's College step test was used to characterize functional capacity. A between-group comparison was performed using the two-way ANOVA statistical test (post hoc Tukey) and p<0.05. Results: Significant differences were found in mean R-Ri (p<0.01) and cardiac parasympathetic modulation between sexes in the same city (p=0.02) and between groups exposed to different air pollution concentrations (p<0.01). Conclusion: Our results suggest that long-term exposure to air pollutants, specifically smoke, has an unfavorable impact on HRV, with reduced cardiac vagal autonomic modulation in healthy young adults, especially females.

Valor prognóstico da variabilidade da frequência cardíaca e da eletrocardiografia ambulatorial em cães Boxer com cardiomiopatia arritmogênica do ventrículo direito / Prognostic value of heart rate variability and Holter monitoring in Boxer dogs with arrhythmogenic right ventricular cardiomyopathy

A cardiomiopatia arritmogênica do ventrículo direito (CAVD) é uma importante causa de morte súbita em cães da raça Boxer. A validação de fatores prognósticos para essa doença auxiliaria na detecção de animais mais gravemente afetados e sua exclusão dos programas de reprodução. O objetivo deste estudo foi avaliar o valor prognóstico da presença de manifestações clínicas, dos índices de variabilidade de frequência cardíaca (VFC) e das arritmias supraventriculares ou ventriculares registradas à monitorização eletrocardiográfica com Holter na sobrevida de cães Boxer em diferentes estágios da CAVD. Essas variáveis foram analisadas, de forma prospectiva, em 69 cães Boxer, divididos em cinco grupos: cães Boxer controle (grupo CB, <50 VPC/24 horas, n=28), cães Boxer suspeitos (grupo SB, 50 a 300 VPC/24 horas, n=8), cães Boxer com CAVD (grupo ARVC, >300 VPC/24 horas, n=19), cães Boxer com CAVD e disfunção sistólica sem insuficiência cardíaca congestiva (grupo SDB sem ICC, n=6) e com ICC (grupo SDB com ICC, n=8). A análise estatística compreendeu teste ANOVA, correlação de Pearson e análise de riscos proporcionais de Cox. Comparando-se com o grupo CB, não foi encontrada diminuição nos índices de VFC nos grupos SB, ARVC ou SDB sem ICC; por outro lado, o grupo SDB com ICC apresentou diminuição desses índices. Não houve relação entre os índices de VFC e a morte de origem cardíaca; porém, a presença de síncopes com ou sem sinais clínicos de ICC e o número de episódios de taquicardia ventricular (TV) correlacionaram-se com a sobrevida dos animais. Estes resultados permitem concluir que a presença de sinais clínicos de ICC, a presença de síncopes e o número de TV ao Holter apresentam valor prognóstico de sobrevida em cães Boxer com CAVD.(AU)

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden death in Boxer dogs. Validation of prognostic factors for this disease could help in detecting more severely affected animals and their exclusion from breeding programs. The aims of this study were to evaluate the prognostic significance of presence of symptoms, heart rate variability (HRV) indices and ventricular or supraventricular arrhythmias recorded by Holter monitoring on survival of Boxer dogs with ARVC at different stages. Symptoms, arrhythmias registered on Holter and five HRV indices were prospectively analyzed in 69 client-owned Boxer dogs divided into five groups: control Boxer dogs (CB group, <50 VPC/24 hours, n=28), suspicious Boxers (SB group, 50 to 300 VPC/24 hours, n=8), Boxers with ARVC (ARVC group, >300 VPC/24 hours, n=19), Boxers with ARVC and systolic dysfunction without congestive heart failure (SDB without CHF group, n=6) and with CHF (SDB with CHF group, n=8). Statistical analyses consisted of an ANOVA test, Pearson correlation and Cox's proportional hazards regression. Compared to the CB group, no decrease in HRV indices was found in SB, ARVCB or SDB without CHF groups; otherwise, SDB with CHF group had impaired indices. No relation was found between HRV indices and cardiac-related death, but the presence of syncopes with or without clinical signs of heart failure and number of ventricular tachycardia (VT), were correlated with survival. These results allow us to conclude that the presence of symptoms of heart failure, presence of syncopes and number of VT on Holter examination seem to have prognostic value in Boxer ARVC.(AU)

Assessment of heart Rate turbulence in hypertensive patients: rationale, perspectives, and insight into autonomic nervous system dysfunction

Heart rhythm turbulence is classically impaired in patients with previous myocardial infarction and congestive heart failure and is poorly investigated in patients with essential hypertension. To evaluate heart rhythm turbulence parameters [turbulence onset, [TO]; turbulence slope, [TS] in a series of hypertensive patients while gaining insight into autonomic nervous system dysfunction. University hospital, cross-sectional monocentric study. Heart rhythm turbulence was assessed in 50 hypertensive [case group] and 40 normotensive patients [control group]. TO and TS were found independently correlated with hypertension. The mean TO was found at -1.64% +/- 2.85% in the normotensive patients compared to 1.21% +/- 1.95% in the hypertensive patients; the mean TS was found at 4.29 +/- 3.18 ms/RR in the normotensive patients compared to 2.27 +/- 0.93 ms/RR in the hypertensive patients. Hypertension has a predictive value on heart rhythm turbulence impairment [OR 4.99, 95% CI 1.28-19.41, P = 0.02]. Insights into the role of autonomic nervous system dysfunction for the management of hypertensive patients and prevention of malignant ventricular arrhythmia are presented and discussed with regard to heart rhythm turbulence. Essential hypertension is correlated with blunted heart rhythm turbulence parameters

Avaliação da variabilidade da frequência cardíaca de idosos diabéticos e não diabéticos / Assessment of heart rate variability in elderly diabetic and nondiabetic patients

INTRODUÇÃO: O cenário de envelhecimento populacional e o aumento das Doenças Crônicas Não Transmissíveis (DCNT) requer o desenvolvimento e validação de métodos diagnóstico e de ferramentas não invasivas para identificação de fatores de risco e estadiamento destas doenças. Entre estes métodos evidencia-se a análise da modulação autonômica do coração por meio da Variabilidade da Frequência Cardíaca (VFC). OBJETIVO: Analisar a variabilidade da frequência cardíaca de idosos diabéticos (DM+) e não diabéticos (DM–) residentes em um município baiano; avaliar a resposta da variabilidade da frequência cardíaca na realização da manobra de levantar-se rapidamente. MÉTODOS: estudo epidemiológico transversal, de abordagem censitária. Desenvolvido com 205 idosos da zona urbana do munícipio de Aiquara-BA, após aplicação os critérios de inclusão e exclusão. Os dados da VFC foram coletados através do monitor Polar RS800CX...

INTRODUCTION: The scenario of population aging and the increase of Chronic Noncommunicable Diseases (NCDs) requires the development and validation of diagnostic methods and non-invasive tools for identification of risk factors and staging of these diseases.Among these methods, the analysis of autonomic modulation of the heart using the Heart Rate Variability (HRV) becomes evident. OBJECTIVE: To analyze the heart rate variability in diabetic (DM+) and nondiabetic (DM–) elderlies residents in a municipality of Bahia, and also to know the response of heart rate variability in performance of the quickly stand up maneuver. METHODS: cross-sectional study of censitary approach. Carried out with 205 elderlies in the urban area of the municipality of Aiquara-BA, after had applied the inclusion and exclusion criteria. HRV data were collected through the Polar RS800CX...

Alterations of the myenteric plexus of the ileum and the descending colon caused by Toxoplasma gondii (genotype III) / Alterações do plexo mientérico do íleo e cólon descendente causadas por Toxoplasma gondii (genótipo III)

Alterations caused by a genotype III strain of Toxoplasma gondii were assessed with respect to the number and the morphometry of the myenteric neurons in the terminal ileum and the descending colon. Eighteen rats were divided into four groups: Acute Control Group (ACG, n=4); Acute Experimental Group (AEG, n=4); Chronic Control Group (CCG, n=5) and Chronic Experimental Group (CEG, n=5). NaCl solution was administered through gavage to the animals in the ACG and CCG. Toxoplasma gondii tachyzoites (10(4)) from a genotype III strain were orally administered to the AEG and CEG. Acute Groups were died after 24 hours, and the Chronic Groups after 30 days. Neuronal loss was not observed in both organs. The neurons atrophied in the terminal ileum as the opposite occurred with the neurons at the descending colon during the chronic phase of infection. In the terminal ileum, the neurons atrophied during the chronic phase of the infection as no alteration was found during the acute phase. For the descending colon, the neurons became hypertrophic during the chronic infection in opposition to the atrophy found during the acute phase.

Objetivou-se avaliar as alterações causadas por uma cepa genótipo III de Toxoplasma gondii, sobre o número e a morfometria de neurônios mientéricos, do íleo terminal e do cólon descendente. Dividiu-se dezoitos ratos em quatro grupos: controle agudo (GCA, n=4), experimental agudo (GEA, n=4), controle crônico (GCC, n=5) e experimental crônico (GEC, n=5). Os animais do GCA e GCC receberam solução de NaCl por gavagem, e os animais do GEA e GEC 10(4) taquizoítos de uma cepa genótipo III de T. gondii por via oral. Os grupos agudos após 24 horas foram mortos e os crônicos após 30 dias. Observou-se que não houve perda neuronal em ambos os órgãos. No íleo terminal, os neurônios atrofiaram-se na fase crônica da infecção, enquanto nenhuma alteração ocorreu na fase aguda. Já no cólon descendente, os neurônios tornaram-se hipertróficos na fase crônica da infecção, em oposição à atrofia observada na fase aguda.

Cardiovascular autonomic dysfunction in multiple sclerosis: correlations with clinical, brainstem auditory evoked potential and magnetic resonance imaging

Multiple sclerosis [MS] is one of the most disabling neurological disorders, in which autonomic impairment is not rare. The aim of the current study was to assess the frequency of cardiovascular [CV] autonomic dysfunction in MS patients. We also related these autonomic abnormalities to the brainstem dysfunctions in those patients evidenced by brainstem auditor evoked potential [BAEP] and magnetic resonance imaging [MRI] studies. We studied 20 patients with clinically definite relapsing remitting MS and 20 sex and age matched healthy control. The patients were evaluated clinically using expanded disability status scale [EDSS]. Autonomic functions were evaluated with blood pressure response to both standing and static exercise [sympathetic], and 24-hour electrocardiographic [ECG] recording, time domain [parasympathetic]. Brainstem auditory evoked potential and MRI were performed to all patients. The MS patients included 11 [55%] males and nine [45%] females with a mean age of 29.8 +/- 8.4 years, whereas control group was composed of five [50%] males and five [50%] females with a mean age of 34.2 +/- 13.4 years. Regarding tests of CV autonomic functions, 13 [65%] patients had at least one abnormal test. The results showed statistically significant differences in all CV autonomic tests when comparing MS patients to controls. We found significant correlations between autonomic tests with duration of the disease. Significant correlations were detected between autonomic tests and brainstem lesions as well as periventricular parameters of MRI. BAEP findings were indicative of brainstem affection and there was a significant correlation between autonomic tests and I-V interpeak latency. These results suggest that a significant number of patients with MS show evidence of CV autonomic dysfunction, which is correlated with brainstem function

Estudo comparativo entre o tratamento farmacológico, o treinamento físico moderado e o treinamento postural passivo em pacientes portadores de síncope neurocardiogênica / Comparative study among the pharmacological treatment, the moderate physical and the tilt training in neurocardiogenic syncope patients

Introdução: A síncope neurocardiogênica é caracterizada por uma disfunção autonômica é caracterizada por uma disfunção autonômica que leva à profunda hipotensão e perda de consciência. Cada vez mais, medidas não farmacológicas, como o treinamento postural passivo (TPP) e o treinamento físico moderado (TFM) vêm sendo considerados como alternativas para o tratamento desta disautonomia / Introduction: Neurocardiogenic suncope is characterized as an autonomic dysfunction wich leads to hypotension and loss of consciousness. Nowadays, non-pharmacological approaches, such as tilt training (TT)and physical training (PT) are being considered as alternative treatments for this disautonomia...

Ultrastructural Studies of Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract (GIT). Although interstitial cells of Cajal has been suggested as origin of this tumor, the cytological and ultrastructural features of GISTs are heterogeneous and unclear. A total 10 cases of normal gastrointestinal tissue (control), 13 GISTs of the stomach (8), small intestine (3), mesocolon (1) and liver (1), and 2 gastrointestinal autonomic nervous tumor (GANT) of small intestine were ultrastructurally studied. Normal interstitial cells of Cajal (ICC) were abundantly present around the myenteric plexuses or individually scattered through the wall of GIT. ICC was characterized by slender cytoplasmic processes, well-developed endoplasmic reticulum (ER), mitochondria, Golgi apparatus, caveolae and intermediate filaments. The GISTs and GANTs had overlapping ultrastructures. The most common and important ultrastructural features of GISTs were rich villous cytoplasmic processes, dispersed intermediate filaments and abundant SER, and those of GANTs were neurosecretory granules and skenoid fibers. Compared with ICC, the GISTs and GANTs had remarkably reduced caveolae and gap junctions. Our study suggested that ultrastructural analysis gives much information to investigate lineage differentiation of neoplastic cells and make a differential diagnosis of these tumors from other mesenchymal tumors and between GISTs and GANTs.

Neuropatia autonómica cardiovascular en pacientes diabéticos no insulinodependientes / Cardiovascular autonomic neuropathy in diabetic patients with non-insulin-dependent diabetes mellitu

La neuropatía autonómica cardiovascular es una complicación frecuente en pacientes diabéticos, que implica un incremento en la mortalidad y morbilidad. Se estudiaron 30 pacientes diabéticos no insulino dependientes entre 35 y 68 años (15 masculinos y 15 femeninos) y 30 controles sanos entre 35 y 65 años (18 masculinos y 12 femenino) no diabéticos a quienes fue realizado electrocardiograma convencional, pruebas de Rines Valcardi (RV), igualmente se evaluaron signos y síntomas de neuropatía autonómica no cardiovascular. El promedio de puntuación RV fue menor (14,4) en los diabéticos que en el grupo control (31,7) (p<0,010). Para frecuencia cardíaca, los pacientes diabéticos presentaron mayor promedio (83,9) que los controles (77,9) (p<0,052) y dentro del grupo de diabéticos, la frecuencia cardíaca fue mayor en pacientes con RV<15 (89,4) en comparación con aquella de los pacientes con RV>15 (78,4) (p<0,016). No se encontraron diferencias significativas para la edad en ambos grupos. Se encontró una relación negativa significativa (p<0,05) entre el RV con la edad, la frecuencia cardíaca y los años de evolución de la enfermedad en pacientes diabéticos, comparando los pacientes con RV<15 con aquellos con RV>15 se encontraron lo siguientes valores: síntomas de hipotensión postural 40,0 y 6,7 por ciento (p<0,040); pérdida de sensación miccional matutina 53,3 y 20,0 por ciento (p<0,064); diarreas periódicas nocturnas 40,0 y 20,0 por ciento (ns); impotencia 44,4 y 0,0 por ciento (p<0,092), respectivamente. El 50 por ciento de los pacientes diabéticos presentaron Neuropatía Autonómica Cardiovascular determinada por el método de Rines Valcardi

Contribuiçäo ao conhecimento da cardiopatia chagásica aguda: estudo sistematizado dos sistemas excito-condutor e nervoso autônomo intracardíaco em caso autóctone do Acre / A contribution to the knowledge of acute chagasic cardiopathy: a systematized study of the conducting system and the autonomic intracardiac nervous system in an autochthonous case in Acre

The histopathology of the heart is described in an acute case of Chagas' disease (DC). Lesions involving the conducting system (SC) and the autonomic intracardiac nervous system (SNAIC) are emphasized. Light microscopy showed acute pan-carditis with plenty of Trypanosoma cruzi amastigotes within heart muscle cells. Multiple inflammatory foci were found in the SC with parasitic nests within the atrioventricular node and left his bundle. There were also severe atrial periganglionitis and perineuritis with or without peripheral involvement of those structures. Apparently there was no cardiac neuronal depopulation. The epidemiological study suggested transmission through Rhodnius pictipes. To the best of our knowledge, this is the first reported case of acute DC from the Amazonian basin with systematized microscopy study of the SC and SNAIC.

Ensayo terapéutico con gangliosidos en la cardioneuropatía chagasica en dos poblaciones sudamericas (Venezuela y Arganetina) / Therapeutic essay with gangliosides in the chagasic cardioneurophathy in two sudamerican population (Venezuela and Argentina)

Hasta el presente no se ha encontrado un tratamiento farmacológico efetivo de la cardioneuropatía chagásica, una de las causas más frecuentes de Insuficiencia Cardíaca Congestiva y de Muerte Súbita en el mundo. Se realizó un estudio en una población de 128 adultos con serología positiva para la Enfermedad de Chagas y pruebas anormales del Sistema Nervioso Autónomo. El estudio tuvo las características de: doble ciego paralelo y placebo-controlado y se ajustó a las normas, de la FDA; requeridas para la investigación en la aplicación de una nueva droga. Se utilizó Cronassial (Mezcla de Gangliósidos) en inyecciones intramuscular por 4 a 8 semanas. Se tomaron todas las normas de seguridad durante el tratamiento y 31 casos fueron excluídos por presentar Insuficiencia Cardíaca Congestiva. En los 97 pacientes restantes se determinó: la respuesta postural, mediante los cambios de la frecuencia cardíaca, presión arterial sistólica y del doble producto como respuesta al adoptar la posición erecta; del mismo modo, los cambios en la frecuencia cardíaca inducidos por el reflejo de la tos y de la hiperventilación. El Cronassial se mostró seguro y mediante el analisis estadístico ANOVA demostró que hubo mejoría significativa de la presión sistólica (P<0.14) y del doble producto (P<0.059) al estrés postural y de la respuesta de la frecuencia cardíaca a la Hiperventilación (0.017) comparado con el placebo

Síndrome de Parry Romberg con y sin esclerodermia: coincidencia o vinculación patogénica? / Parry-Romberg's syndrome with and without sclerodermya: coincidence pathogenic vinculation

Se estudian dos casos de hemiatrofia facial progresiva (H.F.P.) que ilustran las dos posibilidades de esta afección: con o sin esclerosis. Ambos comienzan en la adolescencia. el caso 1 presenta discromía que excede la zona afectada y precede al cuadro en su instalación con esclerosis más evidente en sectores e hialinosis (microscopía óptica), atrofia ósea y muscular. Consulta por fractura de maxilar inferior consecutiva a contracturas tónico-clónicas. El caso 2 se asocia a malformación de Arnold-Chiari, tiene atrofia cutánea y muscular, sin esclerosis ni hialinosis. No hay discromía. El examen neurológico evidencia actividad denervatoria a distancia en el caso 1

Cardiopatia chagásica crônica causando insuficiência cardíaca congestiva na infância: estudo clínico e histopatológico de um caso, com ênfase para as lesöes dos sistemas excito-condutor e nervoso autônomo intracardíaco / Chronic Chagas' cardiopathy causing congestive heart failure in childhood: a clinical and histopathological study of a case with emphasis on the lesions of the intracardiac conduction and autonomic nervous systems

Descreve-se caso de cardiopatia chagásica em menino de nove anos, natural e procedente do sul de Goiás, que desenvolveu insuficiência cardíaca congestiva quatro meses antes do óbito. As reaçöes sorológicas para doença de Chagas eram reagentes, e positivo o xenodiagnóstico. Os eletrocardiogramas mostraram taquicardia sinusal, extra-sístoles ventriculares e supraventriculares, hemibloqueio anterior esquerdo, bloqueio completo do ramo direito e sinais de sobrecarga de câmaras. O exame ecocardiográfico evidenciou dilataçäo de câmara com hipocontratilidade difusa. O quadro se agravou progressivamente, complicando-se por vários episódios pneumônicos, o último dos quais provocou o óbito. A necrópsia, verificou-se, no coraçäo, inflamaçäo crônica dos três folhetos, com miocardite crônica fibrosante predominando no septo interventricular e no ventrículo esquerdo. As estruturas componentes do sistema excito-condutor mostraram processo flogístico crônico, essencialmente exsudativo, ora discreto, ora moderado. No sistema nervoso autônomo constataram-se focos esparsos de discreta periganglionite crônica, e raros fenômenos degenerativos dos neurônios sem despopulaçäo neuronal

Sistema nervoso autônomo intracardíaco em caso humano fatal de doença de Chagas aguda / Intracardial autonomous nervous system in a fatal case of acute Chagas' disease

Procedeu-se à análise do sistema nervoso autônomo intracardíaco (SNAIC) em 150 cortes histológicos obtidos a partir de fragmentos atriais de homem de 74 anos, falecido de insuficiência cardíaca consecutiva à doença de Chagas aguda (DCA), provavelmente adquirida por via digestiva. Em 10 lâminas havia discretos infiltrados de mononucleares em torno de gânglios e/ou filetes nervosos sem alteraçöes morfológicas significativas do neurônios; em um preparado constatou-se ganglionite e periganglionite, de moderada intensidade, associadas a alteraçöes neuronais. Epicardite focal, em geral discreta, foi observada em todas as lâminas. Os achados sugerem que a inflamaçäo dos gânglios e fibras do SNAIC na DCA ocorre, pelo menos em parte, da propagaçäo da epicardite adjacente e, que mesmo nos casos fatais da tripanosomose cruzi as lesöes morfológicas do SNAIC podem ser discretas

Ultrasonographic study of gall bladder volume changes in diabetes with and without diabetic neuropathy

Forty patients with diabetes mellitus and ten control individuals were studied for evaluation of the effect of autonomic neuropathy on resting and postpr and ial gall bladder volume. There was a significant increase in fasting gall bladder volume in diabetes with autonomic neuropathy, than those without autonomic neuropathy and the volume was still more significantly larger than in control individuals. The fractional gall bladder emptying in diabetics with autonomic neuropathy was significantly less than those diabetics without neuropathy, and even so than control group. There was a significant delay in peak gall bladder emptying in diabetics than in control and this delay was more significant in patients with autonomic neuropathy