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Cardiac autonomic neuropathy in patients with diabetes mellitus

World Journal of Diabetes 2014年第1期5卷 17-39页

作者： Gerasimos Dimitropoulos Abd A Tahrani Martin J Stevens Department of Diabetes and Endocrinology Heart of England National Health Service Foundation Trust Centre of Endocrinology Diabetes and MetabolismSchool of Clinical and Experimental MedicineUniversity of Birmingham

Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.

关键词： Diabetes mellitus Cardiac Cardiovascular autonomic Neuropathy Dysfunction Cardiac auto-nomic neuropathy Sympathetic Parasympathetic Heart rate variability Spectral analysis Diabetic cardio-myopathy Postural hypotension

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autonomic Nervous Activity in Multiparous Women during Early Postpartum Period: A Descriptive Study

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Open Journal of Nursing 2017年第7期7卷 734-742页

作者： Michiko Nakakita-Kenyon Faculty of Nursing Kyoritsu Women’s University Tokyo Japan

Background: The purpose of the present study is to analyze the autonomic nervous activity in multiparas while resting, nursing, and rooming-in/rooming-out during days 1 to 3 of early postpartum period. Methods: Subjects were asked to record the actions they performed while wearing a heart rate monitor. Changes in autonomic nervous activity from 9 am to 12 pm and relaxation based on the relaxation (RE) scale were surveyed in multiparous women experiencing a normal postpartum period, on postpartum days 1 to 3. Results: Thirteen subjects were enrolled but heart rate data for all 3 days were available for only 5 of them. In these patients, the autonomic nervous activity (heat rate, high frequency [HF], or low frequency [LF]/HF) showed no significant differences between the days during any of the time periods. However, of the 3 days, day 2 demonstrated a lower HF and higher LF/HF. Subjective sense of relaxation was higher on postpartum day 3 compared to days 1 and 2, but there was no significant difference observed in the 3-day total score. Though no significant differences in HF and LF/HF at rest and during nursing were observed for any of the 3 days, there was a tendency for HF to be lower and LF/HF to be higher during nursing than at rest. Conclusions: autonomic nervous activity demonstrated no significant major changes between the 3 days of postpartum (day 1 to 3). However, the lower HF and higher LF/HF during nursing and rooming-in suggest that even multiparas, who are supposedly accustomed to nursing and child-rearing, can be tense. Results suggest that multiparas require monitoring, personal care, and attention so that they can be relaxed and less tense while nursing and caring for their children.

关键词： autonomic Nervous Activity Early Postpartum Multiparous Women Rooming-In Nursing

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Liver cirrhosis-effect on QT interval and cardiac autonomic nervous system activity

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World Journal of Gastrointestinal Pathophysiology 2018年第1期9卷 28-36页

作者： Elias Tsiompanidis Spyros I Siakavellas Anastasios Tentolouris Ioanna Eleftheriadou Stamatia Chorepsima Anastasios Manolakis Konstantinos Oikonomou Nikolaos Tentolouris First Department of Propaedeutic Internal Medicine Medical School National and Kapodistrian University of Athens Laiko General Hospital

AIM To examine the impact of liver cirrhosis on QT interval and cardiac autonomic neuropathy(CAN). METHODS A total of 51 patients with cirrhosis and 51 controls were examined. Standard 12-lead electrocardiogram recordings were obtained and QT as well as corrected QT interval(QTc) and their dispersions(dQT, dQTc) were measured and calculated using a computer-based program. The diagnosis of CAN was based upon the battery of the tests proposed by Ewing and Clarke and the consensus statements of the American Diabetes Association. CAN was diagnosed when two out of the four classical Ewing tests were abnormal. RESULTS QT, QTc and their dispersions were significantly longer(P < 0.01) in patients with cirrhosis than in controls. No significant differences in QT interval were found among the subgroups according to the etiology of cirrhosis. Multivariate regression analysis after controlling for age, gender and duration of cirrhosis demonstrated significant association between QT and presence of diabetes mellitus [standardized regression coefficient(beta) = 0.45, P = 0.02] and treatment with diuretics(beta = 0.55, P = 0.03), but not with the Child-Pugh score(P = 0.54). Prevalence of CAN was common(54.9%) among patients with cirrhosis and its severity was associated with the Child-Pugh score(r = 0.33, P = 0.02). Moreover, patients with decompensated cirrhosis had more severe CAN that those with compensated cirrhosis(P = 0.03). No significant association was found between severity of CAN and QT interval duration.CONCLUSION Patients with cirrhosis have QT prolongation. Treatment with diuretics is associated with longer QT. CAN is common in patients with cirrhosis and its severity is associated with severity of the disease.

关键词： QT interval Cardiac autonomic neuropathy Cirrhotic cardiomyopathy Child-Pugh score Model for end-stage liver disease score Liver cirrhosis

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autonomic nervous system activity in patients with Fabry disease

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Open Journal of Internal Medicine 2012年第2期2卷 116-122页

作者： Eric Alamartine Aurore Sury Frédéric Roche Vincent Pichot Jean-Claude Barthelemy Department of Nephrology Saint-Etienne University Hospital Saint-Etienne France Department of Physiology Saint-Etienne University Hospital Saint-Etienne France

Background: Fabry disease is an inherited, multisystemic and progressive lysosomal storage disorder. The first symptoms of Fabry neuropathy reflect progressive loss of function of both peripheral somatic and autonomic nerve cells. We aimed to evaluate autonomic nervous system (ANS) activity in a cohort of patients with Fabry disease. Methods: ANS activity was evaluated by determining heart rate variability, spontaneous baroreflex sensitivity and ambulatory blood pressure in 9 patients with Fabry disease. Possible correlations between ANS activity and clinical phenotype were investigated. Results: Indices of global activity were frequently high, while ANS balance was disturbed only in a few patients. Sympathetic nervous system parameters were within normal ranges, but indices of parasympathetic parameters were highly variable. Baroreflex sensitivity was significantly correlated with glomerular filtration rate. Conclusion: Distribution of ASN activity indices is wide in patients with Fabry disease. autonomic imbalance has been associated with non-Fabry chronic kidney disease and cardiovascular risk. In Fabry disease, monitoring of ANS activity may contribute to comprehensive disease staging, and may be of value in identifying patients at high risk of developing renal and cardiac events.

关键词： Fabry Disease autonomic Nervous System Severity

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Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease

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World Journal of Gastroenterology 2015年第22期21卷 6982-6989页

作者： Branislav Milovanovic Branka Filipovic Slavica Mutavdzin Marija Zdravkovic Tatjana Gligorijevic Jovana Paunovic Marina Arsic Department of Cardiology Neurocardiology Laboratory Clinical and Hospital Center "Bezanijska Kosa" Department of Gastroenterology Clinical and Hospital Center "Bezanijska Kosa" Department of Cardiology Clinical and Hospital Center "Bezanijska Kosa"

AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34),who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center "Bezanijska Kosa"with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability(HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in7.9% of controls(P autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.

关键词： autonomic nervous system Blood pressuremonitoring Cardiovascular reflex test ECG monitoring Gastroesophageal reflux disease

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autonomic Software Component QoS Matchmaking Algorithm Based on Fidelity Factor in Agent-Based autonomic Computing System

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Journal of Software Engineering and Applications 2009年第2期2卷 103-110页

作者： Kun Zhang Manwu Xu Hong Zhang 不详

autonomic software component (ASC) QoS matchmaking problem for autonomic element has been taken as one of the most important issue in field of autonomic computing based on agent. Aimed at overcoming drawbacks such as subjec-tiveness and unfairness, and improving the self-configuration capability for autonomic element, we introduce evalua-tion mechanism of confidence of individual QoS attributes during ASC QoS matchmaking, i.e., fidelity factor for each attribute, and propose an ASC QoS matchmaking algorithm based on fidelity factor. Simulation experiments demon-strate that our proposed algorithm performs best performance in terms of QoS than other existing algorithms, and has better compromise between attribute quality and users’ evaluation when selecting ASC.

关键词： autonomic Software Component QoS Matchmaking Fidelity Factor autonomic Computing autonomic Element

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autonomic Neuropathy in HIV: A Case Report and Review of Potential Symptoms in an Advanced-Stage, HIV Cohort

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World Journal of AIDS 2012年第3期2卷 265-269页

作者： Jessica Robinson-Papp Kathryn J. Elliott Maria Pizzirusso Susan Morgello Department of Neurology Mount Sinai School of Medicine New York USA

A woman with a seventeen-year history of HIV infection on effective antiretroviral therapy presented with signs and symptoms of distal symmetric polyneuropathy (DSP). She developed significant side effects (dizziness, nausea, edema) with medications for pain management. Chart review revealed a history of similar intolerance to multiple antiretrovirals, which was not explained by known cardiac or gastrointestinal disease or psychological factors. Specialized testing revealed the presence of an autonomic neuropathy, which provided an explanation for her medication intolerance. The patient was educated on the symptoms of autonomic neuropathy and its relationship to DSP and subsequent symptomatic medications were initiated at the lowest possible doses. Although symptom management remained challenging, the patient exhibited lower frustration and greater acceptance of medication trials. Review of 168 advanced stage HIV infected individuals demonstrated that 81% experienced at least one, and 33% three or more, symptoms potentially attributable to autonomic neuropathy. Potentially autonomic symptoms were significantly associated with the presence of symptomatic DSP. autonomic neuropathy is difficult to diagnose without specialized testing, as its symptoms are non-specific and overlap with a large number of somatic disorders. The high prevalence of autonomic-type symptoms in chronic HIV, and their association with peripheral neuropathy, may warrant further investigation of the potential for autonomic dysfunction in individuals with HIV-related symptomatic DSP.

关键词： HIV Neuropathy autonomic

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Effects of Yogurt Containing <i>Lactobacillus gasseri</i>OLL2716 on autonomic Nerve Activities and Physiological Functions

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Health 2015年第3期7卷 397-405页

作者： Kaiho Otomi Takuji Ymaguchi Shin Watanabe Akiko Kobayashi Hiroyuki Kobayashi Naoyuki Hashiguchi Department of Emergency and Disaster Medicine Juntendo University School of Medicine Tokyo Japan Kobayashi Medical Clinic Tokyo Tokyo Japan Center for Advanced Kampo Medicine and Clinical Research Juntendo University School of Medicine Tokyo Japan Department of Hospital Administration Juntendo University School of Medicine Tokyo Japan

The purpose of this study was to investigate the effects of yogurt containing Lactobacillus gasseri OLL2716 (LG21) on autonomic nerve activities, peripheral blood flow, skin condition (skin pig-mentations and moisture), saliva s-IgA and examination of quality of life (QOL). 20 healthy female volunteers (yogurt containing LG21 group: 10 people, yogurt containing Bifidobacterium (Bif) group: 10 people) were examined. The subjects ingested 100 g of yogurt twice daily for 4 weeks. Analysis was before and after 4 weeks dosage. By the effects for the autonomic nervous activity, parasympathetic increase was observed in the LG21 yogurt group, but was not significant increase. The LG21 yogurt was significantly increased on the peripheral blood flow. The LG21 yogurt was significantly increased on saliva s-IgA. The LG21 yogurt and Bif yogurt were significantly decrease on skin pigmentation. Also, LG21 yogurt was significantly increased on skin moisture. As a result of QOL questionnaire, incomplete evacuation, lower abdominal fullness, cold extremities and pimply or rough skin improved in LG21 yogurt and Bif yogurt after the administration period. These results suggest that the improvement effects of LG21 yogurt may be related to the activity of the parasympathetic nervous system.

关键词： Yogurt Lactobacillus gasseri OLL2716 (LG21) autonomic Nerve Activities Blood Flow Skin Condition

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Frequency and Associated Factors of autonomic Dysfunction in Patients with Parkinson’s Disease in Khartoum State

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Advances in Parkinson's Disease 2019年第4期8卷 63-74页

作者： Abdel Mumin Sidahmed Husam A. M. Ali Omdurman Teaching Hospital Omdurman Sudan

Background: autonomic dysfunction in idiopathic Parkinson disease is a frequent and disabling complication, with an estimated prevalence of 47% and has a significant impact on the patient’s quality of life. Objectives: The main objective of this study was to determine the frequency of autonomic dysfunction among Sudanese Parkinson patients and identify possible risk factors attribute to develop autonomic dysfunction and to assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life. Methods: In this descriptive perspective, cross-sectional hospital-based study, 51 patients were studied using standardized questionnaire including history and clinical examination. Results: A total of 51 patients have been examined: male to female ratio 1.5:1;mean age 55 ± 5 years;Parkinson disease duration, 7 ± 2 years. 47% of the patients had one or more symptoms of autonomic dysfunction with mean age 59 ± 10. Constipation and bloating were the most common symptoms where sweating abnormality was the least symptoms to observe. The symptom of autonomic dysfunction has been worse with disease progression in 50% of the patients and 47% of the patients reported that both motors and autonomic dysfunction symptoms were causing disability than autonomic dysfunction symptoms alone. Conclusions: The study demonstrates that autonomic dysfunction is not only common in Parkinson Disease, but it increases in severity with increasing disease stages. Older age with long disease duration was also considered along with advanced disease stages strong factors determining the presence of autonomic dysfunction. The study recommends that symptoms of autonomic dysfunction survey be a routine aspect of the evaluation of Parkinson disease patients, especially with advanced age.

关键词： Idiopathic Parkinson Disease autonomic Dysfunctions Associated Factors Frequency

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Long-Term Monitoring and Analysis of Age-Related Changes on autonomic Nervous Function

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Health 2017年第2期9卷 323-344页

作者： Kenichi Itao Makoto Komazawa Zhiwei Luo Hiroyuki Kobayashi WINFrontier Co. Ltd. Tokyo Japan Juntendo University Tokyo Japan Organization of Advanced Science and Technology Kobe University Kobe Japan

This study used a small wearable heart rate sensor to monitor the daily autonomic function of 600 subjects from across all age groups over a prolonged period of time. The results indicated that the LF/HF ratio (Heart Rate Variability, LF: frequencies between 0.04 Hz - 0.15 Hz, HF: frequencies between 0.15 Hz - 0.4 Hz) an indicator of balance in the autonomic nervous system, tended to peak for subjects in their 40’s and decline thereafter. This conceivably may be partially due to the causes for concern and stress changing and/or declining for the group aged 50-plus. A decline in diurnal variation of autonomic nervous activity was also exhibited in subjects aged 50 and up, showing a tendency for decline in the function of rising sympathetic nerve activity particularly in the morning. It is conceivable that this stems from a decline in the responsiveness of the autonomic nervous system. Subjects in the 50-plus group furthermore exhibited a tendency for declining variation in autonomic nervous activity between sleeping and waking hours. This phenomenon was consistent with the tendency for there to be a rise in wake after sleep onset coupled with a decline in slow-wave sleep in middle- to old-age.

关键词： Heart Rate Variability autonomic Nervous System Stress Age Circadian Rhythm Sleep

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