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Anil A, Netam RK, Roy A, Chandran DS, Jaryal AK, Makharia GK, Parshad R, Deepak KK. Cardiovascular Autonomic Deficits in Different Types of Achalasia. Cureus 2024; 16:e59444. [PMID: 38826939 PMCID: PMC11140828 DOI: 10.7759/cureus.59444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Background and objective Achalasia cardia is a primary esophageal motility disorder, and the etiopathology of this disease's progression is not known. Moreover, autonomic dysfunction has not been studied in different types of achalasia. In light of this, we aimed to address this lack of data in this study. Methods The diagnosis of achalasia was done using high-resolution esophageal manometry (HRM)-based Chicago classification v4.0. Autonomic function tests (AFT) such as the head-up tilt test, deep breathing test (DBT), Valsalva maneuver (VM), handgrip test (HGT), and cold pressor test (CPT), as well as the heart rate variability (HRV) test, were performed among the cohort and the results were compared with those of 39 age- and sex-matched healthy controls. Results AFT and HRV tests were done on 62 patients (30 achalasia type I, 28 type II, and 4 type III) and compared with 39 age- and sex-matched healthy controls. The mean duration of symptoms, high Eckardt score, and dysphagia were most common in type I achalasia, followed by type II and III. The results of AFT showed a generalized loss of parasympathetic and baroreflex-independent sympathetic reactivity in all types of achalasia. However, baroreflex-dependent cardiovascular adrenergic reactivity was normal. Regarding cardiac autonomic tone, there was a loss of parasympathetic and sympathetic influence, but sympathovagal balance was maintained. The severity of the loss of autonomic functions was higher in type I, followed by type II. Conclusions In all types of achalasia, parasympathetic reactivity, baroreflex-independent sympathetic reactivity, and cardiac autonomic tone were lower compared to healthy controls, and the severity of dysfunction increased during the progression of the disease from type II to type I.
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Affiliation(s)
- Abhijith Anil
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ritesh K Netam
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Atanu Roy
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Dinu S Chandran
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rajinder Parshad
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Furuzawa-Carballeda J, Barajas-Martínez A, Olguín-Rodríguez PV, Ibarra-Coronado E, Fossion R, Coss-Adame E, Valdovinos MA, Torres-Villalobos G, Rivera AL. Achalasia alters physiological networks depending on sex. Sci Rep 2024; 14:2072. [PMID: 38267468 PMCID: PMC10808234 DOI: 10.1038/s41598-024-52273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
Achalasia is a rare esophageal motility disorder for which the etiology is not fully understood. Evidence suggests that autoimmune inflammatory infiltrates, possibly triggered by a viral infection, may lead to a degeneration of neurons within the myenteric plexus. While the infection is eventually resolved, genetically susceptible individuals may still be at risk of developing achalasia. This study aimed to determine whether immunological and physiological networks differ between male and female patients with achalasia. This cross-sectional study included 189 preoperative achalasia patients and 500 healthy blood donor volunteers. Demographic, clinical, laboratory, immunological, and tissue biomarkers were collected. Male and female participants were evaluated separately to determine the role of sex. Correlation matrices were constructed using bivariate relationships to generate complex inferential networks. These matrices were filtered based on their statistical significance to identify the most relevant relationships between variables. Network topology and node centrality were calculated using tools available in the R programming language. Previous occurrences of chickenpox, measles, and mumps infections have been proposed as potential risk factors for achalasia, with a stronger association observed in females. Principal component analysis (PCA) identified IL-22, Th2, and regulatory B lymphocytes as key variables contributing to the disease. The physiological network topology has the potential to inform whether a localized injury or illness is likely to produce systemic consequences and the resulting clinical presentation. Here we show that immunological involvement in achalasia appears localized in men because of their highly modular physiological network. In contrast, in women the disease becomes systemic because of their robust network with a larger number of inter-cluster linkages.
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Affiliation(s)
- Janette Furuzawa-Carballeda
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Antonio Barajas-Martínez
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
| | - Paola V Olguín-Rodríguez
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
| | - Elizabeth Ibarra-Coronado
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico
| | - Enrique Coss-Adame
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Miguel A Valdovinos
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Gonzalo Torres-Villalobos
- Departments of Surgery and Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico.
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, 14060, Mexico, Mexico.
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Żyliński M, Niewiadomski W, Cybulski G, Gąsiorowska A. Device for Controlling Stimulus Self-Application During Autonomic Nervous System Tests. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:165-172. [PMID: 34104008 PMCID: PMC8179790 DOI: 10.2147/mder.s300384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Assessment of autonomic nervous system (ANS) functioning may be performed non-invasively using autonomic tests which are based on evaluation of response of cardiovascular system to the applied stimuli, such as increased air pressure during Valsalva maneuver, skeletal muscle contraction during static handgrip or deep slow breathing. The cardiovascular response depends, besides ANS reaction and test protocol, also on the way stimulus is self-applied by the test subject. We present a versatile device for controlling stimulus self-application during three ANS tests: Valsalva maneuver, static handgrip, and deep breathing. It integrates two different gauges and a pace setter for breathing into one device. The core of the device is a linear LED display which, using green, yellow, and red diodes, informs the subject about the correctness of self-application of respective stimulus. The settings of the device can be adjusted to the needs of the protocol chosen. The device can record the duration of mouth air pressure or the force produced by the subject during ANS tests, which assures correctness of the tests, thus allowing to track individual variability changes in the response to the test. The device was verified during ANS tests and its use was intuitive for patients, reducing the time needed for training before tests and decreasing the effort of the physician.
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Affiliation(s)
- Marek Żyliński
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Wiktor Niewiadomski
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Gerard Cybulski
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Anna Gąsiorowska
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
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Barajas-Martínez A, Ibarra-Coronado E, Fossion R, Toledo-Roy JC, Martínez-Garcés V, López-Rivera JA, Tello-Santoyo G, Lavin RD, Gómez JL, Stephens CR, Aguilar-Salinas CA, Estañol B, Torres N, Tovar AR, Resendis-Antonio O, Hiriart M, Frank A, Rivera AL. Sex Differences in the Physiological Network of Healthy Young Subjects. Front Physiol 2021; 12:678507. [PMID: 34045977 PMCID: PMC8144508 DOI: 10.3389/fphys.2021.678507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Within human physiology, systemic interactions couple physiological variables to maintain homeostasis. These interactions change according to health status and are modified by factors such as age and sex. For several physiological processes, sex-based distinctions in normal physiology are present and defined in isolation. However, new methodologies are indispensable to analyze system-wide properties and interactions with the objective of exploring differences between sexes. Here we propose a new method to construct complex inferential networks from a normalization using the clinical criteria for health of physiological variables, and the correlations between anthropometric and blood tests biomarkers of 198 healthy young participants (117 women, 81 men, from 18 to 27 years old). Physiological networks of men have less correlations, displayed higher modularity, higher small-world index, but were more vulnerable to directed attacks, whereas networks of women were more resilient. The networks of both men and women displayed sex-specific connections that are consistent with the literature. Additionally, we carried out a time-series study on heart rate variability (HRV) using Physionet's Fantasia database. Autocorrelation of HRV, variance, and Poincare's plots, as a measure of variability, are statistically significant higher in young men and statistically significant different from young women. These differences are attenuated in older men and women, that have similar HRV distributions. The network approach revealed differences in the association of variables related to glucose homeostasis, nitrogen balance, kidney function, and fat depots. The clusters of physiological variables and their roles within the network remained similar regardless of sex. Both methodologies show a higher number of associations between variables in the physiological system of women, implying redundant mechanisms of control and simultaneously showing that these systems display less variability in time than those of men, constituting a more resilient system.
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Affiliation(s)
- Antonio Barajas-Martínez
- Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Elizabeth Ibarra-Coronado
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Claudio Toledo-Roy
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Vania Martínez-Garcés
- Plan de Estudios Combinados en Medicina (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Antonio López-Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Rusland D Lavin
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - José Luis Gómez
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Christopher R Stephens
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Bruno Estañol
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Nimbe Torres
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Armando R Tovar
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Osbaldo Resendis-Antonio
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto Nacional de Medicina Genómica, Coordinación de la Investigación Científica-Red de Apoyo a la Investigación, UNAM, Mexico City, Mexico
| | - Marcia Hiriart
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Fisiología Celular, Mexico City, Mexico
| | - Alejandro Frank
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico.,El Colegio Nacional, Mexico City, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
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