Tonic Investigation Concept of Cervico-vestibular Muscle Afferents

Abstract Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3Dtrunk- excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.

El endotelio mantiene elevada la capacidad de conducción arterial y reduce la poscarga dinámica ventricular de una manera frecuencia-dependiente / Endothelium maintains capacity of arterial conduction high and reduces ventricular dynamic afterload in a frecuency dependent way

Introducción: Las propiedades geométricas y la viscosidad (V) y elasticidad (E) arteriales son determinantes de la función de conducción (FC) y amortiguamiento arterial (FA), así como del trabajo elástico (WE) y viscoso (WV) desarrollado por el ventrículo durante la eyección (poscarga dinámica externa). Se desconoce el rol endotelial en el control de la V, FC, FA, WE y WV, y resta por establecerse si el endotelio controla la poscarga dinámica de manera frecuencia-dependiente. Objetivo: Caracterizar el rol endotelial en la regulación de la V, FC, FA, WE y WV, y analizar el control endotelial de la poscarga dinámica ante aumentos de frecuencia de estimulación. Material y método: Arterias braquiocefálicas ovinas (n=9) se estudiaron en un simulador circulatorio en condiciones hemodinámicas símil fisiológicas. Se midió flujo, presión y diámetro arterial a 60, 80 y 100 latidos/minuto. Para cada frecuencia se calculó E, V, FC, FA, WE y Wv, antes y luego de remover el endotelio. La adecuada eliminación endotelial se comprobó mediante estudios histológicos. Resultados: La presencia de endotelio permitió mantener reducidos E, V, WE y WV, y elevada la FC (p<0,05). La reducción de los determinantes de la poscarga fue mayor a elevados niveles de frecuencia de estimulación (p<0,05). Conclusiones: El endotelio regula la viscoelasticidad arterial, reduciendo la poscarga dinámica, a la vez que permite mantener elevada la FC y no modifica la capacidad de la arteria de autoprotegerse. La mayor reducción de la poscarga a mayor frecuencia (mayor consumo de oxígeno), supone un beneficio adicional sobre la función ventricular.

Introduction: The geometrical properties, the viscosity (V) and elasticity (E) of the arteries determine the arterial conduit (CF) and buffer (BF) functions, as well as the elastic (WE) and viscous (WV) work developed by the ventricle during the ejection (external dynamic afterload). It remains to be established the role of the endothelium in controlling V, CF, BF, WE and WV, and if the endothelium’s regulation of the dynamic afterload depends on the frequency. Objetive: To characterize the endothelial role in the regulation of V, CF, BF, WE and WV, and to analyze the endothelial control of the dynamic afterload during the increase in the frequency of stimulation. Methods: Ovine brachiocephalic arteries (n=9) were studied in a circulation mock during physiological haemodynamic conditions. Arterial flow, pressure and diameter were measured at 60, 80 and 100 cycles/minute. At each frequency E, V, CF, BF, WE y Wv, were calculated before and after the endothelium removal. Hystological studies verified the adequacy of the endotelial removal. Results: The endothelium allowed keeping E, V, WE and WV in low levels, and a high CF (p<0,05). The reduction in the afterload determinants was higher at higher levels of frequency (p<0,05). Conclusions: The endothelium regulates the arterial viscoelasticity, with a reduction in the dynamic afterload; at the time it allows keeping the CF at high levels, and does not change the arterial auto-protection. The higher reduction in the afterload at high frequencies (increased oxigen demand), represents an additional beneficial effect in the ventricle function.