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Life (Basel, Switzerland) Jun 2024Stress is recognized as a significant trigger and exacerbator of various medical conditions, particularly in the field of cardiovascular disease (CVD). Given that heart... (Review)
Review
Stress is recognized as a significant trigger and exacerbator of various medical conditions, particularly in the field of cardiovascular disease (CVD). Given that heart rate variability (HRV) offers insight into the functioning of the autonomic nervous system and has been identified as a predictive factor for increased cardiovascular mortality, exploring the correlation between stress and HRV is pertinent. We systematically reviewed trials where researchers investigated the effects of stress-reducing interventions on biomarkers and time-domain/frequency-domain parameters of HRV in CVD. Eligible studies underwent meta-analysis utilizing a random-effects model. The meta-analysis showed overall beneficial effects of stress-reducing interventions on HRV for the standard deviation of Normal-to-Normal intervals (SDNN) in short-term and 24 h assessments, as well as for the low-frequency power (LF) in short-term assessment. Overall effect sizes were notably high and showed significant -values (short-term SDNN: MD = 6.43, = 0.01; 24 h SDNN: MD = 10.92, = 0.004; short-term LF: MD = 160.11, < 0.001). Our findings highlight the significant impact of stress-reducing interventions in modulating HRV by influencing short-term SDNN and LF parameters, as well as the 24 h assessment of SDNN. These results emphasize the importance of stress-reducing measures in lowering the risk of further progression in CVD and improving patient outcomes.
PubMed: 38929732
DOI: 10.3390/life14060749 -
Progress in Neuro-psychopharmacology &... Jun 2024Heart rate variability (HRV) is a useful tool for evaluating cardiovascular autonomic nervous system (ANS) functions. This systematic review and meta-analysis examined... (Review)
Review
BACKGROUND
Heart rate variability (HRV) is a useful tool for evaluating cardiovascular autonomic nervous system (ANS) functions. This systematic review and meta-analysis examined the potential effects of transcranial direct current stimulation (tDCS) protocols on HRV parameters.
METHODS
This study acquired 97 comparisons from 24 qualified studies for data synthesis. Using standardized mean difference (SMD), individual and overall effect sizes were estimated to show differences in HRV variables between active tDCS and sham stimulation conditions. More positive effect size values indicated that active tDCS caused greater increases in HRV than sham stimulation. Furthermore, moderator variable analyses were performed to determine whether changes in HRV variables differed depending on (a) task types (physical stress versus psychological stress versus resting condition), (b) targeted brain regions, (c) stimulation polarity, (d) characteristics of participants, and (e) specific HRV variables. Finally, we used meta-regression analyses to determine whether different tDCS parameters (i.e., the number of tDCS sessions, stimulation duration, and density) were associated with changes in HRV patterns.
RESULTS
The random-effects model meta-analysis showed that tDCS protocols significantly improved HRV variables (SMD = 0.400; P < 0.001). Moreover, for increasing HRV during the physical stress task (SMD = 1.352; P = 0.001), anodal stimulation on the M1 was effective, while combined polarity stimulation on the PFC improved HRV during the psychological stress task (SMD = 0.550; P < 0.001) and resting condition (SMD = 0.192; P = 0.012). Additional moderator variables and meta-regression analyses failed to show that tDCS protocols had positive effects in certain conditions, such as different stimulus polarity, characteristics of participants, specific HRV variables, and tDCS parameters.
CONCLUSION
These findings tentatively suggest that using tDCS protocols to stimulate optimal targeted brain areas may be effective in improving HRV patterns potentially related to cardiovascular ANS functions.
PubMed: 38925337
DOI: 10.1016/j.pnpbp.2024.111072 -
Journal of Clinical Medicine May 2024Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal... (Review)
Review
Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies ( = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.
PubMed: 38892833
DOI: 10.3390/jcm13113122 -
Pain Physician May 2024Sympathetic ganglion block (SGB) technique is becoming increasingly prevalent in the treatment of complex regional pain syndromes (CRPS). Given the varied reported... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sympathetic ganglion block (SGB) technique is becoming increasingly prevalent in the treatment of complex regional pain syndromes (CRPS). Given the varied reported effectiveness of these techniques and the heterogeneity of treatment regimens, there is an urgent need for consistent and high-quality evidence on the efficacy and safety of such procedures.
OBJECTIVES
This study aimed to compare the efficacy of SGB therapy for CRPS-related pain.
STUDY DESIGN
A meta-analysis of randomized controlled trials (RCTs).
METHODS
PubMed, EMBASE, Web of Science, CINAHL, US National Institutes of Health Clinical Trials Registry, Google Scholar, and Cochrane Library Databases were systematically searched between January 1967 and April 2023. A meta-analysis of the included RCTs on SGB was conducted to evaluate the effectiveness and risk of bias (ROBs) of SGB.
RESULTS
After screening 8523 records, 12 RCTs were included in this meta-analysis. Compared with controls, the visual analog pain score decreased by a weighted mean difference (WMD) of -6.24 mm (95% CI, -11.45, -1.03; P = 0.019) in the random-effects model, and the numerical scale score was reduced by a WMD of -1.17 mm (95% CI, -2.42, 0.08; P = 0.067) in the fixed-effects model, indicating a pain relief. The methodological quality of the included RCTs was high, with an average PEDro score of 7.0 (range: 5-9).
LIMITATIONS
The number of included trials was limited.
CONCLUSIONS
SGB therapy can reduce pain intensity in patients with CRPS with few adverse events. However, owing to the relatively high heterogeneity of the included RCTs, a larger sample of high-quality RCTs is needed to further confirm this conclusion.
Topics: Humans; Complex Regional Pain Syndromes; Stellate Ganglion; Autonomic Nerve Block; Randomized Controlled Trials as Topic
PubMed: 38805523
DOI: No ID Found -
The Journal of International Medical... May 2024The efficacy of ultrasound-guided stellate ganglion block (SGB) in alleviating postoperative pain remains unclear. This meta-analysis was performed to determine the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The efficacy of ultrasound-guided stellate ganglion block (SGB) in alleviating postoperative pain remains unclear. This meta-analysis was performed to determine the efficacy of ultrasound-guided SGB in relieving acute postoperative pain in patients undergoing surgery with general anesthesia.
METHODS
This systematic review and meta-analysis focused on randomized controlled trials comparing SGB with control or placebo. The primary outcome was the pain score at 24 hours after surgery. A random-effects model was used to calculate the mean difference (MD) or risk ratio with a confidence interval (CI) of 95%.
RESULTS
Eight studies involving 470 patients were included in the meta-analysis. The results revealed that ultrasound-guided SGB was significantly associated with a lower pain score at 24 hours after surgery (MD = -0.74; 95% CI = -1.39, -0.08; I = 86%; low evidence) and at 8 hours after surgery (MD = -0.65; 95% CI = -1.03, -0.28; I = 29%; moderate evidence).
CONCLUSION
Ultrasound-guided SGB is effective in alleviating acute postoperative pain. However, considering the limited number of trials performed to date, more large-scale and high-quality randomized controlled trials are required to confirm these findings.
Topics: Humans; Stellate Ganglion; Pain, Postoperative; Ultrasonography, Interventional; Autonomic Nerve Block; Randomized Controlled Trials as Topic; Treatment Outcome; Acute Pain; Pain Measurement
PubMed: 38759220
DOI: 10.1177/03000605241252237 -
Annals of Clinical and Translational... Jun 2024Fabry disease is caused by enzymatic defects in alpha-galactosidase A that leads to the accumulation of glycosphingolipids throughout the body, resulting in a...
OBJECTIVE
Fabry disease is caused by enzymatic defects in alpha-galactosidase A that leads to the accumulation of glycosphingolipids throughout the body, resulting in a multisystemic disorder. The most common neurological manifestations are neuropathic pain, autonomic nervous system dysfunction and strokes, but some rarer neurological manifestations exist. Among these, aseptic meningitis is a possible complication. Our objectives were to measure the prevalence of this complication in a cohort of patients with Fabry disease, and to describe its clinical features.
METHODS
We conducted a retrospective review of Fabry disease patients followed at our tertiary referral center between 1995 and September 2023 with at least one episode of meningitis, and performed a systematic review to identify similar published cases.
RESULTS
Four patients out of 107 (3.7%) had at least one episode of aseptic meningitis. Our systematic review identified 25 other observations. The median age of these 29 patients was 29.0 years, the median cerebrospinal fluid leukocyte count was 24 cells/mm3 with a predominance of lymphocytes in 64.7% of cases. In 82.8% of the patients, the diagnosis of Fabry disease was unknown before the meningitis. Large artery stenosis was present in 17.2% of patients and 57.1% of patients had a recent stroke concomitant with the meningitis. Several differential diagnoses were evoked, such as multiple sclerosis or central nervous system vasculitis.
INTERPRETATION
Our study suggests that Fabry disease should be considered as a cause of aseptic meningitis. The pathophysiological mechanisms underlying meningeal inflammation remain largely unknown but may reflect the dysregulation of pro-inflammatory signaling pathways.
Topics: Humans; Fabry Disease; Meningitis, Aseptic; Adult; Male; Female; Retrospective Studies; Middle Aged; Young Adult; Adolescent; Aged; Child
PubMed: 38717582
DOI: 10.1002/acn3.52043 -
The effect of hyperoxia on muscle sympathetic nerve activity: a systematic review and meta-analysis.Clinical Autonomic Research : Official... Apr 2024We conducted a meta-analysis to determine the effect of hyperoxia on muscle sympathetic nerve activity in healthy individuals and those with cardio-metabolic diseases. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We conducted a meta-analysis to determine the effect of hyperoxia on muscle sympathetic nerve activity in healthy individuals and those with cardio-metabolic diseases.
METHODS
A comprehensive search of electronic databases was performed until August 2022. All study designs (except reviews) were included: population (humans; apparently healthy or with at least one chronic disease); exposures (muscle sympathetic nerve activity during hyperoxia or hyperbaria); comparators (hyperoxia or hyperbaria vs. normoxia); and outcomes (muscle sympathetic nerve activity, heart rate, blood pressure, minute ventilation). Forty-nine studies were ultimately included in the meta-analysis.
RESULTS
In healthy individuals, hyperoxia had no effect on sympathetic burst frequency (mean difference [MD] - 1.07 bursts/min; 95% confidence interval [CI] - 2.17, 0.04bursts/min; P = 0.06), burst incidence (MD 0.27 bursts/100 heartbeats [hb]; 95% CI - 2.10, 2.64 bursts/100 hb; P = 0.82), burst amplitude (P = 0.85), or total activity (P = 0.31). In those with chronic diseases, hyperoxia decreased burst frequency (MD - 5.57 bursts/min; 95% CI - 7.48, - 3.67 bursts/min; P < 0.001) and burst incidence (MD - 4.44 bursts/100 hb; 95% CI - 7.94, - 0.94 bursts/100 hb; P = 0.01), but had no effect on burst amplitude (P = 0.36) or total activity (P = 0.90). Our meta-regression analyses identified an inverse relationship between normoxic burst frequency and change in burst frequency with hyperoxia. In both groups, hyperoxia decreased heart rate but had no effect on any measure of blood pressure.
CONCLUSION
Hyperoxia does not change sympathetic activity in healthy humans. Conversely, in those with chronic diseases, hyperoxia decreases sympathetic activity. Regardless of disease status, resting sympathetic burst frequency predicts the degree of change in burst frequency, with larger decreases for those with higher resting activity.
Topics: Humans; Hyperoxia; Sympathetic Nervous System; Muscle, Skeletal; Heart Rate
PubMed: 38709357
DOI: 10.1007/s10286-024-01033-4 -
Cureus Apr 2024As the world accelerates, sedentary and unhealthy lifestyles have an increasingly negative impact on human physical and emotional well-being. Millions of people... (Review)
Review
As the world accelerates, sedentary and unhealthy lifestyles have an increasingly negative impact on human physical and emotional well-being. Millions of people globally are thought to have chronic kidney disease (CKD), which is frequently brought on by diabetes, hypertension, and glomerulonephritis. Over time, the illness gets worse and eventually results in irreversible renal failure. A person's life can be seriously affected by CKD in many different ways, including emotionally, socially, physically, and financially. Apart from physiological manifestations like anemia, discomfort, and exhaustion, CKD can also result in psychological problems like anxiety and depression, which can impair one's overall standard of life. Numerous studies have demonstrated the beneficial effects of yoga and meditation on people with chronic renal disease, enhancing their general health and quality of life. Because of therapeutic limitations, familial pressures, financial restraints, and symptoms of end-stage kidney disease, people with CKD frequently experience stress and anxiety. By reducing stress and anxiety, yoga and meditation can help individuals with chronic conditions maintain their health and improve their overall well-being. Recent research has found that yoga can improve blood pressure, sympathetic activity, and basal metabolic rate as well as reduce blood pressure and blood sugar levels by balancing the autonomic nervous system. Furthermore, studies have demonstrated that yoga helps CKD patients live healthier lives by lowering stress, anxiety, and sadness. Healthcare professionals can help patients with chronic renal disease manage their symptoms and enhance their general health and well-being by adding yoga and meditation into their treatment regimens. Modifying lifestyle is essential for both the prevention and treatment of chronic renal disease. CKD often co-occurs with other age-related and sedentary lifestyles and poor diet-related chronic conditions. The dearth of targeted treatment for a large percentage of CKD patients led to the investigation of the therapeutic applications of yoga and meditation in this study. These affordable, non-invasive therapies provide a comprehensive approach to controlling CKD, benefiting both healthy individuals and those with CKD in terms of their physical and mental well-being.
PubMed: 38707181
DOI: 10.7759/cureus.57546 -
Menopause (New York, N.Y.) Jul 2024The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified...
OBJECTIVE
The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified through the COMMA (Core Outcomes in Menopause) global consensus process relating to vasomotor symptoms: frequency, severity, distress/bother/interference, impact on sleep, satisfaction with treatment, and side effects.
METHODS
A systematic review was conducted to identify relevant definitions for the outcome of side-effects and PROMs with acceptable measurement properties for the remaining five core outcomes. The consensus process, involving 36 participants from 16 countries, was conducted to review definitions and PROMs and make final recommendations for the measurement of each core outcome.
RESULTS
A total of 21,207 publications were screened from which 119 reporting on 40 PROMs were identified. Of these 40 PROMs, 36 either did not adequately map onto the core outcomes or lacked sufficient measurement properties. Therefore, only four PROMs corresponding to two of the six core outcomes were considered for recommendation. We recommend the Hot Flash Related Daily Interference Scale to measure the domain of distress, bother, or interference of vasomotor symptoms and to capture impact on sleep (one item in the Hot Flash Related Daily Interference Scale captures interference with sleep). Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events, which is a requirement of Good Clinical Practice.
CONCLUSIONS
We identified suitable definitions and PROMs for only three of the six core outcomes. No suitable PROMs were found for the remaining three outcomes (frequency and severity of vasomotor symptoms and satisfaction with treatment). Future studies should develop and validate PROMs for these outcomes.
Topics: Humans; Female; Hot Flashes; Menopause; Patient Reported Outcome Measures; Consensus; Patient Satisfaction; Vasomotor System; Quality of Life
PubMed: 38688464
DOI: 10.1097/GME.0000000000002370 -
Journal of Thermal Biology Apr 2024Cryostimulation and cold-water immersion (CWI) have recently gained widespread attention due to their association with changes in cardiovascular and cardiac autonomic... (Meta-Analysis)
Meta-Analysis Review
The effects of cold exposure (cold water immersion, whole- and partial- body cryostimulation) on cardiovascular and cardiac autonomic control responses in healthy individuals: A systematic review, meta-analysis and meta-regression.
BACKGROUND
Cryostimulation and cold-water immersion (CWI) have recently gained widespread attention due to their association with changes in cardiovascular and cardiac autonomic control responses. Therefore, the aim of the present systematic review and meta-analysis was to identify the global impact of such cold exposures on cardiovascular and cardiac autonomic activity.
METHODS
Three databases (PubMed, Embase, Web-of-Science) were used. Studies were eligible for inclusion if they were conducted on healthy participants using cryostimulation and/or CWI. The outcomes included measurements of blood pressure (BP), heart rate (HR), and heart rate variability (HRV) indices: RR interval (RR), Root mean square of successive RR interval differences (RMSSD), low frequency band (LF), high frequency band (HF), and LF/HF ratio.
RESULTS
Among the 27 articles included in our systematic literature review, only 24 were incorporated into the meta-analysis. Our results reveal a significant increase in HRV indices: RMSSD (Standardized mean difference (SMD) = 0.61, p < 0.001), RR (SMD = 0.77, p < 0.001), and HF (SMD = 0.46, p < 0.001), as well as significantly reduced LF (SMD = -0.41, p < 0.001) and LF/HF ratio (SMD = -0.25, p < 0.01), which persisted up to 15 min following cold exposure. Significantly decreased heart rate (SMD = -0.16, p < 0.05), accompanied by slightly increased mean BP (SMD = 0.28, p < 0.001), was also observed. These results seem to depend on individual characteristics and the cooling techniques.
CONCLUSION
Our meta-analysis suggests that cryostimulation and/or CWI exposure enhance parasympathetic nervous activity. There is scarce scientific literature regarding the effect of individual characteristics on cold-induced physiological responses.
Topics: Humans; Autonomic Nervous System; Blood Pressure; Cold Temperature; Cryotherapy; Heart; Heart Rate; Immersion
PubMed: 38663342
DOI: 10.1016/j.jtherbio.2024.103857