Fetal heart rate variability (fHRV) of normal-to-normal (NN) beat intervals provides high-temporal resolution access to assess the functioning of the autonomic nervous system (ANS).
To determine ...critical periods of fetal autonomic maturation. The developmental pace is hypothesized to change with gestational age (GA).
Prospective longitudinal observational study.
60 healthy singleton fetuses were followed up by fetal magnetocardiographic heart rate monitoring 4-11 times (median 6) during the second half of gestation.
FHRV parameters, accounting for differential aspects of the ANS, were studied applying linear mixed models over four predefined pregnancy segments of interest (SoI: <27; 27+0-31+0; 31+1-35+0; >35+1 weeks GA). Periods of fetal active sleep and quiescence were accounted for separately.
Skewness of the NN interval distribution VLF/LF band power ratio and complexity describe a saturation function throughout the period of interest. A decreasing LF/HF ratio and an increase in pNN5 indicate a concurrent shift in sympathovagal balance. Fluctuation amplitude and parameters of short-term variability (RMSSD, HF band) mark a second acceleration towards term. In contrast, fetal quiescence is characterized by sequential, but low-margin transformations; ascending overall variability followed by an increase of complexity and superseded by fluctuation amplitude.
An increase in sympathetic activation, connected with by a higher ability of parasympathetic modulation and baseline stabilization, is reached during the transition from the late 2nd into the early 3rd trimester. Pattern characteristics indicating fetal well-being saturate at 35 weeks GA. Pronounced fetal breathing efforts near-term mirror in fHRV as respiratory sinus arrhythmia.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Stroke-induced immunodepression is a major risk factor for severe infectious complications in the immediate post-stroke period. We investigated the predictive value of heart rate variability (HRV) to ...identify patients at risk of post-stroke infection, systemic inflammatory response syndrome, or severe sepsis during the post-acute interval from days 3 to 5 after stroke onset. A prospective, observational monocentric cohort study was conducted in a university hospital stroke unit of patients with ischemic infarction in the territory of the middle cerebral artery without an ongoing infection at admission. Standard HRV indices were processed from Holter ECG. Recording started within the first day after the onset of stroke. Infection (primary endpoint: pneumonia, urinary tract, unknown localization) was assessed between days 3 and 5. The predictive value of HRV adjusted for clinical data was analyzed by logistic regression models and area under the receiver operating characteristic curve (AUC). From 287 eligible patients, data of 89 patients without event before completion of 24-h Holter ECG were appropriate for prediction of infection (34 events). HRV was significantly associated with incident infection even after adjusting for clinical covariates. Very low frequency (VLF) band power adjusted for both, the National Institutes of Health Stroke Scale (NIHSS) at admission and diabetes predicted infection with AUC = 0.80 (cross-validation AUC = 0.74). A model with clinical data (diabetes, NIHSS at admission, involvement of the insular cortex) performed similarly well (AUC = 0.78, cross-validation AUC = 0.71). Very low frequency HRV, an index of integrative autonomic-humoral control, predicts the development of infectious complications in the immediate post-stroke period. However, the additional predictive value of VLF band power over clinical risk factors such as stroke severity and insular involvement was marginal. The continuous HRV monitoring starting immediately after admission might probably increase the predictive performance of VLF band power. That needs to be clarified in further investigations.
Fetal brain development involves the development of the neuro-vegetative (autonomic) control that is mediated by the autonomic nervous system (ANS). Disturbances of the fetal brain development have ...implications for diseases in later postnatal life. In that context, the fetal functional brain age can be altered. Universal principles of developmental biology applied to patterns of autonomic control may allow a functional age assessment. The work aims at the development of a fetal autonomic brain age score (fABAS) based on heart rate patterns. We analysed n = 113 recordings in quiet sleep, n = 286 in active sleep, and n = 29 in active awakeness from normals. We estimated fABAS from magnetocardiographic recordings (21.4-40.3 weeks of gestation) preclassified in quiet sleep (n = 113, 63 females) and active sleep (n = 286, 145 females) state by cross-validated multivariate linear regression models in a cross-sectional study. According to universal system developmental principles, we included indices that address increasing fluctuation range, increasing complexity, and pattern formation (skewness, power spectral ratio VLF/LF, pNN5). The resulting models constituted fABAS. fABAS explained 66/63% (coefficient of determination R(2) of training and validation set) of the variance by age in quiet, while 51/50% in active sleep. By means of a logistic regression model using fluctuation range and fetal age, quiet and active sleep were automatically reclassified (94.3/93.1% correct classifications). We did not find relevant gender differences. We conclude that functional brain age can be assessed based on universal developmental indices obtained from autonomic control patterns. fABAS reflect normal complex functional brain maturation. The presented normative data are supplemented by an explorative study of 19 fetuses compromised by intrauterine growth restriction. We observed a shift in the state distribution towards active awakeness. The lower WGA dependent fABAS values found in active sleep may reflect alterations in the universal developmental indices, namely fluctuation amplitude, complexity, and pattern formation that constitute fABAS.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
According to recent OECD statistics, Estonia is the European Union country with the highest income inequalities. Among all the ex-Warsaw bloc states, the Baltic country also has the highest household ...debt. Despite these dire socio-economic indicators, Estonia’s path to economic development, the adaptation of the purest forms of neoliberalism to be found in Europe, is often hailed among economists. Former prime minister Mart Laar, one of the key architects of what was dubbed by some the
, admitted that his guideline for the post-Soviet economic reform (and the only book he read on economics) was Milton Friedman’s
How does inequality, social exclusion and growing social stratification manifest itself in Estonian contemporary cinema? The debut films of three directors, Vallo Toomla, Mihkel Ulk and Toomas Hussar, which all have a contemporary setting, address the neoliberal transformation process to various degrees. All three debut films are genre films:
(Hussar, 2012) is a comedy,
(Ulk, 2014) a high-school drama and
(Toomla, 2016) a thriller. None of the films directly addresses the social stratification of Estonian society. The films engage the subject with a low level of politicization, yet each of the films is a chronotope of the engagement of the film medium with society. Especially the question of individual responsibility to society, accountability for social exclusion and possible alternatives to neoliberalism are either addressed in an apprehensive way or, through their absence, deemed irrelevant. How did Friedman’s claim that economic freedom equals political freedom, that the market is the only effective tool and that self-interest is the only acceptable driving force in society affect the Estonian cinemascape? This article argues that the chronotope of contemporary cinema in the small Baltic country is an outopia, a no-place, in which alternatives to the status quo have no more reference points. The outopian outlook on society is manifested either by an absence in the belief of the integrity of politics and media (
), by an implicit acceptance of social exclusion (
) or by the acknowledgement that faking material wealth is the only tool for maintaining social relationships (
).
Objective Carotid endarterectomy and stenting have comparable efficacy in stroke prevention in asymptomatic carotid stenosis. In patients with carotid stenosis, cardiac events have a more than ...threefold higher incidence than cerebrovascular events. Autonomic dysfunction predicts cardiovascular morbidity and mortality, and carotid stenosis interferes with baroreceptor and chemoreceptor function. We assessed the effect of elective carotid revascularization (endarterectomy vs stenting) on autonomic function as a major prognostic factor of cardiovascular health. Methods In 42 patients with ≥70% asymptomatic extracranial carotid stenosis, autonomic function was determined by analysis of heart rate variability (total band power TP, high frequency band power HF, low-frequency band power LF, very low frequency band power VLF), baroreflex sensitivity (αHF, αLF), respiratory chemoreflex sensitivity (central apnea-hypopnea index), and cardiac chemoreflex sensitivity (hyperoxic TP, HF, LF, and VLF ratios) before and 30 days after revascularization. Results Patients with endarterectomy were older than patients with stenting (69 ± 7 vs 62 ± 7 years; P ≤ .008) but did not differ in gender distribution and preintervention autonomic function. Compared with stenting, postintervention heart rate variability was higher (ln TP, 6.7 95% confidence interval (CI), 6.3-7.0 vs 6.1 95% CI, 5.8-6.5; P ≤ .009; ln HF, 4.5 95% CI, 4.1-5.0 vs 4.0 95% CI, 3.4-4.5; P ≤ .05; ln VLF, 6.0 95% CI, 5.7-6.4 vs 5.5 95% CI, 5.2-5.9; P ≤ .02); respiratory chemoreflex sensitivity (central apnea-hypopnea index, 5.5 95% CI, 2.8-8.2 vs 10.0 95% CI, 6.9-13.1; P ≤. 01) and cardiac chemoreflex sensitivity (TP ratio, 1.2 95% CI, 1.1-1.3 vs 1.0 95% CI, 0.9-1.0; P ≤ .0001; HF ratio, 1.4 95% CI, 1.2-1.5 vs 0.9 95% CI, 0.8-1.1; P ≤ .001; LF ratio, 1.5 95% CI, 1.3-1.6 vs 1.0 95% CI, 0.8-1.1; P ≤ .0001; VLF ratio, 1.2 95% CI, 1.1-1.3) vs 1.0 95% CI, 0.9-1.1; P ≤ .002) were lower after endarterectomy. Postintervention baroreflex sensitivity did not differ after endarterectomy and stenting. Conclusions Autonomic function was better after endarterectomy than after stenting. Better autonomic function after endarterectomy was based on restoration of chemoreceptor but not baroreceptor function and may improve cardiovascular long-term outcome.
According to recent OECD statistics, Estonia is the European Union country with the highest income inequalities. Among all the ex-Warsaw bloc states, the Baltic country also has the highest household ...debt. Despite these dire socio-economic indicators, Estonia’s path to economic development, the adaptation of the purest forms of neoliberalism to be found in Europe, is often hailed among economists. Former prime minister Mart Laar, one of the key architects of what was dubbed by some the Estonian Economic Miracle, admitted that his guideline for the post-Soviet economic reform (and the only book he read on economics) was Milton Friedman’s Free to Choose. How does inequality, social exclusion and growing social stratification manifest itself in Estonian contemporary cinema? The debut films of three directors, Vallo Toomla, Mihkel Ulk and Toomas Hussar, which all have a contemporary setting, address the neoliberal transformation process to various degrees. All three debut films are genre films: Mushrooming (Hussar, 2012) is a comedy, Zero Point (Ulk, 2014) a high-school drama and The Pretenders (Toomla, 2016) a thriller. None of the films directly addresses the social stratification of Estonian society. The films engage the subject with a low level of politicization, yet each of the films is a chronotope of the engagement of the film medium with society. Especially the question of individual responsibility to society, accountability for social exclusion and possible alternatives to neoliberalism are either addressed in an apprehensive way or, through their absence, deemed irrelevant. How did Friedman’s claim that economic freedom equals political freedom, that the market is the only effective tool and that self-interest is the only acceptable driving force in society affect the Estonian cinemascape?
(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to ...analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal magnetocardiography with electro-physiologically-based beat-to-beat heart rate recording for analysis of heart rate variability (HRV) and the ‘fetal movement index’ (FMI) was performed. Data were compared to 167 healthy pregnant women retrieved from our pre-existing study database. (3) Results: Fetal vagal tone was increased with gestational diabetes compared to controls, whereas sympathetic tone and FMI did not differ. Within the diabetic population, sympathetic activation was associated with higher maternal blood-glucose levels. Maternal blood-glucose levels correlated positively with birth weight z scores. FMI showed no correlation with birth weight but attenuated the positive correlation between maternal blood-glucose levels and birth weight. (4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls.
•Maternal psychological distress, life event stress, and objective exposure affect offspring outcome.•Functional and structural brain changes underlie the problems observed in the ...offspring.•Alterations in stress system, immune system, and gut microbiome play a significant role.•Epigenetic and telomere biology mechanisms are beginning to be explored.•Interventions focused on offspring also need to be guided by knowledge of changes in biological systems.
Accumulating research shows that prenatal exposure to maternal stress increases the risk for behavioral and mental health problems later in life. This review systematically analyzes the available human studies to identify harmful stressors, vulnerable periods during pregnancy, specificities in the outcome and biological correlates of the relation between maternal stress and offspring outcome. Effects of maternal stress on offspring neurodevelopment, cognitive development, negative affectivity, difficult temperament and psychiatric disorders are shown in numerous epidemiological and case-control studies. Offspring of both sexes are susceptible to prenatal stress but effects differ. There is not any specific vulnerable period of gestation; prenatal stress effects vary for different gestational ages possibly depending on the developmental stage of specific brain areas and circuits, stress system and immune system. Biological correlates in the prenatally stressed offspring are: aberrations in neurodevelopment, neurocognitive function, cerebral processing, functional and structural brain connectivity involving amygdalae and (pre)frontal cortex, changes in hypothalamo-pituitary-adrenal (HPA)-axis and autonomous nervous system.
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