Clinical Autonomic Research最新文献

Objectives: This study aimed to investigate the subjective and objective autonomic nervous system (ANS) abnormalities in children with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) compared with healthy children (HC).

Methods: In total, 69 children were enrolled: 23 in the IBD, 28 in the IBS, and 18 HC group. ANS symptoms were evaluated using the Composite Autonomic Symptom Score (COMPASS-31). The severity and distribution of ANS function were quantitated using adrenergic, cardiovagal, and sudomotor indices of the Composite Autonomic Severity Scale (CASS). Health-related quality of life (HRQoL) was assessed with the Pediatric Quality of Life Inventory (PedsQL).

Results: Children with IBS scored highest on the COMPASS-31, followed by patients with IBD and HC (median 11.5, 6.3, and 1.7, respectively; p = 0.001). There was no significant difference between groups in CASS (p = 0.09); however, children with IBD had a higher score on the sudomotor index (p = 0.012). There was a significant difference in symptomatic autonomic dysfunction (defined as COMPASS-31 > 7.913 and CASS > 0) between children with IBS (61.5%) compared with children with IBD (42.1%) and HC (7.1%), p = 0.004. In multivariable logistic regression, the number of squats decreased the probability of special health care needs by 17.2%, and the presence of symptomatic autonomic dysfunction increased the probability by 515.4%.

Conclusions: The ANS is frequently affected in children with IBD and IBS; children with IBS show greater autonomic symptom burden, while children with IBD have greater sudomotor dysfunction. HRQoL is significantly influenced by observed ANS changes in both groups.

Purpose: Pre-clinical studies have demonstrated direct influences of the autonomic nervous system (ANS) on the immune system. However, it remains unclear if ANS-immune connections delineated in these preclinical studies underlie the relationship between autonomic dysregulation and chronic inflammatory diseases in patients with human immunodeficiency virus (HIV). The aims of this study were: (1) to examine the relationship between interleukin-6 (IL-6) and the parasympathetic/vagal component of baroreflex sensitivity in people with HIV; (2) to determine whether the subtype and severity of HIV-autonomic neuropathy (AN) would predict distinct immunotypes; and (3) to compare the burden of non-acquired immunodeficiency syndrome (AIDS)-related co-morbidities between immunotypes.

Methods: A total of 79 adults with well-controlled HIV underwent a standard battery of autonomic function tests summarized as the Composite Autonomic Severity Score (CASS) and vagal and adrenergic baroreflex sensitivity (BRS-V and BRS-A, respectively) (Low: Mayo Clin Proc 68:748-752, 1993). Levels of immune biomarkers were measured in all participants using the Target 96 Inflammation Panel on the Olink proteomics platform, and immunotypes were identified using unbiased, non-negative matrix factorization. Mass cytometry (CyTOF) was completed on a subset of participants with and without autonomic neuropathy (N = 10).

Results: Reduced BRS-V predicted higher levels of IL-6 (p = 0.002). A pro-inflammatory immunotype defined by elevations in type 1 cytokines (IL-6, IL-17) and increased numbers of CD8+ T-cells was associated with autonomic neuropathy characterized by deficits in sympathetic nervous system activity (adjusted odds ratio 4.7, p = 0.017). This pro-inflammatory immunotype was older with a greater burden of co-morbidities.

Conclusion: Deficits in the parasympathetic/cardiovagal and the sympathetic nervous system are associated with inflammation and disease burden in people living with HIV. Future longitudinal research is needed to examine causality.

Purpose: The aim of this work is to determine the relationship between the cross-sectional area (CSA) of the vagus nerve and cardiovagal function in people with multiple sclerosis (pwMS) and healthy controls (HC).

Methods: We enrolled 50 pwMS and 50 HC. All participants underwent an ultrasound of the vagus nerve and autonomic nervous system testing. The Croatian version of the COMPASS-31 questionnaire was used as a measure of autonomic symptom burden. Cardiovagal function was evaluated with the respiratory sinus arrhythmia (RSA), Valsalva ratio (VR), and heart rate variability.

Results: The mean vagus CSA in pwMS was 2.03 ± 0.49 mm² on the right side and 1.72 ± 0.38 mm² on the left side. The mean vagus CSA in HC was 2.08 ± 0.50 mm² on the right side and 1.74 ± 0.37 mm² on the left side. There was no statistically significant difference between the two groups in right (p = 0.615) or left (p = 0.866) vagus CSA. In the HC, there was a statistically significant positive correlation between the mean right CSA and both RSA (r_p = 0.331, p = 0.019) and VR (r_p = 0.327, p = 0.020). On univariable linear regression analysis in the HC group, the mean right CSA was a predictor of both RSA (B = 5.599, 95% CI 0.974-10.224, p = 0.019) and VR (B = 0.253, 95% CI 0.041-0.466, p = 0.020). These findings were not present in pwMS.

Conclusions: The loss of correlation between vagus nerve CSA and parameters of parasympathetic nervous system function in pwMS corroborates the presence of cardiovagal dysfunction in multiple sclerosis.

Purpose: To revisit the pharmacology and real-world use of carbidopa in the management of autonomic disorders.

Methods: To identify articles suitable for this review, a search of the PubMed database was conducted in January 2025 using the keywords "Carbidopa," "MK-486," and "L-alpha-methyldopa hydrazine."

Results: The pharmacotherapeutic role of carbidopa extends beyond the management of Parkinson's disease. Our literature search revealed the use of carbidopa in three primary autonomic diseases to treat either nausea or symptoms of sympathetic hyperactivity: (1) familial dysautonomia, (2) hyperadrenergic postural orthostatic tachycardia syndrome (POTS), and (3) afferent baroreflex failure (familial or acquired). Even at a dose as high as 600 mg/day, carbidopa was not associated with bothersome side effects in some of the clinical trials on familial dysautonomia. Pre-clinical evidence also suggests in vitro and in vivo inhibition of T-cell activation by carbidopa and a potential therapeutic use in cytokine release syndrome.

Conclusion: Current evidence, although limited, suggests that carbidopa has a favorable safety profile. While large, well-designed studies are warranted, observations from case series and small studies suggest that carbidopa could have utility in treating nausea in familial dysautonomia and symptoms of sympathetic hyperactivity in hyperadrenergic postural orthostatic tachycardia syndrome (POTS) and afferent baroreflex failure.

Objective: This meta-analysis evaluates the effectiveness and safety of ramicotomy versus sympathetic chain interruption (SCI) in treating primary hyperhidrosis (PH).

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Web of Science, Ovid, Cochrane Library, CNKI, and Wanfang, covering studies from their inception through October 2024. A total of 10 studies involving 970 patients were included, with 504 patients undergoing ramicotomy and 466 receiving SCI.

Results: The analysis revealed that patients undergoing ramicotomy experienced significantly lower rates of compensatory hyperhidrosis (CH) [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.85, P = 0.02], severe CH (OR 0.17, 95% CI 0.06, 0.47, P < 0.001), and postoperative hand dryness (OR 0.10, 95% CI 0.01-0.72, P = 0.02), along with a higher recurrence rate (OR 4.03, 95% CI 2.38, 6.85, P < 0.001). No significant differences were observed in operative duration [mean difference (MD) = 0.19, 95% CI -18.23, 18.60, P = 0.98 > 0.05], length of hospital stay (MD = -0.08, 95% CI -0.19, 0.04, P = 0.20 > 0.05), total postoperative complications (OR 0.41, 95% CI 0.07, 2.34, P = 0.32 > 0.05), or surgical satisfaction (OR 0.93, 95% CI 0.45, 1.91, P = 0.83 > 0.05).

Conclusions: While ramicotomy results in lower incidences of CH and postoperative hand dryness, its higher recurrence rate suggests that its application should be cautious to manage PH effectively.