Autonomic Neuroscience-Basic & Clinical最新文献_第7页

Remote-controlled vagal nerve stimulation attenuates ventricular arrhythmias and prevents heart failure progression in a rat model of acute myocardial infarction 遥控迷走神经刺激在急性心肌梗死大鼠模型中减轻室性心律失常和防止心力衰竭进展

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-04-13 DOI: 10.1016/j.autneu.2025.103279

Feng Hu , Yali Wang , Minhua Zang , Guangyu Li , Guangyu Wang , Danfeng Hu , Lihui Zheng , Yan Yao , Jun Pu

Background

Myocardial infarction (MI) often leads to complications like ventricular arrhythmias and heart failure, driven by autonomic nervous system imbalance. This study evaluates the effectiveness of a novel remote-controlled vagal nerve stimulation (VNS) device, featuring adjustable stimulation parameters post-implantation, specifically focusing on its potential to inhibit ventricular arrhythmias and prevent the progression of heart failure in a rat model of acute MI.

Methods

Male Sprague-Dawley rats were randomized, and MI was induced by ligation of the left anterior descending artery. Seven days post-MI, rats were divided into three groups: the MI + VNS group (n = 15), the MI + control group (n = 15), and a sham-operated group (n = 12). In the MI + VNS group, a VNS device was implanted with initial stimulation settings of 0.2 mA, 0.2 ms pulse width, and 20 Hz frequency. During follow-up, stimulation parameters were adjusted to maintain a 5–20 % reduction in heart rate from baseline. Cardiac function, arrhythmia inducibility, and myocardial fibrosis were assessed four weeks after VNS implantation.

Results

Remote-controlled VNS significantly improved left ventricular ejection fraction and fractional shortening compared to the MI + control group (all P < 0.001). The left ventricular end-systolic diameter was also significantly reduced (P = 0.003). Additionally, VNS-treated rats exhibited a lower incidence and duration of ventricular arrhythmias (P = 0.003) and a reduction in myocardial fibrosis (P < 0.001). Plasma levels of B-type natriuretic peptide and noradrenaline were also significantly lower in the VNS group compared to controls (all P < 0.001).

Conclusions

These findings suggest that remote-controlled VNS offers a novel and dynamic approach to treating MI-related complications. By allowing for adaptive stimulation in response to real-time physiological changes, remote-controlled VNS may represent a valuable strategy for reducing the risk of heart failure and arrhythmias post-MI.

背景：在自主神经系统失衡的驱动下，心肌梗死（MI）常导致室性心律失常和心力衰竭等并发症。本研究评估了一种新型遥控迷走神经刺激装置（VNS）的有效性，该装置在植入后具有可调节的刺激参数，特别关注其在急性心肌梗死大鼠模型中抑制室性心律失常和防止心力衰竭进展的潜力。方法随机选取小型Sprague-Dawley大鼠，通过结扎左前降支诱导心肌梗死。术后7 d，将大鼠分为3组：MI + VNS组（n = 15）、MI +对照组（n = 15）和假手术组（n = 12）。在MI + VNS组，植入VNS装置，初始刺激设置为0.2 mA， 0.2 ms脉宽，20 Hz频率。在随访期间，调整刺激参数以保持心率比基线降低5 - 20%。植入VNS后4周评估心功能、心律失常诱发性和心肌纤维化。结果与MI +对照组相比，远程控制VNS可显著改善左心室射血分数和分数缩短(P <；0.001)。左心室收缩末期直径明显减小（P = 0.003）。此外，vns治疗的大鼠室性心律失常的发生率和持续时间较低（P = 0.003），心肌纤维化减少(P <；0.001)。与对照组相比，VNS组血浆b型利钠肽和去甲肾上腺素水平也显著降低(P <；0.001)。结论遥控VNS为治疗心肌梗死相关并发症提供了一种新颖、动态的方法。远程控制的VNS通过对实时生理变化的适应性刺激，可能是降低心肌梗死后心力衰竭和心律失常风险的一种有价值的策略。

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引用次数: 0

Age and orthostatic hypotension are associated with baroreflex sensitivity and cerebral oxygenation after postural change 体位改变后，年龄和体位性低血压与压力反射敏感性和脑氧合有关

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-05-24 DOI: 10.1016/j.autneu.2025.103291

Marjolein Klop , Jurgen A.H.R. Claassen , Arjen Mol , Marijke C. Trappenburg , Richard J.A. van Wezel , Andrea B. Maier , Carel G.M. Meskers

Baroreflex sensitivity (BRS), maintaining blood pressure (BP), and cerebral autoregulation, maintaining cerebral blood flow (CBF), are regulatory mechanisms to counteract posture-related BP changes and their effect on CBF. These mechanisms may fail in geriatric conditions such as orthostatic hypotension (OH) and cause symptoms and falls. This study aimed to determine the association of age, sex, antihypertensive use, comorbidity, and OH with BRS and cerebral oxygenation after postural change.

Thirty-four younger adults (median age 25 years), 30 older adults (median age 77 years), and 41 geriatric outpatients (median age 76 years) performed 2–3 supine-stand transitions, while heart rate (electrocardiogram), BP (volume-clamp photoplethysmography), and cerebral oxygenation (near-infrared spectroscopy) were measured continuously. BRS, cerebral oxygenation and cerebral autoregulation were determined in the time and frequency domain. Associations were investigated using linear regression and group comparisons.

Higher age and presence of OH (OH in at least one supine-stand transition during a continuous BP measurement) were associated with lower BRS (1 % per year, 30 % when having OH). Higher age was associated with higher cerebral oxygenation recovery (0.1 μmol/L per year) after 30 s, while OH was associated with lower cerebral oxygenation recovery (1.3 μmol/L when having OH) at 1 min after postural change. No evidence of cerebral autoregulation impairment was found across all three groups.

Reduced BRS and cerebral oxygenation recovery specifically in participants with OH are in line with their assumed susceptibility to cerebral hypoxia. The role of cerebral autoregulation as a compensatory mechanism for failing BRS could not be confirmed.

压反射敏感性（BRS）、维持血压（BP）和脑自动调节、维持脑血流量（CBF）是抵消姿势相关的血压变化及其对CBF影响的调节机制。这些机制可能在诸如直立性低血压（OH）等老年疾病中失效，并引起症状和跌倒。本研究旨在确定体位改变后BRS和脑氧合与年龄、性别、降压药使用、合并症和OH的关系。34名年轻人（中位年龄25岁）、30名老年人（中位年龄77岁）和41名老年门诊患者（中位年龄76岁）进行了2-3次仰卧-站立转换，同时连续测量心率（心电图）、BP（容积钳光容积脉搏波）和脑氧合（近红外光谱）。在时域和频域上测定BRS、脑氧合和脑自动调节。采用线性回归和组间比较研究相关关系。较高的年龄和OH的存在（连续血压测量期间至少有一次仰卧-站立转换中的OH）与较低的BRS相关（每年1%，当有OH时为30%）。年龄越大，30s后脑氧恢复越快（每年0.1 μmol/L），而OH与体位改变后1min脑氧恢复越慢（有OH时为1.3 μmol/L）相关。在所有三组中均未发现大脑自动调节功能受损的证据。特别是OH患者的BRS降低和脑氧恢复与他们对脑缺氧的易感性一致。大脑自动调节作为BRS失败的代偿机制的作用尚未得到证实。

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引用次数: 0

Menopause and its effects on autonomic regulation of blood pressure: Insights and perspectives 更年期及其对血压自主调节的影响：见解和观点

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-05-29 DOI: 10.1016/j.autneu.2025.103295

E.J. Lee, M.L. Keller-Ross

Cardiovascular disease (CVD) risk increases substantially around the typical age of menopause (∼51 yrs). While the mechanisms underlying this phenomenon remain to be precisely elucidated, menopause-related autonomic (dys)function likely plays a key role in CVD development in postmenopausal females. Sympathetic activity is known to increase with age and may rise more steeply in older females, resulting in autonomic imbalance and chronic disease. The menopausal loss of estradiol, a major female sex hormone, contributes to changes in autonomic and vascular physiology and is implicated in prominent menopause symptoms such as sleep difficulty and vasomotor symptoms (hot flushes/night sweats). Estrogen replacement can mitigate some of these negative health effects, but hormone therapy may not be able to reverse all menopause-linked autonomic dysfunction. Thus, this review explores the vast and complex web connecting menopause physiology and symptomatology, including how sex-hormone loss and menopause symptoms may impact autonomic function– in particular, through altered sympathetic regulation of blood pressure and impaired vagal tone– as a gateway to adverse cardiovascular health and greater CVD risk.

心血管疾病（CVD）的风险在绝经的典型年龄（~ 51岁）左右显著增加。虽然这一现象背后的机制仍有待明确，但绝经相关的自主神经功能可能在绝经后女性心血管疾病的发展中起着关键作用。交感神经活动随着年龄的增长而增加，在老年女性中可能增加得更厉害，从而导致自主神经失衡和慢性疾病。雌二醇是一种主要的女性性激素，绝经期雌二醇的丧失有助于自主神经和血管生理学的变化，并与睡眠困难和血管舒缩症状（潮热/盗汗）等突出的更年期症状有关。雌激素替代可以减轻这些对健康的负面影响，但激素疗法可能无法逆转所有与更年期相关的自主神经功能障碍。因此，本综述探讨了连接更年期生理学和症状学的庞大而复杂的网络，包括性激素丢失和更年期症状如何影响自主神经功能-特别是通过改变血压的交感调节和迷走神经张力受损-作为不良心血管健康和更大心血管疾病风险的门户。

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引用次数: 0

Understanding neurogenic urogenital dysfunction and the clinical application of the EAN/EFAS/INUS NEUROGED guidelines 了解神经源性泌尿生殖功能障碍和EAN/EFAS/INUS NEUROGED指南的临床应用

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-06-20 DOI: 10.1016/j.autneu.2025.103314

Ivan Adamec , Magdalena Krbot Skorić , Luka Crnošija , Alessandra Fanciulli , Jalesh Panicker , Tamara B. Kaplan , Mario Habek

Neurogenic urogenital dysfunction encompasses various urinary and sexual issues resulting from neurological disorders, which significantly impact patients' quality of life. To address these challenges, the European Academy of Neurology (EAN), in collaboration with the European Federation of Autonomic Societies (EFAS) and the International Neuro-Urology Society (INUS), developed the NEUROGED guidelines. These guidelines aim to provide neurologists with evidence-based recommendations for managing neurogenic bladder and sexual dysfunctions. The task force comprised 37 members from 17 countries across four continents, highlighting a comprehensive and collaborative effort. The committee has established evidence-based recommendations for 11 key questions, consensus-based recommendations for eight questions, and good practice statements for 19, addressing the complexities of managing neurogenic urogenital dysfunction. This review seeks to enhance understanding of the NEUROGED guidelines through two sections. The first section examines the neuroanatomy, pathophysiology, and clinical presentation of lower urinary tract symptoms (LUTS) and sexual dysfunction (SD), establishing a basis for the guidelines. The second section explores the impact of the NEUROGED guidelines on the investigation and management of urogenital symptoms, addressing their implementation and potential barriers in clinical practice.

神经源性泌尿生殖功能障碍包括由神经系统疾病引起的各种泌尿和性问题，严重影响患者的生活质量。为了应对这些挑战，欧洲神经病学学会（EAN）与欧洲自主学会联合会（EFAS）和国际神经泌尿学学会（INUS）合作，制定了NEUROGED指南。这些指南旨在为神经科医生提供管理神经性膀胱和性功能障碍的循证建议。工作队由来自四大洲17个国家的37名成员组成，突出了全面和协作的努力。该委员会针对11个关键问题提出了基于证据的建议，针对8个问题提出了基于共识的建议，针对19个问题提出了良好做法声明，解决了神经源性泌尿生殖功能障碍管理的复杂性。本综述旨在通过两个部分加强对NEUROGED指南的理解。第一部分探讨下尿路症状（LUTS）和性功能障碍（SD）的神经解剖学、病理生理学和临床表现，为指南奠定基础。第二部分探讨NEUROGED指南对泌尿生殖系统症状调查和管理的影响，解决其在临床实践中的实施和潜在障碍。

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引用次数: 0

Is cardiovascular disease risk in transgender, gender-diverse, and non-binary adults associated with autonomic imbalance? 跨性别、性别多样化和非二元成人的心血管疾病风险与自主神经失衡有关吗？

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-04-28 DOI: 10.1016/j.autneu.2025.103283

Keila Turino Miranda , Brittany K. Schwende , Alicia Duval , Carl G. Streed Jr , Shannon I. Delage , Kit Chokly , Vegas Hodgins , Charlotte W. Usselman

Blood pressure is a key indicator of cardiovascular health with chronically high levels increasing the risk of cardiovascular diseases (CVD) such as heart attack and stroke. Emerging evidence shows that transgender, gender-diverse, and non-binary (TGD) adults tend to have higher blood pressure than age-matched cisgender adults, corresponding to an increased CVD risk in this population. Yet, the mechanisms underlying elevated blood pressure in TGD adults remain unclear, posing challenges to TGD-affirming healthcare. Given the autonomic nervous system's role in CVD – wherein reduced parasympathetic and heightened sympathetic activity are key risk factors for CVD – this review explores the question: “Is cardiovascular disease risk in TGD adults associated with autonomic imbalance?” Limited research exists on autonomic balance within TGD populations. Accordingly, this review considers how TGD-specific factors, such as minority stress, lifestyle behaviors, sex and gender, and hormones (i.e., testosterone, estrogen, progesterone), may impact autonomic balance. Finally, this review aims to underscore the critical need for interdisciplinary research to elucidate these mechanisms and advance TGD-inclusive healthcare in the domains of autonomic control of blood pressure and overall cardiovascular health.

血压是心血管健康的一个关键指标，长期处于高水平会增加心脏病和中风等心血管疾病的风险。新出现的证据表明，跨性别、性别多样化和非二元（TGD）成年人的血压往往高于年龄匹配的顺性别成年人，这对应于该人群中心血管疾病风险的增加。然而，TGD成人血压升高的机制尚不清楚，这给TGD确认医疗保健带来了挑战。考虑到自主神经系统在心血管疾病中的作用，其中副交感神经活动减少和交感神经活动增加是心血管疾病的关键危险因素，本综述探讨了这样一个问题：“TGD成人心血管疾病风险是否与自主神经失衡有关？”目前对TGD种群的自主平衡研究有限。因此，本综述考虑了tgd特异性因素，如少数民族压力、生活方式行为、性别和性别以及激素（即睾酮、雌激素、孕酮）如何影响自主神经平衡。最后，本综述旨在强调跨学科研究的迫切需要，以阐明这些机制，并在血压自主控制和整体心血管健康领域推进tgd包容性医疗。

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引用次数: 0

Associations between cardiac autonomic function and cognition across the adult female lifespan 成年女性生命周期中心脏自主神经功能与认知之间的关系

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-06-19 DOI: 10.1016/j.autneu.2025.103316

Alicia Duval , Blaine Ditto

A growing body of evidence highlights the direct involvement of the autonomic nervous system on cognitive processes. Vagal-mediated heart rate variability (vmHRV), a measure of cardiac autonomic control, has been linked to cognitive outcomes in both healthy and clinical populations. However, few studies have directly examined this relationship in females. Understanding the interplay between vmHRV and cognitive functioning in females is important for elucidating sex-specific mechanisms contributing to cognitive trajectories across the female lifespan. The present review synthesizes the literature examining vmHRV and cognition in females at different transitional life phases, including the menstrual cycle, menopausal transition, and postmenopausal period, and considers the implications of polycystic ovary syndrome. The evidence summarized describes fluctuations in vmHRV and cognitive function across the female adult lifespan; however, notable gaps in the literature are identified. Further research is needed to better understand these complex interactions and to guide the development of targeted strategies to support female cognitive health with advancing age.

越来越多的证据强调自主神经系统直接参与认知过程。迷走神经介导的心率变异性（vmHRV）是一种衡量心脏自主控制的指标，在健康和临床人群中都与认知结果有关。然而，很少有研究直接检查女性的这种关系。了解vmHRV与女性认知功能之间的相互作用对于阐明女性一生中认知轨迹的性别特异性机制具有重要意义。本文综述了在月经周期、绝经期和绝经后不同过渡时期女性vmHRV与认知的相关文献，并探讨了多囊卵巢综合征的意义。总结的证据描述了女性成年期间vmHRV和认知功能的波动；然而，在文献中发现了显著的差距。需要进一步的研究来更好地了解这些复杂的相互作用，并指导制定有针对性的策略，以支持老年女性的认知健康。

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引用次数: 0

Exposure to predator threat engages sympathetic nervous system outflow to skeletal muscle 暴露在捕食者的威胁下，交感神经系统向骨骼肌流出

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-06-01 DOI: 10.1016/j.autneu.2025.103304

Erin Gorrell , Ashley M. Shemery , Leah Franks , Noor Saman , Meredith Zendlo , Emily Welch , Cassidy Ridley , Ashely Davis , Amber R. Titus , Lydia A. Heemstra , Colleen M. Novak

As obesity and overweight continue to be a public health burden throughout the world, approaches to increase energy expenditure (EE) are sought to reverse the energy imbalance underlying weight gain. Skeletal muscle is a promising target for enhancing energy expenditure. We have previously shown that exposure to predator odor induces skeletal muscle thermogenesis and results in increased physical activity, energy expenditure, and weight loss in rats. Prior evidence supports the importance of sympathetic nervous system (SNS) activation of skeletal muscle through β adrenergic receptors. Here, we measured norepinephrine turnover (NETO) rate to demonstrate that predator threat increases SNS outflow to skeletal muscle and brown adipose tissue (BAT), as well as some white adipose depots, in rats. We surgically excised the primary BAT depot to probe the potential contribution of BAT to muscle thermogenesis. Rats lacking interscapular BAT (iBATX) showed no discernable deficit in predator odor-induced muscle thermogenesis, but showed some differential response to the β3 adrenergic agonist CL-316,243. Altogether, this reaffirms the importance of SNS outflow to skeletal muscle in the thermogenesis elicited by predator threat.

由于肥胖和超重仍然是世界各地的公共卫生负担，因此寻求增加能量消耗（EE）的方法来扭转体重增加背后的能量不平衡。骨骼肌是增强能量消耗的一个有希望的目标。我们之前的研究表明，暴露在捕食者的气味中会诱导骨骼肌产热，导致大鼠的身体活动增加，能量消耗增加，体重减轻。先前的证据支持通过β肾上腺素能受体激活骨骼肌的交感神经系统（SNS）的重要性。在这里，我们测量了去甲肾上腺素周转率（NETO），以证明捕食者的威胁增加了大鼠向骨骼肌和棕色脂肪组织（BAT）以及一些白色脂肪库的SNS流出。我们手术切除了主要的BAT库，以探讨BAT对肌肉产热的潜在贡献。缺乏肩关节间BAT （iBATX）的大鼠在捕食者气味诱导的肌肉产热中没有明显的缺陷，但对β3肾上腺素能激动剂CL-316,243表现出不同的反应。总之，这重申了SNS向骨骼肌流出在食肉动物威胁引起的产热中的重要性。

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引用次数: 0

Acute hyperoxia elicits decreases in muscle sympathetic nerve activity and action potential activation in a sex-dependent manner 急性高氧引起肌肉交感神经活动和动作电位激活以性别依赖的方式减少

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1016/j.autneu.2025.103287

Jinan Saboune , Brittany K. Schwende , Amélie Debray , Charlotte W. Usselman , Margie H. Davenport , Craig D. Steinback

Acute hyperoxia (100 % oxygen) has been shown to reduce muscle sympathetic nerve activity (MSNA), suggesting that hyperoxia could be a potential strategy for lowering blood pressure. However, the efficacy of hyperoxia to reduce blood pressure (e.g., mean arterial pressure; MAP) remains unclear. Therefore, we compared MSNA and MAP responses to acute hyperoxia (1-min pokilocapnic + 3-min, PetO₂ O₂ + 300 Torr) between 18 females and 13 males. Baseline integrated total MSNA was not different between females and males (24 ± 7 vs 23 ± 8 bursts/min, respectively; P = 0.68) while MAP was lower in females than males (85 ± 7 vs 93 ± 7 mmHg; P < 0.01). Overall, hyperoxia evoked reductions in MSNA burst frequency (BF; P = 0.02) but not burst amplitude (BA; P = 0.82) or total MSNA (=BF ∗ BA; P = 0.26), To further probe these responses, 1-min nadir total MSNA response to hyperoxia were extracted within each participant. Total MSNA was reduced from baseline during nadir hyperoxia only in males (sex ∗ cond: P = 0.04). Females exhibited a bimodal distribution of sympatho-inhibitors (F_I) and non-inhibitors (F_NI). F_NI demonstrated limited reductions in BF (P = 0.11 vs inhibitors) coupled with increases in BA (P < 0.01 vs inhibitors), resulting in no net change in total MSNA (P < 0.01 vs inhibitors). Mechanistically, action potential (AP) detection analyses revealed that F_NI increased AP firing during hyperoxia (baseline: 313 ± 172 vs hyperoxia: 404 ± 192 spikes/min; P = 0.02), whereas hyperoxia blunted AP firing in F_I (baseline: 387 ± 263 vs hyperoxia: 267 ± 199 spikes/min; P = 0.02). In sum, approximately 50 % of healthy females responded to acute hyperoxia with unexpected increases in AP firing. These data may suggest that benefit of hyperoxia as a sympatho-inhibitor may be limited in young and healthy females.

急性高氧（100%氧气）已被证明可以减少肌肉交感神经活动（MSNA），这表明高氧可能是降低血压的潜在策略。然而，高氧降低血压(如平均动脉压；MAP)仍不清楚。因此，我们比较了18名女性和13名男性对急性高氧（1分钟pokilapnic + 3分钟，PetO2 O2 + 300 Torr）的MSNA和MAP反应。基线综合总MSNA在女性和男性之间无差异（分别为24±7 vs 23±8次/分钟）；P = 0.68)，而MAP女性低于男性(85±7 vs 93±7 mmHg；P & lt;0.01)。总体而言，高氧诱发了MSNA突发频率(BF；P = 0.02)，但没有爆发幅度(BA；P = 0.82)或总MSNA (=BF * BA；P = 0.26)，为了进一步探讨这些反应，提取每个参与者对高氧的1分钟最低总MSNA反应。只有男性在最低点高氧时总MSNA较基线降低（性别* cond: P = 0.04）。雌性交感神经抑制剂（FI）和非抑制剂（FNI）呈双峰分布。FNI显示BF的有限减少（P = 0.11 vs抑制剂）以及BA的增加(P <；0.01 vs抑制剂)，导致总MSNA无净变化(P <；0.01 vs抑制剂)。机制上，动作电位（AP）检测分析显示，FNI在高氧状态下增加了AP放电(基线：313±172 vs高氧状态：404±192；P = 0.02)，而高氧降低了FI的AP放电(基线：387±263 vs高氧：267±199尖峰/分钟；p = 0.02)。总而言之，大约50%的健康女性对急性高氧的反应是意想不到的AP放电增加。这些数据可能表明，高氧作为交感神经抑制剂的益处在年轻和健康女性中可能有限。

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引用次数: 0

Long term effects of parity on maternal autonomic function 胎次对产妇自主神经功能的长期影响

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1016/j.autneu.2025.103285

Virginia R. Nuckols , Kristen G. Davis , Mark K. Santillan , Donna A. Santillan , Gary L. Pierce

The mechanisms by which parity and gravidity, number of pregnancies reaching twenty weeks gestational age and total number of pregnancies, respectively, contribute to cardiovascular disease risk remains unknown. Autonomic function was assessed in 65 parous women 1–5 years after normotensive pregnancy, quantified by spontaneous cardiovagal baroreflex sensitivity (BRS) and beat-to-beat blood pressure variability (BPV). Gravidity was negatively associated with BRS independent of age and body mass index (β = −2.01, P = 0.003). A similar trend was observed with greater parity (β = −1.74, P = 0.06). Gravidity and parity were not associated with BPV. These findings suggest a persistent and cumulative adverse effect of pregnancy on cardiac autonomic function in women.

胎次和妊娠、达到20周孕龄的怀孕次数和怀孕总数分别导致心血管疾病风险的机制尚不清楚。通过自发性心血管压力反射敏感性（BRS）和搏动间血压变异性（BPV）对65例正常妊娠后1-5年的产妇的自主神经功能进行了评估。体重与BRS呈负相关，与年龄和体重指数无关（β = - 2.01, P = 0.003）。在更大的宇称中观察到类似的趋势（β = - 1.74, P = 0.06）。重力和胎次与BPV无关。这些发现表明妊娠对妇女心脏自主神经功能有持续和累积的不良影响。

引用次数: 0

Self-organized criticality, dragon kings, black swans, and the prediction of vasovagal syncope 自组织临界，龙王，黑天鹅，和血管迷走神经性晕厥的预测

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical

Pub Date : 2025-08-01 Epub Date: 2025-06-05 DOI: 10.1016/j.autneu.2025.103308

Sarah Kerkouri , Jacques-Olivier Fortrat

Vasovagal events occur across a spectrum, from minor events to severe episodes resulting in syncope. The intensity distribution of these events follows a power law, as described by the universal theory of self-organized criticality (SOC). Extreme SOC events may manifest as unpredictable “black swans” or predictable outliers called “dragon kings.” This study aimed to characterize the nature of the most significant events leading to (near)syncope.

We analyzed RR-interval time series from eleven healthy individuals who experienced vasovagal (near)syncope during a head-up tilt test. Bradycardia sequences were evaluated based on their intensity (number of beats) to construct Zipf's distributions and calculate the regression coefficient (r). Following the latest three-step approach for identifying event types, we first compared Zipf's distributions with and without the vasovagal (VV) event. Next, we applied time rescaling, and finally, we refined the definition of bradycardia sequences.

The first step failed to demonstrate vasovagal syncope as a dragon king (r without VV vs. r with VV: 0.98 ± 0.00 and 0.98 ± 0.00, respectively). The second step proved inconclusive, as time rescaling disrupted the power law distribution. However, the third step revealed that the largest events acted as outliers or predictable dragon kings, significantly altering the correlation coefficient of event distribution (r without vs. with outliers: 0.98 ± 0.01 and 0.86 ± 0.02, respectively, p = 0.001).

Our findings suggest that vasovagal syncope represents a dragon king in a self-organized system poised at criticality. These results pave the way for predicting vasovagal syncope based on recent advancements in SOC theory.

血管迷走神经事件发生的范围很广，从轻微事件到导致晕厥的严重事件。这些事件的强度分布遵循幂定律，正如自组织临界（SOC）的普遍理论所描述的那样。极端SOC事件可能表现为不可预测的“黑天鹅”或可预测的异常值，称为“龙王”。本研究旨在描述导致（近）晕厥的最重要事件的性质。我们分析了11名在平视倾斜试验中经历血管迷走神经性（近）晕厥的健康个体的rr间隔时间序列。根据心动过缓序列的强度（心跳次数）进行评估，构建Zipf分布，计算回归系数r。根据最新的识别事件类型的三步方法，我们首先比较了有和没有血管迷走神经（VV）事件的Zipf分布。接下来，我们应用时间重新缩放，最后，我们完善心动过缓序列的定义。第一步未能证明血管迷走神经性晕厥为龙王（无VV的r和有VV的r分别为0.98±0.00和0.98±0.00）。第二步被证明是不确定的，因为时间缩放破坏了幂律分布。然而，第三步显示，最大事件作为异常值或可预测的龙王，显著改变了事件分布的相关系数（无异常值和有异常值的r分别为0.98±0.01和0.86±0.02,p = 0.001）。我们的研究结果表明，血管迷走神经性晕厥代表了一个处于临界状态的自组织系统中的龙王。这些结果为基于SOC理论的最新进展预测血管迷走神经性晕厥铺平了道路。

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