Autonomic responses to aerobic and resistance exercise in patients with chronic musculoskeletal pain: A systematic review.

BACKGROUND: It is unknown whether patients with chronic musculoskeletal pain (CMP) show autonomic dysregulation after exercise, and the interventional effects of exercise on the autonomic dysregulation have not been elucidated. The objectives of this study were to reveal acute autonomic responses after aerobic and resistance exercises and the interventional effects of both exercises on autonomic dysregulation in patients with CMP. METHODS: A systematic search using nine electronic databases was performed based on three key search terms: "chronic musculoskeletal pain," "autonomic nervous system," and "exercise." Data were extracted from measurements of the autonomic nervous system and pain. RESULTS: We found a total of 1170 articles; 17 were finally included, incorporating 12 observational and five interventional studies. Although a comparator has not been specified, healthy controls were compared to patients with CMP in observational studies. Three of five interventional studies were pre-post study with healthy controls as a comparator or no controls. The other two interventional studies were randomized controlled trial with a different treatment e.g., stretching. There were four good, 10 fair, and three poor-quality articles. The total number of participants was 617, of which 551 were female. There was high heterogeneity among the five disease conditions and nine outcome measures. Following one-time exposure to aerobic and resistance exercises, abnormal autonomic responses (sympathetic activation and parasympathetic withdrawal), which were absent in healthy controls, were observed in patients with CMP. The effects of aerobic and resistance exercise as long-term interventions were unclear since we identified both positive effects and no change in the autonomic activities in patients with CMP. CONCLUSIONS: This study indicates dysfunctional autonomic responses following one-time exposure to exercise and inconsistent interventional effects in the autonomic activities in patients with CMP. Appropriate therapeutic dose is necessary for studying the management of autonomic regulation and pain after exercise.

Minimum detectable change in reaction time to the Posner task due to change in sustained attention.

[Purpose] Spatial attention evaluations are beneficial for patients with unilateral spatial neglect or dementia. Thus, such evaluations are crucial among these patients for determining functional disorder extents. The study aimed to determine minimal detectable changes in reaction time to the Posner task among healthy young participants for establishing spatial attention evaluation protocols. [Participants and Methods] The study recruited 10 healthy young adults (five males and five females; mean age: 28.9 ± 4.0 years). Each participant completed two sessions of the Posner task with 160 trials per session. The reaction time for each trial was measured. Data obtained by the two blocks were analyzed by Bland-Altman analysis, and intraclass correlation coefficient case 1 and minimal detectable changes at the 95% confidence interval were calculated. [Results] Bland-Altman analysis indicated no systematic bias. The intraclass correlation coefficient case 1 exceeded 0.80 under all conditions of the Posner task, whereas the minimal detectable changes at the 95% confidence interval spanned 23-34 ms. [Conclusion] The results exhibited high reliability for reaction time to the Posner task. The minimal detectable changes as the 95% confidence interval values determined in this study based on reaction time can be applied to establish spatial attention evaluation protocols.

A newly designed holder for grafts with four side branches used in total arch replacement.

Grafts with four presewn side branches have proven very useful for total aortic arch replacement worldwide. However, the four side branches often obscure the surgeon's view of the distal anastomotic site. Thus, we designed a holder for this graft, which sheaths and hides the graft body and branches, allowing the surgeon a better view of the distal anastomosis. By using this device, distal anastomosis can be achieved early and quickly without obstruction of the surgeon's view, resulting in reduced cardiac ischemic time in aortic arch surgery.

Injury to the tricuspid valve and membranous atrioventricular septum caused by huge calcified right ventricular myxoma: report of a case.

A 64-year-old female, admitted because of severe dyspnea on exertion and facial edema, showed echocardiographic findings of a large tumor in the right ventricle (RV). Echocardiography revealed a cardiac mass extending from the RV across the tricuspid valve into the right atrium, synchronized with the cardiac cycle, and severe tricuspid regurgitation was apparent. The mass was removed under cardiopulmonary bypass. It measured 7 x 5 x 5 cm with diffuse superficial calcification and arose from the posterior wall of the RV, just under the tricuspid valve ring, with a short pedicle. During the same procedure, after the successful excision of the tumor, small atrial and ventricular septal defects were found that had been caused by the tumor and these were closed directly. The tricuspid valve was repaired with valvuloplasty, chordoplasty and annuloplasty. The microscopic findings were of typical myxoma; however, a right ventricular myxoma protruding into the right atrium is exceedingly rare.

Pathogenetic significance of myxomatous degeneration in fenestration-related massive aortic regurgitation.

BACKGROUND: Aortic valvular regurgitation has several mechanisms and the present study investigated its clinicopathological correlations with aortic valve fenestration. METHODS AND RESULTS: Six male patients with massive regurgitation and enlarged fenestrations or ruptured fenestrated fibrous cords underwent aortic valve replacement. The clinicopathological features showed many similarities. Four cases had family histories of aortic regurgitation. All six patients showed moderate to severe myxomatous degeneration of the aortic valve and enlargement of aortic annulus. Four patients had 1-2 ruptured fibrous cords, located at the right coronary cusp. Echocardiographic examinations showed an abnormal fibrous cord attached to the prolapsing cusp in 3 cases with ruptured fenestrated valve and detailed examination by transesophageal echocardiography showed an intact fenestrated fibrous cord at the commissure in 1 case. CONCLUSION: Extensively fenestrated cusps with an enlarged aortic annulus because of myxomatous degeneration can cause chronic regurgitation or sudden deterioration after rupture of the fibrous cord. There is an increasing incidence of fenestration-related aortic regurgitation in the Japanese population. An important pathogenetic factor in male patients is myxomatous degeneration of the aortic cusp and annulus.