Delayed responses to electrical stimuli reflect C-fiber responsiveness in human microneurography

The slowing of impulse conduction during the relative refractory period has often been used to assess activation of C-fibers, in particular, in human microneurography. This study aimed to evaluate the sensitivity of this method and the factors affecting it. Thirty cutaneous C-fibers were recorded from the peroneal nerves of healthy human subjects. Intracutaneous electrical stimulation in the receptive field at 4 s intervals, after some minutes of adaptation, induced spike discharges at constant latency. One or more conditioning stimulus pulses were interpolated at different intervals and the increase in latency after the subsequent regular pulse was assessed. The latency shift was found to depend on the number of interposed pulses, on the time interval between conditioning and conditioned stimulus, and on the conduction velocity of the C-unit. The increase in latency was larger with greater distance between stimulating and recording electrodes, indicating a contribution of the conductile membrane over its whole length. On the other hand, slowing was more pronounced, on average, in slower conducting C-units and conduction velocities were slower when recordings were performed more distally. These findings indicate that the slower terminal nerve branches contribute most to the latency increases. Even a single additional spike in between two regular pulses caused a reliable latency shift of 1.2±0.2 ms (mean ±SEM) and additional pulses lead to an approximately linear latency increase (2 pulses: 2.3±0.3 ms; 4 pulses: 5.9±0.7 ms). In contrast to the number of interposed stimuli, different intervals between interposed and regular stimuli had only a minor impact on the latency shifts. It is concluded that latency shifts are reliable indicators of C-fiber activation, being sensitive enough to detect even single spike responses. Furthermore, latency increases may be used as a relative measure of C-fiber activation, e.g., when comparing responses to stimuli of different strength.     

Maintained pregnancy levels of oestrogen afford complete protection from post-partum exacerbation of collagen-induced arthritis.

Pregnancy is known to influence the course of rheumatoid arthritis (RA) in women, as well as type II collagen-induced arthritis (CIA) in DBA/1 mice. A characteristic feature is the remission during gestation and the exacerbation of the diseases during the post-partum period. In the case of CIA in DBA 1 mice, two hormonal changes have been assumed to be critical for the induction of the post-partum flare: (i) the fall in steroid hormone levels from those present during pregnancy; and (ii) surges of prolactin (PRL) release at and after delivery. Our results show that treatment with oestradiol during a short period immediately after parturition protects the mouse from a post-partum flare of the disease, and that treatment with bromocriptine, a drug known to inhibit the endogenous PRL release, has a significant though less marked effect. Studies of lactating (i.e. animals with physiological stimulation of endogenous PRL release) and non-lactating arthritic mice revealed no clear-cut differences, indicating that PRL is of minor importance for the induction of the post-partum flare. Some steroids other than oestradiol, which may be implicated in the exacerbation of arthritis, namely progesterone and hydrocortisone, had no clinical effect. Analyses of agalactosyl IgG levels in mice with CIA, and anti-collagen II antibodies in sera collected at the end of the experiments revealed no significant differences between the oestradiol and the control groups. The successful oestradiol treatment of the mice indicates that the drop in endogenous oestradiol levels prior to delivery ends the oestrogen-mediated protection against arthritis during pregnancy.     

Cardiovascular indices of physiological arousal in boys with fragile X syndrome

In this study, the relationship between physiological arousal, as indexed by heart rate variability, was examined in boys with fragile X syndrome (FXS) and typically developing boys matched on chronological age. In addition, the relationship of heart activity to clinical and molecular factors in the group of boys with FXS was examined. Results suggest that boys with FXS have higher levels of heart activity during the passive phases, as reflected in shorter heart periods. This high level of heart activity appears to be due to increased sympathetic activity and reduced parasympathetic activity. Boys with FXS did not display the expected patterns of heart activity in response to phases of increasing challenge, and sympathetic and parasympathetic systems did not appear coordinated in these boys with FXS. Clinical factors may be related to neural regulation of heart activity while molecular factors do not appear to be.     

围产期母亲和胎儿心动周期信号分析

同时分析围产期胎儿和孕妇心动周期信号的数字特征(混沌和谱特征)以评价自主神经系统功能。用可视化程序设计的方法实现提取和分析围产期母亲和胎儿心动周期信号。受试者取仰卧位，心电信号从置于腹壁下部耻骨联合导联获得。胎儿心电信号用小波分解进行信号预处理。采用本实验室已经完成开发的技术实现心动周期信号数字特征的分析。该系统可以评价胎儿和孕妇的自主神经系统功能，特别是分别定量评价交感和副交感神经系统功能；该系统还可用以预测胎儿窘迫。胎儿和其它年龄段的心动周期信号数字特征随年龄的变化提示了自主神经系统的发育、成熟和衰老的生理过程，基于这一点我们可以寻找抗衰老的方法；胎儿的心动周期信号数字特征介于新生儿和成人之间，提示胎儿的自主神经系统的调节可能受母体神经内分泌系统的影响。     

Ultrastructure of the neuroglial fatty metamorphosis (virchow) in the perinatal period

Summary The ultrastructure of neuroglial fatty metamorphosis (GFM) has been investigated in the telencephalic white matter of 12 premature and mature infants (gestational age 22–40 weeks; survival 0–96 days). GFM was found in all cases apart from a 22-week-old fetus, and involves predominantly astrocytic cells (68.8%), then glioblasts (43.5%), but only 7.4% of oligodendrocytes. GFM, therefore, seems to be independent of the myelination process and indicates the vulnerability of the immature neuroglial population in the metabolic and circulatory disorders of the perinatal period. Since GFM is found in almost all children dying within the early postnatal period, this subtle alteration reflects a special form of minimal brain damage. The relationship between GFM, astrocytic hypertrophy and periventricular leucomalacia and their role in the telencephalic leucoencephalopathy are discussed.

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Zusammenfassung Die Gliazellverfettung im unreifen Großhirn-Marklager wurde bei 12 Kindern ultrastrukturell untersucht (Gestationsalter 22–40 Wochen; Überlebenszeit 0–96 Tage). Die fettige Metamorphose der Neuroglia (Virchow) fand sich in allen Fällen, ausgenommen den 22 Wochen alten Feten, und betrifft vorwiegend junge Astrozyten (68,8%), ferner zu 43,5% unreife Vorstufen, jedoch nur zu 7.4% die (z.Z. der Geburt erst in Erscheinung tretende) Oligodendroglia. Die Fett-Metamorphose der unreifen Glia stellt einen sensiblen Indikator für metabolisch-zirkulatorische Störungen der Perinatalperiode dar und erfolgt unabhängig von dem Prozeß der Markscheidenbildung. Zusammen mit einer oft auffälligen Astroglia-Proliferation ist die intracytoplasmatische Akkumulation nicht membrangebundener Lipide Ausdruck einer temporären Differenzierungsstörung der unreifen Neuroglia. Die resultierende Reifungsdissoziation mit Unterdrückung der oligodendrozytären Zellinie führt zur retardierten Markscheidenbildung und dem Bild der telencephalen Leucoencephalopathie.

     

Publication Guidelines for Heart Rate Studies in Man

Publication guidelines are provided for the collection, quantification, and analysis of heart rate data.     

Description of Heart-Rate Variability Data in Accordance With a Physiological Model for the Genesis of Heartbeats

A survey is presented of techniques which transform heart-rate variability data into a signal that is both visually informative and accessible for analysis. The Instantaneous Heart-Rate (IHR) signal is introduced, i.e. the signal having the value of the heart rate (inverse interbeat interval) during the interval concerned. The IHR signal differs from the standard Delayed Heart-Rate (DHR) signal, which is always one beat late. The relationship is discussed between the different representation methods and the Integral Pulse Frequency Modulation (IPFM) model, the latter being a physiologically plausible model for the transformation of a continuous input signal (e.g., nervous influence on the cardiac pacemaker) into a series of events (heartbeats). It is shown that when the IHR signal is used as input of the IPFM model, the event series from which the signal was derived appears at the output. Hence, if the IPFM model is accepted as a model of the pacemaker, the IHR signal may be considered as an approximation of the neural (sympathetic and parasympathetic) influence on the pacemaker. In addition we show that the appearance of the IHR signal is less affected by trigger errors or extrasystoles than the standard DHR signal. It is concluded that the most attractive time-domain representation of physiological event series consists of the IHR signal, because this signal, being conceptually and computationally simple, is consistent with the IPFM model.     

Cardiovascular patterns associated with threat and challenge appraisals: a within-subjects analysis

Previous studies demonstrated distinct cardiovascular patterns associated with threat and challenge appraisals for groups of participants. We extend these results by assessing whether appraisals continue to be associated with these cardiovascular response patterns within an individual as appraisals change. Participants completed four verbal mental arithmetic tasks for which they made appraisals before and after each task. Cardiac reactivity and total peripheral resistance (TPR) were calculated for the first and last minutes of each task, and the number of responses and percent correct were measured for each task. In line with our prediction, pretask appraisals were related to some task-related cardiac responses across the four tasks. In addition, task-related cardiovascular reactivity and behaviors both influenced appraisals following the task. Our findings suggest that an idiographic analysis of appraisals, cardiovascular physiology, and task-related behaviors provides a richer understanding of the appraisal process and reveals sex differences deserving further assessment.     

Heart rate reactivity and heart period variability throughout the first year after heart transplantation

Heart rate reactivity to mental stress is substantially blunted early after heart transplantation, suggesting that the loss of neural modulation limits the cardiovascular response to mental stress. We tested whether reactivity to mental stress recovers during the first year after heart transplantation. Hemodynamic and respiratory responses to mental arithmetic challenge were studied in 20 heart transplant recipients 3, 6, and 12 months after surgery. A normal comparison group was studied at equivalent intervals. Heart rate reactivity to mental arithmetic was significantly reduced in the cardiac transplant group compared to the normal subjects. This effect persisted up to 1 year after transplantation. Heart period variability in the heart transplant recipients was minimal in all three-test sessions. The findings suggest that no functional reinnervation or other compensatory adaptation occurs up to 1 year after heart transplantation.     

全膝关节置换后不放置引流的相关管理策略

背景:近年来,随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用,其总失血量不断减少,术后引流量也逐渐减少,术后快速康复理论应运而生,引流管放置也再次成为骨科医生所热议的问题,越来越多的医生认为可以常规取消放置引流,引流似乎已可有可无。目的:旨在复习既往文献,对全膝关节置换后引流放置的相关问题归纳总结,提供围术期引流管理的相关经验。方法:检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库,以及PubMed、The Cochrane Library、WebofScience、EMBASE、OVID等外文数据库,以"引流,膝关节置换术"及"totalknee arthroplasty,drainage"为检索词,检索自建库始至2020年2月为止所有与主题相关的文献,总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。结果与结论:①引流管的放置问题关乎全膝关节置换手术的最终结果,与术后出血、血肿、血栓、感染等并发症的发生关系密切;②目前全膝关节置换术后不推荐常规放置引流,但不意味着不需要管理,其实际上对临床医护在围术期各方面的管理提出更高的要求,包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。