Impact of pulse pressure on the respiratory-related arterial pressure variability and its autonomic control in the rat

The autonomic control of respiratory-related arterial pressure variability (RAPV) remains uncharacterised. We set out to test the hypothesis that the autonomic nervous system may participate in RAPV via its effect on pulse pressure (PP). Experiments were performed on adult male Sprague-Dawley rats anaesthetised with ketamine and paralysed with pancuronium under positive-pressure ventilation. Respiratory variability in each parameter was quantified by auto-spectral analysis and the relationship between variabilities in two signals assessed by cross-spectral analysis. PP and systolic pressure (SP) exhibited similar powers of respiratory variability that were far more pronounced than for diastolic pressure (DP) or mean pressure (MP). The variability in PP preceded that in SP, MP or DP. The largest phase lag occurred between PP and DP and was equivalent to the time delay of one pulse interval. Coherence between respiratory variabilities in PP and MP was nearly perfect. Propranolol dose dependently suppressed respiratory variability in each pressure parameter and eventually disrupted the PP-MP relationship in respiratory variability. However, the influence of lung volume on MP persisted with a near-zero phase lag. Combined administration of phentolamine and atropine facilitated respiratory variability in PP and SP and failed to block the effect of propranolol. However, the combined administration moved the dose/response curve of propranolol and respiratory variability in each pressure parameter to the right. We conclude that, in addition to non-autonomic mechanisms, RAPV may be facilitated by cardiac sympathetic function via the effect on PP variability. The autonomic mechanism can still be evoked during combined alpha-adrenoceptor and muscarinic blockade, possibly via baroreflex mechanisms.     

Effect of left ventricular assist device on circulatory autonomic nervous activity

PURPOSE: For evaluation of the autonomic nervous system (ANS) activity of patients with mechanical circulatory support including LVAD, IABP and PCPS, arterial pressure variability (APV) was examined. APV is the power density values of pressure signals. High frequency (0.15 to 0.4 Hz) and low frequency (0.04 to 0.15 Hz) components of APV are regarded as a function of the autonomic nervous system. METHODS: Arterial pressure signals were acquired every 2 hours at 100 Hz for 6 minutes. Power spectral analysis was carried out, and APV was observed in 18 patients with IABP and/or PCPS. APV was also observed in 3 patients with LVADs (Xemex, Zeon Medical, Japan) before their discharge from ICU for transfer to another hospital for cardiac transplantation. RESULTS: Although the value gradually increased in 18 patients with IABP and/or PCPS, sustained low values of LFAnorm of APV in 6 patients were related to prolonged mechanical support, and 4 patients among them died consequently. The normalized power spectral component with low frequency (LFAnorm) was maintained at relatively high values in 3 patients with LVADs. CONCLUSION: The study results suggest that power spectral analysis of systemic arterial pressure offers a reasonable means for the evaluation of the severity of patient cardiovascular condition and for the prediction of clinical outcome. It also suggested that LVAD support exerts a favorable effect on ANS in patients with severe heart failure before cardiac transplantation.     

Feature-based classification of myoelectric signals using artificial neural networks

A pattern classification system, designed to separate myoelectric signal records based on contraction tasks, is described. The amplitude of the myoelectric signal during the first 200 ms following the onset of a contraction has a non-random structure that is specific to the task performed. This permits the application of advanced pattern recognition techniques to separate these signals. The pattern classification system described consists of a spectrographic preprocessor, a feature extraction stage and a classifier stage. The preprocessor creates a spectrogram by generating a series of power spectral densities over adjacent time segments of the input signal. The feature extraction stage reduces the dimensionality of the spectrogram by identifying features that correspond to subtle underlying structures in the input signal data. This is realised by a self-organising artificial neural network (ANN) that performs an advanced statistical analysis procedure known as exploratory projection pursuit. The extracted features are then classified by a supervised-learning ANN. An evaluation of the system, in terms of system performance and the complexity of the ANNs, is presented.     

Neural network for photoplethysmographic respiratory rate monitoring

The reflection mode photoplethysmographic (PPG) signal was studied with the aim of determining respiratory rate. The PPG signal includes respiratory synchronous components, seen as frequency modulation of the heart rate (respiratory sinus arrhythmia), amplitude modulation of the cardiac pulse and respiratory-induced intensity variations (RIIVs) in the PPG baseline. PPG signals were recorded from the foreheads of 15 healthy subjects. From these signals, the systolic wavefrm diastolic waveform, respiratory sinus arrhythmia, pulse amplitude and RIIVs were extracted. Using basic algorithms, the rates of false positive and false negative detection of breaths were calculated separately for each of the five components. Furthermore, a neural network was assessed in a combined pattern recognition approach. The error rates (sum of false positive and false negative breath detections) for the basic algorithms ranged from 9.7% (pulse amplitude) to 14.5% (systolic waveform). The corresponding values for the neural network analysis were 9.5–9.6%. These results suggest the use of a combined PPG system for simultaneous monitoring of respiratory rate and arterial oxygen saturation (pulse oximetry).     

Verylow frequency variability in arterial blood pressure and blood volume pulse

Several parameters of the cardiovascular system fluctuate spontaenously owing to the activity of the autonomic nervous system. In the study, the simultaneous very low frequency (VLF) fluctuations of the arterial blood pressure, the tissue blood content and the tissue blood volume pulse are investigated. The latter two parameters are derived from the baseline BL and the amplitude AM of the photoplethysmographic (PPG) signal, measured on the fingertips of 20 healthy male subjects: the changes in the PPG parameters AM and BV, defined by BV=const.-BL, are related to the change in the tissue blood volume pulse and the total tissue blood volume, respectively. The VLF fluctuations in BV and AM are directly correlated, those of AM preceding those of BV by 4–13 heart-beats. The VLF fluctuations in the systolic (SBP) and the diastolic (DBP) blood pressure are inversely correlated to those of AM and BV, those of AM preceding those of SBP and lagging behing those of DBP by about one heart-beat. For most subjects, the period P of the PPG pulse, which is equal to the cardiac cycle period, directly correlates with AM and BV and inversely correlates with DBP and SBP. On average, the fluctuations fluctuations in tissue blood volume, systolic blood volume pulse, diastolic and systolic blood pressure, and heart period, together with their interrelationship, can provide a better understanding of the autonomic nervous control of the peripheral circulation and a potential tool for the evaluation of its function.     

一种可监测人体脉搏波的汽车方向盘辅助装置

目的脉搏波的波形特征与心血管疾病密切相关。本文拟设计一种安装在汽车方向盘上的能独立实时监测脉搏波信号的辅助装置,在驾驶员无意识下获取其血流动力学的相关信息,为监测健康状况提供数据支持。方法该装置利用置于方向盘套表面的反射式脉搏波光电传感器采集脉搏波信号。经过滤波、放大和A／D转换,利用嵌于方向盘助力器内的配套装置对脉搏波信号进行数字处理,实现对脉搏波信号周期的确定、心率和平均动脉压数据的计算,以及信号和数据的存储。最后将处理后的脉搏波波形、心率数据及平均动脉压显示在配套装置的液晶显示屏上,还可通过配套装置中的SD卡接口进行数据传输及存储。结果经受试者实际测试,传感器能够准确测出手指脉搏波并输出,使得方向盘套和助力器具有测量脉搏波、心率及平均动脉压的功能。结论该汽车方向盘辅助器可为用户实时监测脉搏波、心率和平均动脉压,帮助使用者实时监测自己的健康状况。     

微波激励热声信号采集系统

为了能够成功采集和提取微波脉冲照射生物组织所产生的微弱热声信号,实现对组织的微波热声成像,开发出了一种热声信号数据采集系统.制作了增益105dB、带宽3MHz的可调增益信号预处理器,结合软件设计解决了四通道大数据量保存问题;通过对LabVIEW和C语言进行混合编程实现数字式平均计算,对强噪声背景中的信号进行消噪处理,解决了平均计算过程中的数据漂移问题,这种方法还能够去除奇异信号从而获得更为准确的结果;最后通过实验对微波激励的信号进行采集和分析.实验结果证明本采集系统完全可以满足微波热声成像中热声信号采集的要求.达到预期效果.     

Large arteries in hypertension. Pharmacological and therapeutic aspects.

The blood pressure curve may be divided into two components: mean arterial pressure, the steady component, and pulse pressure, the pulsatile component. Whereas pharmacological interventions in hypertension have been focused mainly on mean arterial pressure, little has been done to reduce selectively pulse pressure. However, increased pulse pressure with nearly normal mean arterial pressure is the classical hallmark of systolic hypertension in the elderly and a strong independent predictor of cardiac mortality, mainly for myocardial infarction. In this report, after the analysis of the factors influencing pulse pressure, a review of the pharmacological agents susceptible to reduce this hemodynamic factor is performed.     

Cardiac-related sympathetic nerve activity during circulation with only the left ventricular assist device.

Circulatory maintenance with a left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation has been evaluated. To assess the effect on the autonomic nervous system, the sympathetic neurogram was analyzed by power spectrum and coherence function. LVAD were inserted between the left atrium and the descending aorta in seven adult mongrel dogs and ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with only LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed during maintenance of the circulation with only LVAD contributed to the sympathetic neurogram.     

Chronic activation of endogenous angiotensin-converting enzyme 2 protects diabetic rats from cardiovascular autonomic dysfunction

In this study, we evaluated whether the activation of endogenous angiotensin-converting enzyme 2 (ACE2) would improve the cardiovascular autonomic dysfunction of diabetic rats. Ten days after induction of type 1 diabetes (streptozotocin, 50 mg kg(-1) i.v.), the rats were treated orally with 1-[(2-dimethylamino)ethylamino]-4-(hydroxymethyl)-7-[(4-methylphenyl) sulfonyl oxy]-9H-xanthene-9-one (XNT), a newly discovered ACE2 activator (1 mg kg(-1) day(-1)), or saline (equivalent volume) for 30 days. Autonomic cardiovascular parameters were evaluated in conscious animals, and an isolated heart preparation was used to analyse cardiac function. Diabetes induced a significant decrease in the baroreflex bradycardia sensitivity, as well as in the chemoreflex chronotropic response and parasympathetic tone. The XNT treatment improved these parameters by ≈ 76% [0.82 ± 0.09 versus 1.44 ± 0.17 Ratio between changes in pulse interval and changes in mean arterial pressure (ΔPI/ΔmmHg)], ～85% (-57 ± 9 versus -105 ± 10 beats min(-1)) and ≈ 205% (22 ± 2 versus 66 ± 12 beats min(-1)), respectively. Also, XNT administration enhanced the bradycardia induced by the chemoreflex activation by v 74% in non-diabetic animals (-98 ± 16 versus -170 ± 9 Δbeats min(-1)). No significant changes were observed in the mean arterial pressure, baroreflex tachycardia sensitivity, chemoreflex pressor response and sympathetic tone among any of the groups. Furthermore, chronic XNT treatment ameliorated the cardiac function of diabetic animals. However, the coronary vasoconstriction observed in diabetic rats was unchanged by ACE2 activation. These findings indicate that XNT protects against the autonomic and cardiac dysfunction induced by diabetes. Thus, our results provide evidence for the viability and effectiveness of oral administration of an ACE2 activator for the treatment of the cardiovascular autonomic dysfunction caused by diabetes.     

The candidate neuroprotective agent artemin induces autonomic neural dysplasia without preventing peripheral nerve dysfunction

Artemin (ART) signals through the GFR alpha-3/RET receptor complex to support sympathetic neuron development. Here we show that ART also influences autonomic elements in adrenal medulla and enteric and pelvic ganglia. Transgenic mice over-expressing Art throughout development exhibited systemic autonomic neural lesions including fusion of adrenal medullae with adjacent paraganglia, adrenal medullary dysplasia, and marked enlargement of sympathetic (superior cervical and sympathetic chain ganglia) and parasympathetic (enteric, pelvic) ganglia. Changes began by gestational day 12.5 and formed progressively larger masses during adulthood. Art supplementation in wild type adult mice by administering recombinant protein or an Art-bearing retroviral vector resulted in hyperplasia or neuronal metaplasia at the adrenal corticomedullary junction. Expression data revealed that Gfr alpha-3 is expressed during development in the adrenal medulla, sensory and autonomic ganglia and their projections, while Art is found in contiguous mesenchymal domains (especially skeleton) and in certain nerves. Intrathecal Art therapy did not reduce hypalgesia in rats following nerve ligation. These data (1) confirm that ART acts as a differentiation factor for autonomic (chiefly sympathoadrenal but also parasympathetic) neurons, (2) suggest a role for ART overexpression in the genesis of pheochromocytomas and paragangliomas, and (3) indicate that ART is not a suitable therapy for peripheral neuropathy.     

Pulse Rate and Transit Time Analysis to Predict Hypotension Events After Spinal Anesthesia During Programmed Cesarean Labor

Prophylactic treatment has been proved to reduce hypotension incidence after spinal anesthesia during cesarean labor. However, the use of pharmacological prophylaxis could carry out undesirable side-effects on mother and fetus. Thus, the prediction of hypotension becomes an important challenge. Hypotension events are hypothesized to be related to a malfunctioning of autonomic nervous system (ANS) regulation of blood pressure. In this work, ANS responses to positional changes of 51 pregnant women programmed for a cesarean labor were explored for hypotension prediction. Lateral and supine decubitus, and sitting position were considered while electrocardiographic and pulse photoplethysmographic signals were recorded. Features based on heart rate variability, pulse rate variability (PRV) and pulse transit time (PTT) analysis were used in a logistic regression classifier. The results showed that PRV irregularity changes, assessed by approximate entropy, from supine to lateral decubitus, and standard deviation of PTT in supine decubitus were found as the combination of features that achieved the best classification results sensitivity of 76%, specificity of 70% and accuracy of 72%, being normotensive the positive class. Peripheral regulation and blood pressure changes, measured by PRV and PTT analysis, could help to predict hypotension events reducing prophylactic side-effects in the low-risk population.     

低体温与心率变异性和血压变异性的关系

目的: 研究低体温与自主神经功能变化的关系。方法: 采用体表物理降温法逐步降低直肠温度,直肠温度变化范围为19-37 ℃。分别记录不同直肠温度下大鼠动态心电和血压信号。应用心率变异性和血压变异性分析系统评价低体温对心率变异性和收缩压变异性的影响。结果: 心率变异分析表明，直肠温度下降到29 ℃以下,R-R间期均延长（P<0.01）,提示心率明显降低;当直肠温度下降到19-21 ℃时,心率变异归一化低频功率降低（P<0.05）和归一化高频功率增加（P<0.05），而且自主神经的平衡向心迷走神经张力增强的方向发生了转移（P<0.05）。血压变异性分析表明，体温下降到31℃时与呼吸有关的归一化高频功率开始增加（P<0.01）；直肠温度下降到29 ℃以下(除27 ℃外),与呼吸有关的归一化高频功率增加（P<0.05或P<0.01），同时自主神经的平衡也发生了改变（P<0.05）。结论： 随着体温的降低，心血管迷走神经活性增加，自主神经的平衡向迷走神经张力增强的方向转移。低体温对血压变异性的影响敏感于心率变异性。     

Effects of Antiretroviral Therapy on Autonomic Function in Early HIV Infection: A Preliminary Report

Background: A prospective study was conducted in human immunodeficiency virus (HIV)-infected patients as they undergo alterations in their antiretroviral therapy (ART) to determine the effect of ART on autonomic function.Methods: HIV-infected subjects who were either 1) naïve to ART and initiating ART, or 2) receiving ART and in HIV virologic failure for at least 4 months and were about to switch ART were enrolled in this study. Autonomic function assessment (cardiovagal, adrenergic, and sudomotor tests) was performed prior to and 4 months after initiating the new ART. Changes in clinical autonomic symptoms and virologic assessment were assessed.Results: Twelve subjects completed the study: 92% male; median age (Q1, Q3) was 41.0 (28.0, 48.2) years; and 50% White/Non-Hispanic. Seventy-five percent were ART naïve while 25% were failing their ART regimen. The median CD4 count was 336.5 (245.3, 372.3) cells/mm³. All subjects achieved an undetectable HIV viral load by the 4-month follow-up visit. The majority of naïve subjects were started on an ART regimen of tenofovir / emtricitabine / efavirenz. There were no significant differences in autonomic function assessment, as measured by cardiovagal, adrenergic, and sudomotor tests, with regards to ART initiation.Conclusion: This is the first study to examine the effects of initiating ART on autonomic function in early HIV infection. This study found no appreciable differences of ART on the autonomic nervous system when ART is initiated early in the course of HIV disease. ART may not contribute to short-term changes in autonomic function.     

Circulatory effects of chloralose-urethane and sodium pentobarbitone anaesthesia in the rabbit

1. The effects of chloralose-urethane and sodium pentobarbitone anaesthesia on heart rate, blood pressure and cardiac output were studied in normal rabbits, in animals given atropine and in animals without functioning autonomic effectors. The findings under anaesthesia were compared during spontaneous and artificial intermittent positive pressure respiration.2. The circulatory effects of chloralose-urethane and sodium pentobarbitone anaesthesia differed significantly for the first hour after induction of anaesthesia. During the subsequent 3 hr of maintained anaesthesia differences in the circulatory effects of the two anaesthetics were small.3. The direct local effects of these anaesthetics were assessed during the maintenance phase from the responses of animals without functioning autonomic effectors. With both anaesthetics there was peripheral vasodilatation and minimal effects on heart rate.4. The autonomic activity in the normal animal was assessed by comparing the changes in normal, atropinized and ;de-efferented' rabbits without functioning autonomic effectors. During chloralose-urethane anaesthesia there was reduction in cardiac vagal efferent activity and no change in cardiac sympatho-adrenal activity. With both anaesthetics there was an increase in peripheral sympatho-adrenal constrictor activity, tending to minimize the local vasodilator effects.     

人体脉搏波传播时差检测系统

脉搏波的波形和传播速度与血管的几何和物理性质有密切关系,可通过检测脉搏波形和传播速度的变异判别动脉血管的弹性功能。作者采用固体压阻式脉压传感器,脉搏信号预处理装置,TP—801单板机组成检测脉搏波及其传播时差的系统,可对脉搏信号进行无创提取,贮存及处理,以供临床分析应用。     

Causal relationship between heart rate and arterial blood pressure variability signals

A method is described which allows the determination of the causal relationship existing between two biological signals (heart rate and arterial blood pressure variability signals) which carry information about the role of control elicited by the autonomic nervous system. This method assumes an autoregressive (AR) model for the two signals to check the cross-correlation of the two residuals after AR identification. This information, together with the classical parameters of the spectral analysis (mean, variance, frequency and power in two typical bands, gain, phase and coherence) may provide a more precise evaluation of the complex mechanisms involved in the control of heart rate and blood pressure in numerous physiopathological situations.     

前庭生理功能在适应特殊重力环境中的作用

外周前庭系统能够感受线性加速度(重力和头部倾斜)和旋转运动,并将其转化为神经信号,传递到中枢神经系统从而调节生理功能,其在调节躯体稳定性、眼球运动、自主神经活动、动脉压力、体温、肌肉和骨骼代谢中发挥重要的作用。重力环境可对上述功能产生影响归因于前庭系统的高可塑性。本文综述超重和微重力环境引起的前庭相关生理功能的变化,包括动脉压力、肌肉和骨骼代谢、食物摄入和体温等,旨在更好理解和研究前庭生理功能在适应特殊重力环境中的作用。     

The effects of haemorrhage in the unanaesthetized rabbit

1. The circulatory response following acute loss of 26% of the blood volume was examined in unanaesthetized rabbits. The groups of animals studied were normal rabbits; adrenalectomized rabbits; animals subjected to prolonged treatment with guanethidine in which peripheral adrenergic nerve transmission is blocked, but which can reflexly liberate adrenal medullary hormones; animals subjected to combined adrenalectomy and guanethidine treatment with no functional adrenergic effectors; in each case with or without administration of atropine. The responses of animals with section of the carotid sinus and aortic nerves were also examined.

2. The spontaneous rate of replacement of the blood volume after haemorrhage by reabsorption of extravascular fluid was the same in all the above preparations, the blood volume returning to normal 3-4 hr after bleeding.

3. The `passive' effects of haemorrhage were examined in animals without functioning autonomic effectors and include a large fall in right atrial pressure and cardiac output, arterial hypotension, no significant change in total peripheral resistance, and a bradycardia of gradual onset. Reflex autonomic effector activity in normal animals minimizes the fall in atrial pressure, cardiac output and arterial blood pressure, and produces a significant increase in total peripheral resistance and tachycardia. Increased sympathetic nerve activity and secretion of adrenal medullary hormones each play an important and complementary part in the normal circulatory response to haemorrhage of the rabbit. There is also reflex reduction in vagal efferent activity.

4. Reflexes from the carotid sinus and aortic arch limit the fall in arterial pressure for the first 4 hr after haemorrhage. These reflexes also account for the tachycardia normally observed after haemorrhage. The baroreceptor reflexes rather than the chemoreceptors appear to be dominant in these responses.

5. Twenty-four hours after haemorrhage the haemodynamic pattern is similar in all preparations irrespective of their autonomic effector status: blood volume, right atrial pressures and cardiac outputs are all elevated, and the arterial pressure has virtually recovered, consistent with the development of hypervolaemic anaemia at this time.