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Elamin ABA, Forsat K, Senok SS, Goswami N. Vagus Nerve Stimulation and Its Cardioprotective Abilities: A Systematic Review. J Clin Med 2023; 12:jcm12051717. [PMID: 36902505 PMCID: PMC10003006 DOI: 10.3390/jcm12051717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Despite the vagus nerve stimulator (VNS) being used in neuroscience, it has recently been highlighted that it has cardioprotective functions. However, many studies related to VNS are not mechanistic in nature. This systematic review aims to focus on the role of VNS in cardioprotective therapy, selective vagus nerve stimulators (sVNS), and their functional capabilities. A systemic review of the current literature was conducted on VNS, sVNS, and their ability to induce positive effects on arrhythmias, cardiac arrest, myocardial ischemia/reperfusion injury, and heart failure. Both experimental and clinical studies were reviewed and assessed separately. Of 522 research articles retrieved from literature archives, 35 met the inclusion criteria and were included in the review. Literature analysis proves that combining fiber-type selectivity with spatially-targeted vagus nerve stimulation is feasible. The role of VNS as a tool for modulating heart dynamics, inflammatory response, and structural cellular components was prominently seen across the literature. The application of transcutaneous VNS, as opposed to implanted electrodes, provides the best clinical outcome with minimal side effects. VNS presents a method for future cardiovascular treatment that can modulate human cardiac physiology. However, continued research is needed for further insight.
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Affiliation(s)
| | - Kowthar Forsat
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Solomon Silas Senok
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Nandu Goswami
- Institute of Physiology (Gravitational Physiology and Medicine), Medical University of Graz, 8036 Graz, Austria
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
- Correspondence:
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Kaniusas E, Samoudi AM, Kampusch S, Bald K, Tanghe E, Martens L, Joseph W, Szeles JC. Stimulation Pattern Efficiency in Percutaneous Auricular Vagus Nerve Stimulation: Experimental Versus Numerical Data. IEEE Trans Biomed Eng 2019; 67:1921-1935. [PMID: 31675313 DOI: 10.1109/tbme.2019.2950777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Percutaneous electrical stimulation of the auricular vagus nerve (pVNS) is an electroceutical technology. The selection of stimulation patterns is empirical, which may lead to under-stimulation or over-stimulation. The objective is to assess the efficiency of different stimulation patterns with respect to individual perception and to compare it with numerical data based on in-silico ear models. METHODS Monophasic (MS), biphasic (BS) and triphasic stimulation (TS) patterns were tested in volunteers. Different clinically-relevant perception levels were assessed. In-silico models of the human ear were created with embedded fibers and vessels to assess different excitation levels. RESULTS TS indicates experimental superiority over BS which is superior to MS while reaching different perception levels. TS requires about 57% and 35% of BS and MS magnitude, respectively, to reach the comfortable perception. Experimental thresholds decrease from non-bursted to bursted stimulation. Numerical results indicate a slight superiority of BS and TS over MS while reaching different excitation levels, whereas the burst length has no influence. TS yields the highest number of asynchronous action impulses per stimulation symbol for the used tripolar electrode set-up. CONCLUSION The comparison of experimental and numerical data favors the novel TS pattern. The analysis separates excitatory pVNS effects in the auricular periphery, as accounted by in-silico data, from the combination of peripheral and central pVNS effects in the brain, as accounted by experimental data. SIGNIFICANCE The proposed approach moves from an empirical selection of stimulation patterns towards efficient and optimized pVNS settings.
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Kaniusas E, Kampusch S, Tittgemeyer M, Panetsos F, Gines RF, Papa M, Kiss A, Podesser B, Cassara AM, Tanghe E, Samoudi AM, Tarnaud T, Joseph W, Marozas V, Lukosevicius A, Ištuk N, Lechner S, Klonowski W, Varoneckas G, Széles JC, Šarolić A. Current Directions in the Auricular Vagus Nerve Stimulation II - An Engineering Perspective. Front Neurosci 2019; 13:772. [PMID: 31396044 PMCID: PMC6667675 DOI: 10.3389/fnins.2019.00772] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/09/2019] [Indexed: 01/05/2023] Open
Abstract
Electrical stimulation of the auricular vagus nerve (aVNS) is an emerging electroceutical technology in the field of bioelectronic medicine with applications in therapy. Artificial modulation of the afferent vagus nerve - a powerful entrance to the brain - affects a large number of physiological processes implicating interactions between the brain and body. Engineering aspects of aVNS determine its efficiency in application. The relevant safety and regulatory issues need to be appropriately addressed. In particular, in silico modeling acts as a tool for aVNS optimization. The evolution of personalized electroceuticals using novel architectures of the closed-loop aVNS paradigms with biofeedback can be expected to optimally meet therapy needs. For the first time, two international workshops on aVNS have been held in Warsaw and Vienna in 2017 within the scope of EU COST Action "European network for innovative uses of EMFs in biomedical applications (BM1309)." Both workshops focused critically on the driving physiological mechanisms of aVNS, its experimental and clinical studies in animals and humans, in silico aVNS studies, technological advancements, and regulatory barriers. The results of the workshops are covered in two reviews, covering physiological and engineering aspects. The present review summarizes on engineering aspects - a discussion of physiological aspects is provided by our accompanying article (Kaniusas et al., 2019). Both reviews build a reasonable bridge from the rationale of aVNS as a therapeutic tool to current research lines, all of them being highly relevant for the promising aVNS technology to reach the patient.
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Affiliation(s)
- Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Stefan Kampusch
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Cologne Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Fivos Panetsos
- Neurocomputing & Neurorobotics Research Group, Complutense University of Madrid, Madrid, Spain
| | - Raquel Fernandez Gines
- Neurocomputing & Neurorobotics Research Group, Complutense University of Madrid, Madrid, Spain
| | - Michele Papa
- Laboratory of Neuronal Networks, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Attila Kiss
- Ludwig Boltzmann Cluster for Cardiovascular Research at Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Bruno Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research at Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Emmeric Tanghe
- Department of Information Technology, Ghent University/IMEC, Ghent, Belgium
| | | | - Thomas Tarnaud
- Department of Information Technology, Ghent University/IMEC, Ghent, Belgium
| | - Wout Joseph
- Department of Information Technology, Ghent University/IMEC, Ghent, Belgium
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Arunas Lukosevicius
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Niko Ištuk
- Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, Split, Croatia
| | | | - Wlodzimierz Klonowski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Giedrius Varoneckas
- Sleep Medicine Centre, Klaipeda University Hospital, Klaipėda, Lithuania
- Institute of Neuroscience, Lithuanian University of Health Sciences, Palanga, Lithuania
| | | | - Antonio Šarolić
- Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, Split, Croatia
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Laborde S, Mosley E, Mertgen A. A unifying conceptual framework of factors associated to cardiac vagal control. Heliyon 2018; 4:e01002. [PMID: 30623126 PMCID: PMC6313821 DOI: 10.1016/j.heliyon.2018.e01002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/20/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022] Open
Abstract
Cardiac vagal control (CVC) reflects the activity of the vagus nerve regulating cardiac functioning. CVC can be inferred via heart rate variability measurement, and it has been positively associated to a broad range of cognitive, emotional, social, and health outcomes. It could then be considered as an indicator for effective self-regulation, and given this role, one should understand the factors increasing and decreasing CVC. The aim of this paper is to review the broad range of factors influencing CVC, and to provide a unifying conceptual framework to integrate comprehensively those factors. The structure of the unifying conceptual framework is based on the theory of ecological rationality, while its functional aspects are based on the neurovisceral integration model. The structure of this framework distinguishes two broad areas of associations: person and environment, as this reflects adequately the role played by CVC regarding adaptation. The added value of this framework lies at different levels: theoretically, it allows integrating findings from a variety of scientific disciplines and refining the predictions of the neurovisceral integration model; methodologically, it helps identifying factors that increase and decrease CVC; and lastly at the applied level, it can play an important role for society regarding health policies and for the individual to empower one's flourishing.
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Affiliation(s)
- Sylvain Laborde
- German Sport University Cologne, Institute of Psychology, Department of Performance Psychology, Germany.,Normandie Université Caen, UFR STAPS, EA 4260, Germany
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Laborde S, Mosley E, Mertgen A. Vagal Tank Theory: The Three Rs of Cardiac Vagal Control Functioning - Resting, Reactivity, and Recovery. Front Neurosci 2018; 12:458. [PMID: 30042653 PMCID: PMC6048243 DOI: 10.3389/fnins.2018.00458] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/15/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of this paper is to set the stage for the vagal tank theory, showcasing a functional resource account for self-regulation. The vagal tank theory, building on neurophysiological, cognitive and social psychology approaches, will introduce a physiological indicator for self-regulation that has mainly been ignored from cognitive and social psychology, cardiac vagal control (also referred to as cardiac vagal activity). Cardiac vagal control reflects the contribution of the vagus nerve, the main nerve of the parasympathetic nervous system, to cardiac regulation. We propose cardiac vagal control to be an indicator of how efficiently self-regulatory resources are mobilized and used. Three systematic levels of cardiac vagal control analysis are suggested: resting, reactivity, and recovery. Based on this physiological indicator we derive the metaphor of the vagal tank, which can get depleted and replenished. Overall, the vagal tank theory will enable to integrate previous findings from different disciplines and to stimulate new research questions, predictions, and designs regarding self-regulation.
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Affiliation(s)
- Sylvain Laborde
- German Sport University Cologne, Cologne, Germany.,EA 4260 Normandie Université, Caen, France
| | - Emma Mosley
- Southampton Solent University, Southampton, United Kingdom.,Bournemouth University, Bournemouth, United Kingdom
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Anderson JG, Suchicital L, Lang M, Kukic A, Mangione L, Swengros D, Fabian J, Friesen MA. The Effects of Healing Touch on Pain, Nausea, and Anxiety Following Bariatric Surgery: A Pilot Study. Explore (NY) 2015; 11:208-16. [DOI: 10.1016/j.explore.2015.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 10/24/2022]
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Djeddi DD, Kongolo G, Stéphan-Blanchard E, Ammari M, Léké A, Delanaud S, Bach V, Telliez F. Involvement of autonomic nervous activity changes in gastroesophageal reflux in neonates during sleep and wakefulness. PLoS One 2013; 8:e83464. [PMID: 24349512 PMCID: PMC3862728 DOI: 10.1371/journal.pone.0083464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/05/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. We sought to establish whether transient ANS dysfunction (as assessed by heart rate variability) is associated with the occurrence of GER events in neonates during sleep and wakefulness. METHODS Nineteen neonates with suspected GER underwent simultaneous, synchronized 12-hour polysomnography and esophageal multichannel impedance-pH monitoring. We compared changes in HRV parameters during three types of periods (control and prior to and during reflux) with respect to the vigilance state. RESULTS The vigilance state influenced the distribution of GER events (P<0.001), with 53.4% observed during wakefulness, 37.6% observed during active sleep and only 9% observed during quiet sleep. A significant increase in the sympathovagal ratio (+32%, P=0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P=0.017)), relative to the control period. This phenomenon was observed during both wakefulness and active sleep. CONCLUSION Our results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux in neonates.
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Affiliation(s)
- Djamal-Dine Djeddi
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
- Pediatric Gastroenterology Unit, Amiens University Medical Center, Amiens, France
| | - Guy Kongolo
- Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
- GRAMFC (INSERM U 1105), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Erwan Stéphan-Blanchard
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Mohamed Ammari
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - André Léké
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
- Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Stéphane Delanaud
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Véronique Bach
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Frederic Telliez
- PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
- * E-mail:
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Kuo P, Bravi I, Marreddy U, Aziz Q, Sifrim D. Postprandial cardiac vagal tone and transient lower esophageal sphincter relaxation (TLESR). Neurogastroenterol Motil 2013; 25:841-e639. [PMID: 23895280 DOI: 10.1111/nmo.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/27/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transient lower esophageal sphincter relaxation (TLESR) is a vagally mediated reflex that occurs most frequently after a meal. Cardiac vagal tone (CVT) decreases after a meal, and correlates with changes in gastric electrical activity. Furthermore, decreased CVT has been reported in patients with gastro-esophageal reflux disease. We therefore aimed to characterize the association between postprandial changes in CVT and the occurrence of TLESR and reflux. METHODS Ten healthy volunteers underwent simultaneous autonomic nervous system, gastric myoelectric activity, lower esophageal-sphincter pressure, and reflux monitoring for 30 min in the fasting state, followed by a standard meal, and a further 4 h postprandially. Results are in mean ± SEM. KEY RESULTS The number of TLESRs (P < 0.0001) and reflux episodes (P < 0.0001) increased after the meal, while CVT decreased (P < 0.01). Cardiac sensitivity to baroreceptor reflex (CSB) showed similar time course changes to CVT (P = 0.06). During the first postprandial hour there was a strong correlation between the number of TLESRs and reflux episodes with CVT (R(2) = 0.51 and R(2) = 0.50, respectively; P < 0.05). There was also an increase in the dominant power and power ratio on electrogastrography (P < 0.05) after the meal. CONCLUSIONS & INFERENCES In healthy volunteers, the increase in the number of TLESRs and reflux episodes after a meal occurred mostly at a time of reduced CVT. Further studies should explore whether modulation of CVT can modify frequency of TLESRs and also this relationship should be further explored in patients with reflux disease.
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Affiliation(s)
- P Kuo
- Centre for Digestive Diseases, Blizard Institute and Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Cipryan L, Litschmannova M. Intra-day and inter-day reliability of heart rate variability measurement. J Sports Sci 2012; 31:150-8. [DOI: 10.1080/02640414.2012.721931] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pollatos O, Schandry R. Accuracy of heartbeat perception is reflected in the amplitude of the heartbeat-evoked brain potential. Psychophysiology 2010; 41:476-82. [PMID: 15102134 DOI: 10.1111/1469-8986.2004.00170.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurotransmission from the heart to the brain results in a heartbeat-evoked potential (HEP). In this study, the influence of the ability to detect one's heartbeats based on the HEP was examined. According to their results in a heartbeat perception task, subjects were classified as good (n=18) or poor (n=26) heartbeat perceivers. EEG, EOG, and ECG were recorded while participants attended to their heartbeats. The R-wave of the ECG served as a trigger for EEG averaging. In the latency range of 250-350 ms after the ECG R-wave, the HEP amplitude at the right central location was significantly higher in good heartbeat perceivers. A significantly positive correlation was observed between the heartbeat perception score and the mean HEP amplitude. Our results confirm that the accuracy of heartbeat perception is reflected in the amplitude of the HEP. Thus, the HEP may be a suitable research tool for the study of brain processes related to visceral perception.
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Affiliation(s)
- Olga Pollatos
- Biological Psychology, Department of Psychology, Ludwig-Maximilians-University Munich, Germany
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Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore (NY) 2010; 6:29-41. [PMID: 20129310 DOI: 10.1016/j.explore.2009.10.004] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Indexed: 12/15/2022]
Abstract
It has become increasingly evident that bidirectional ("top-down and bottom-up") interactions between the brain and peripheral tissues, including the cardiovascular and immune systems, contribute to both mental and physical health. Therapies directed toward addressing functional links between mind/brain and body may be particularly effective in treating the range of symptoms associated with many chronic diseases. In this paper, we describe the basic components of an integrative psychophysiological framework for research aimed at elucidating the underlying substrates of mind-body therapies. This framework recognizes the multiple levels of the neuraxis at which mind-body interactions occur. We emphasize the role of specific fronto-temporal cortical regions in the representation and control of adverse symptoms, which interact reciprocally with subcortical structures involved in bodily homeostasis and responses to stress. Bidirectional autonomic and neuroendocrine pathways transmit information between the central nervous system and the periphery and facilitate the expression of affective, autonomic, hormonal, and immune responses. We propose that heart rate variability (HRV) and markers of inflammation are important currently available indices of central-peripheral integration and homeostasis within this homeostatic network. Finally, we review current neuroimaging and psychophysiological research from diverse areas of mind-body medicine that supports the framework as a basis for future research on the specific biobehavioral mechanisms of mind-body therapies.
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Herbert BM, Pollatos O. Interozeptive Sensitivität, Gefühle und Verhaltensregulation. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2008. [DOI: 10.1024/1016-264x.19.3.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die zentralnervöse Verarbeitung afferenter Signale aus dem Körperinneren ist nicht nur bei der basalen Kontrolle homöostatischer Prozesse im Körper zur Regulation fundamentaler Adaptationsprozesse des Organismus relevant, sondern spielt zusammen mit der bewussten Perzeptionsgenauigkeit dieser körperlichen Signale („interozeptive Sensitivität“) auch bei der Regulation komplexer kognitiver, emotionaler und behavioraler Prozesse eine nicht zu unterschätzende Rolle. Diese Übersichtsarbeit stellt theoretische Grundlagen zur interozeptiven Sensitivität dar und gibt einen Überblick über aktuelle empirische Forschungsergebnisse.
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Affiliation(s)
- Beate M. Herbert
- Institut für Neuropsychologie und Klinische Psychologie, Ruprecht-Karls-Universität Heidelberg, Zentralinstitut für Seelische Gesundheit, Mannheim, Department Psychologie, Ludwig-Maximilians-Universität München
| | - Olga Pollatos
- Department Psychologie, Ludwig-Maximilians-Universität München, Neurologische Poliklinik, Department Neurologie, Ludwig-Maximilians-Universität München
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Bär KJ, Boettger MK, Neubauer R, Grotelüschen M, Jochum T, Baier V, Sauer H, Voss A. Heart rate variability and sympathetic skin response in male patients suffering from acute alcohol withdrawal syndrome. Alcohol Clin Exp Res 2006; 30:1592-8. [PMID: 16930222 DOI: 10.1111/j.1530-0277.2006.00191.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. METHODS We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n = 20, no treatment required) and in patients with moderate to severe AW syndrome (n = 20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. RESULTS Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. CONCLUSIONS We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies.
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Affiliation(s)
- Karl-Jürgen Bär
- Department of Psychiatry, Friedrich-Schiller-University of Jena, Jena, Germany.
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Lee YC, Wang HP, Lin LY, Chuang KJ, Chiu HM, Wu MS, Chen MF, Lin JT. Circadian change of cardiac autonomic function in correlation with intra-esophageal pH. J Gastroenterol Hepatol 2006; 21:1302-8. [PMID: 16872314 DOI: 10.1111/j.1440-1746.2006.04147.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Although autonomic alterations are observed in patients with gastroesophageal reflux disease (GERD), the influence of visceral receptor responses on the dynamics of autonomic function remains unknown. The aim of this study was to investigate the autonomic functional changes in association with intra-esophageal pH under ambulation. METHODS Thirty patients referred for 48 h ambulatory pH monitoring underwent simultaneous 24 h cardiac monitoring for heart rate variability (HRV). We used linear mixed-effects models to estimate the relationship between esophageal acid exposure and power spectral analysis of HRV, including low-frequency power (0.04 < LF < 0.15 Hz), high-frequency power (0.15 < or = HF < 0.4 Hz), and LF/HF power ratio. RESULTS Over the 24-h period, patients with pathological reflux had lower average LF and HF powers than patients with functional heartburn, but the LF/HF power ratios were similar for the two patient groups. As we stratified the data according to waking and sleeping times, a significantly higher HF power but lower LF/HF power ratio was found during sleeping time regardless of diagnosis. In the regression analysis, esophageal pH was positively associated with change (not basal tone) of both LF and HF powers during waking, but only with change of HF power during sleeping time. The significant associations between pH values and changes in HRV decreased gradually with time. The LF/HF power ratio did not alter significantly with pH. CONCLUSION Esophageal acid exposure is generally associated with decreases in autonomic tone. A predominant parasympathetic fluctuation during sleeping and a superimposed sympathetic interaction during waking dictate diurnal characteristics of autonomic regulation.
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Affiliation(s)
- Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Cuomo R, De Giorgi F, Adinolfi L, Sarnelli G, Loffredo F, Efficie E, Verde C, Savarese MF, Usai P, Budillon G. Oesophageal acid exposure and altered neurocardiac function in patients with GERD and idiopathic cardiac dysrhythmias. Aliment Pharmacol Ther 2006; 24:361-70. [PMID: 16842463 DOI: 10.1111/j.1365-2036.2006.02987.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oesophageal sensory stimuli alter neurocardiac function through autonomic reflexes. AIM To evaluate in patients with idiopathic supraventricular cardiac dysrhythmias and gastro-oesophageal reflux disease (GERD) whether GE reflux alters neurocardiac function and the effect of acid suppression on cardiac symptoms. METHODS Thirty-two patients (13 females and 19 males; age: 20-69 years) with dysrhythmias plus GERD, and nine patients (five females and four males; age: 43-58 years) with GERD only, underwent simultaneous 24-h pH-metry and ECG monitoring. Power spectrum analysis of heart rate variability (PSHRV) was obtained with both its low frequency (LF, sympathetic modulation) and high frequency (HF, vagal modulation) components. Hourly mean oesophageal pH and LF/HF ratio were correlated. A 3 months full-dosage PPI therapy (esomeprazole 40 mg/day) was prescribed. RESULTS In 18 (56%) of the 32 patients with dysrhythmia and in none with GERD only, a significant (P < 0.05) correlation between oesophageal pH and LF/HF ratio (oesophagus-heart correlation) was observed. A significant reduction of cardiac symptoms after PPI therapy was observed only in these patients (13/16 vs. 4/11, P < 0.01). CONCLUSIONS This study has identified a subgroup of dysrhythmic patients in whom the oesophageal acid stimulus elicited cardiac autonomic reflexes. In these patients acid suppression seems to improve GERD and cardiac symptoms.
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Affiliation(s)
- R Cuomo
- Department of Clinical and Experimental Medicine, Gastroenterology, University Federico II, Naples, Italy.
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Somsen RJM, Jennings JR, Van der Molen MW. The cardiac cycle time effect revisited: temporal dynamics of the central-vagal modulation of heart rate in human reaction time tasks. Psychophysiology 2005; 41:941-53. [PMID: 15563347 DOI: 10.1111/j.1469-8986.2004.00241.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lacey and Lacey (1974) suggested that during reaction time tasks higher brain centers dynamically adjust efferent vagal nerve pulses to the sino-atrial node of the heart, inducing phase-dependent heart rate changes. Since then, animal and human neuro-physiological results have provided evidence for this hypothesis. Higher subcortical and cortical brain centers may have reciprocal interactive pathways relating to autonomic control comparable to those at the level of peripheral autonomic changes and brain stem reflexes. In humans such central effects may be observed in the short latency vagal control of heart rate that has been studied mostly in reaction time (RT) tasks. RT task parameters modulate vagal pulses to the cardiac sino-atrial node (SAN), which in turn exerts a phase-dependent change in the ongoing cardiac interbeat interval. Simulations of human RT task effects in an animal model of heart rate change support this hypothesis. The current study examined evidence for vagal control of three human phasic heart rate responses in RT tasks. The evidence indicates that the initiation of an RT response triggers a reflexive shift from vagal activation to vagal inhibition. This shift is cardiac cycle phase dependent. Graded anticipatory cardiac deceleration during the warning interval of an RT task varies with task relevance and time uncertainty. This response may be part of a control process engaged in time keeping. Hence, temporal variables mediate the central-autonomic-vagal modulation of heart rate.
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Affiliation(s)
- Riek J M Somsen
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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17
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Lee YC, Wang HP, Lin LY, Lee BC, Chiu HM, Wu MS, Chen MF, Lin JT. Heart rate variability in patients with different manifestations of gastroesophageal reflux disease. Auton Neurosci 2005; 116:39-45. [PMID: 15556836 DOI: 10.1016/j.autneu.2004.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Revised: 06/05/2004] [Accepted: 08/17/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Autonomic nervous dysfunction has frequently been observed in patients with gastroesophageal reflux diseases (GERD) and impacts the pathogenesis of GERD. However, the characteristics that distinguish between GERD patients with different manifestations remain unknown. AIM To investigate the autonomic nervous function in subgroups of GERD patients. PATIENTS Of the 164 participants in this study, 57 were healthy controls, 34 had non-erosive reflux disease (NERD), 40 had symptomatic esophagitis (SE), and 33 asymptomatic esophagitis (AE). METHODS Resting autonomic activity was assessed by measuring the 5-min heart rate variability (HRV) and HRV indices including time-domain parameters (standard deviation of normal-to-normal intervals [SDNN] and root mean square of successive differences [RMSSD]) and frequency-domain parameters (low-frequency power [LF; 0.04-0.15 Hz], high-frequency power [HF; 0.15-0.4 Hz], and LF/HF power ratio). Mental stress was assessed by use of a self-reported questionnaire (Brief Symptom Rating Scale [BSRS]). RESULTS HF power was (ANOVA, p=0.041) but time-domain parameters, LF power, LF/HF power ratio, and BSRS parameters were not significantly different between the four groups. A higher HF power was found in examinees with NERD than in those with SE and AE (LSD methods: both p=0.02). When split into two groups (erosive vs. non-erosive), nearly all measures of autonomic tonus were significantly lower in the erosive than non-erosive group. Age and the presence of endoscopic esophagitis influenced the RMSSD and HF power results in the regression analysis. Mental stress or gender did not correlate with any HRV index. CONCLUSION In comparison with NERD subjects, autonomic tonus in patients with endoscopically confirmed esophagitis (even without symptom) is lower. This finding may suggest that the structural state of esophagus but not symptomatology dictates autonomic function status.
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Affiliation(s)
- Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, Taiwan
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18
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Gilad O, Swenne CA, Davrath LR, Akselrod S. Phase-averaged characterization of respiratory sinus arrhythmia pattern. Am J Physiol Heart Circ Physiol 2005; 288:H504-10. [PMID: 15388498 DOI: 10.1152/ajpheart.00366.2004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A method for the accurate time-domain characterization of respiratory sinus arrhythmia (RSA) pattern is presented and applied to two groups of healthy subjects to lay the baseline of RSA patterns and to underlay their features: response to standing, stability in successive recordings, and individuality of the shape of RSA pattern. RSA pattern is evaluated by selective averaging of heart rate (HR) changes from multiple respiratory cycles over the respiratory phase and represents the complete modulating function of HR by respiration. The RSA pattern is evaluated with free respiration and even in cases of severe arrhythmia. Estimation error is 6–8% in magnitude, phase resolution is 0.2 rad, and sensitivity margin for respiratory-related HR variability (HRV) components is 1%. RSA magnitude, phase lag, and expiration-to-inspiration time ratio are derived in addition to the entire pattern. In a group of 10 healthy young adults, a phase lag difference of 11.4 ± 8.5% (mean ± SD, P < 0.004) was observed between supine and standing postures, possibly ascribed to breathing mechanics. A second group of 15 healthy young adults at supine rest showed stability of the RSA pattern in successive recordings (several weeks apart) as well as individuality among subjects. This may suggest a nonscalar individual long-term index for cardiorespiratory coupling. The method is complementary to the existing statistical and spectral methods. It allows the complete characterization of the primary RSA components and may provide new insight into the effects of vagal activity and changes in clinical conditions.
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Affiliation(s)
- O Gilad
- Raymond and Beverly Sackler Faculty of Exact Sciences, School of Physics and Astronomy, Abramson Center for Medical Physics, Tel Aviv University, Tel Aviv, Israel
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Drewes AM, Gregersen H, Arendt-Nielsen L. Experimental pain in gastroenterology: a reappraisal of human studies. Scand J Gastroenterol 2003; 38:1115-30. [PMID: 14686714 DOI: 10.1080/00365520310004399] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A M Drewes
- Center for Visceral Biomechanics and Pain, Dept. of Medical Gastroenterology, Aalborg University Hospital, Denmark.
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Abstract
Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. Decisions about anorexia and cachexia treatment are guided by prioritizing the different, concurrent physical, psychosocial, and existential problems and by considering the natural course of the cancer and the effects of antineoplastic therapies. Reversible causes for anorexia and cachexia need to be identified and treated, if appropriate. Nutritional interventions are often indicated; patients with a predominant starvation component and without inflammation may profit the most. New pharmacologic therapies for primary anorexia and cachexia syndrome are expected to enter clinical practice soon; however, until then, treatment with corticosteroids, progestins, or prokinetics may be indicated for some patients. To understand a multicausal syndrome, multimodal and interdisciplinary therapy is required. Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.
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Affiliation(s)
- Florian Strasser
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0008, Houston, TX 77030, USA
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