The detection and quantification of coupling strength and direction are important aspects for achieving a deeper understanding of physiological regulatory processes in the field of network physiology. Due to the limitations of established approaches, we developed directionality indices based on simple mathematical symbolization principles and simple computational procedures that allow a quick and comprehensive understanding of the underlying couplings. We introduced a new directionality index (DHRJSD) derived from the pattern family density matrix of the High-Resolution Joint Symbolic Dynamics (HRJSD) approach and its multivariate version (mHRJSD) to determine coupling direction and driver-response relationships. The mHRJSD approach contains the multivariate directionality index DmHRJSD (DmHRJSD(x,y|z), DmHRJSD(x,z|y), and DmHRJSD(y,z|x)), allowing us to determine the primary driver **DmHRJSD, the secondary driver *DmHRJSD, and the dominant responder −DmHRJSD in multivariate systems that are at least weakly coupled. Different linear and non-linear bi- and multivariate coupled systems (Gaussian autoregressive models) with different mutual influences were generated to validate these indices. The simulation results showed that DHRJSD was able to correctly detect the dominant coupling direction in linear bivariate coupled systems but was partly able to detect the dominant coupling direction in non-linear bivariate coupled systems. The proposed directionality index DmHRJSD derived from the mHRJSD approach is able to correctly detect the driver-responder relationships in linear coupled systems. The main advantages of the newly introduced directionality indices include their insensitivity to non-stationary time series, their ability to capture couplings through a simple, fast, and easy-to-implement symbolization procedure, and their scale invariance. Additionally, they are independent of time series length, model order selection, and the procedure for determining their significance level.

Introduction: Expression of ER, PR, HER2, and Ki67 serve as valuable prognostic and predictive markers, with PGR expression believed to predict favourable outcomes in ER+ HER2- breast cancer (BC). Traditionally, the expression of these markers is determined by immunohistochemistry (IHC), which is well established for ER, PR and HER2, but for Ki-67 faces challenges in standardization. Several quantitative gene expression tests, like Oncotype Dx, aim to overcome these challenges but are often limited by their costs. The APIS Breast Cancer Subtyping Kit offers an accurate and cost-efficient method for determining ER/PR, HER2, and Ki67 expression. This study seeks to assess the relationship between Oncotype Dx recurrence score (RS) and PGR expression as determined by the APIS kit. Methods: Tissue from a cohort (N=153) of ER+/HER- BC patients diagnosed between 2020 and 2022 at Cantonal Hospital Basel-Land and Basel University Hospital was included in this study. Each patient had a valid Oncotype DX RS score on file and received at least one line of adjuvant therapy. PGR expression was determined using the APIS kit, following instructions for use. Spearman correlation tests were applied to the data to examine the association between the tests. The model classification explorer (JMP v 16.0) was used to predict PGR expression cut-offs for RS and plot a receiver operator curve (ROC) for the data. Results: A moderate Spearman’s correlation coefficient of ρ = -0.4876 between the APIS kit and the Oncotype Dx RS was observed. ROC curve for PGR prediction of oncotype score was (0.782 (95% CI 0.717-0.847)). When stratifying RS scores by low (<26) and high risk (>26) a PGR ∆Ct of above 3.06 was calculated to identify the low-risk group. The specificity for low-risk RS was 93.5% (95% CI 79.3-98.2%), with a positive predictive value of 0.949. Conclusions: This study demonstrates that PGR expression, as assessed by APIS Breast Cancer Subtyping Kit, could potentially predict low-risk tumours identified by Oncotype Dx reliably, offering a cost-effective pre-screening tool. Additional validation is necessary to affirm its diagnostic accuracy. Citation Format: Anna Gasior, Marcus Vetter, Elena-Diana Chiru, Joanna Gorniak, Sara Rollinson, Andreas Voss, Leanne Gough, Mathew Harrison, Kimberly Howard, Martina Sonderegger-Stalder, Matthias Matter, Simone Muenst, Christian Kurzeder. High Progesterone Receptor (PR/PGR) Expression Determined by APIS Breast Cancer Subtyping Kit Correlates with Oncotype Dx Recurrence Score [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-11-13.

Underlying biological mechanisms leading to the dramatically increased cardiac mortality in patients with schizophrenia (SCZ) are largely unknown. Cardiac autonomic dysfunction (CADF), which has been extensively described in patients with SCZ, represents an important physiological link to cardiovascular disease (CVD). This study investigated the prevalence of CADF in patients with SCZ using HRV across multiple domains (time and frequency, nonlinear dynamics, complexity measures, symbolic dynamics, and segmented Poincaré plot analysis). HRV-based clustering classified 119 SCZ patients as having or not having CADF based on deviations from 119 age- and sex-matched healthy controls. Our findings showed that approximately half of the patients had normal cardiac autonomic function, while the other half had significant abnormalities. The severity of CADF correlated with age, body mass indes (BMI), disease duration, and symptom severity. About half of SCZ patients have significant CADF, which increases their risk for cardiac events. These findings highlight the potential of HRV-based biomarkers in improving CVD risk prediction and stratification in SCZ. Future research should explore integrating HRV analysis with other biomarkers to enhance early detection and intervention strategies.

The detection and quantification of the coupling strength and direction are important aspects for a more detailed understanding of physiological regulatory processes in the field of Network Physiology. Here, we introduced a new directionality index ($D_{\text {HRJsd }}$) derived from the pattern family density matrix from the High Resolution Joint Symbolic Dynamics approach (HRJSD) to determine the coupling direction and driver-response relationships. For the validation of this index different linear and non-linear multivariate coupled systems (Gaussian autoregressive models) with different mutual influences were generated. The simulation results revealed that $D_{\text {HRJSd }}$ was able to correctly detect the dominating coupling direction in linear bivariate coupled systems, but is only partly able to detect the dominating coupling direction in non-linear bivariate coupled systems.

Abstract Background Healthcare professionals in hospitals are exposed to a high level of professional stress, time pressure, workload, and often times poor organizational support. This makes them especially susceptible to burnout. In this pragmatic randomized controlled trial, we test the hypothesis that participation in a 9-week program (LAGOM) that was designed in close collaboration with healthcare professionals, incorporating both individual and organizational aspects reduces emotional exhaustion in healthcare professionals (primary outcome). Methods Eighty four nurses and physicians working at the Charité – Universitätsmedizin Berlin and the Immanuel Hospital Berlin are automatically randomized to the LAGOM program (n = 42) or to usual care (n = 42) in a one-to-one allocation rate. The primary outcome emotional exhaustion is measured by the Maslach Burnout Inventory—Human Services Survey at baseline, post-intervention, and 1-month follow-up via an online survey. Secondary outcomes include depersonalization, personal accomplishment, subjective stress, mental well-being, self-care, self-efficacy, working conditions, mindfulness, and adverse events. Electrophysiological measures for heart rate variation analysis are captured. The PRECIS-2 tool is used to characterize the degree of pragmatism in our trial. Data analysis and primary intention-to-treat analysis using repeated measures analysis of variance are performed blind to intervention allocation. Per-protocol, subgroup, and secondary outcome analyses are conducted exploratively. An advisory board consisting of various stakeholders accompanies the study process. Discussion If LAGOM proves to be effective in reducing symptoms of burnout, the program could make an important contribution to tackling the problem of the very high burnout rates among healthcare professionals and become an integral part of preventive services offered by hospitals. Trial registration German Clinical Trials Register, DRKS00034060. Registered 31 May 2024.

Abstract Emotional aging research is dominated by the idea of age-related improvements that result from shifts in motivation. Socioemotional selectivity theory (SST) proposes that as individuals age, they increasingly favor emotion-related goals and savor positive but avoid negative emotions. Previous age-comparative studies on everyday emotional experience typically were descriptive or studied the processes underlying emotional experience in isolation. We aimed at a more holistic approach to test hypotheses derived from SST regarding age-related differences in general emotional dispositions (i.e., anchoring), emotional reactivity, and emotion regulation by using a comprehensive computational approach. We applied our Model of Intraindividual Variability in Affect (MIVA) to data on everyday emotional experiences in an age-diverse sample (N = 378, age range 14 – 86 years). Parameter estimations were carried out within a Bayesian framework. Our results provide partial support for predictions derived from SST. Consistent with SST, affect elicited by pleasant events was down-regulated less by older adults and affect elicited by unpleasant events was down-regulated more by older compared to younger adults. Inconsistent with SST, anchoring showed a negative age-related trend, indicating a more positive general affect disposition in younger, not older adults. Reactions to pleasant events showed no age-related differences. Reactivity to unpleasant events was highest in midlife and lower for younger and older adults. We discuss the broader implications of our approach for understanding emotional development across the lifespan.

EDITORIAL article Front. Netw. Physiol., 13 October 2023Sec. Information Theory Volume 3 - 2023 | https://doi.org/10.3389/fnetp.2023.1284256

A large portion of the elderly population are affected by cardiovascular diseases. Early prognosis of cardiomyopathies remains a challenge. The aim of this study was to classify cardiomyopathy patients by their etiology based on significant indexes extracted from the characterization of the baroreflex mechanism in function of the influence of the cardio-respiratory activity over the blood pressure. Forty-one cardiomyopathy patients (CMP) classified as ischemic (ICM-24 patients) and dilated (DCM-17 patients) were considered. In addition, thirty-nine control (CON) subjects were used as reference. The beat-to-beat (BBI) time series, from the electrocardiographic (ECG) signal, the systolic (SBP), and diastolic (DBP) time series, from the blood pressure signal (BP), and the respiratory time (TT), from the respiratory flow (RF) signal, were extracted. The three-dimensional representation of the cardiorespiratory and vascular activities was characterized geometrically, by fitting a polygon that contains 95% of data, and by statistical descriptive indices. DCM patients presented specific patterns in the respiratory response to decreasing blood pressure activity. ICM patients presented more stable cardiorespiratory activity in comparison with DCM patients. In general, CMP shown limited ability to regulate changes in blood pressure. In addition, patients also shown a limited ability of their cardiac and respiratory systems response to regulate incremental changes of the vascular variability and a lower heart rate variability. The best classifiers were used to build support vector machine models. The optimal model to classify ICM versus DCM patients achieved 92.7% accuracy, 94.1% sensitivity, and 91.7% specificity. When comparing CMP patients and CON subjects, the best model achieved 86.2% accuracy, 82.9% sensitivity, and 89.7% specificity. When comparing ICM patients and CON subjects, the best model achieved 88.9% accuracy, 87.5% sensitivity, and 89.7% specificity. When comparing DCM patients and CON subjects, the best model achieved 87.5% accuracy, 76.5% sensitivity, and 92.3% specificity. In conclusion, this study introduced a new method for the classification of patients by their etiology based on new indices from the analysis of the baroreflex mechanism.

In today's fast-paced society, chronic stress has become an increasing problem, as it can lead to psycho-physiological health problems. University students are also faced with stress due to the demands of many courses and exams. The positive effects of mindfulness-based stress reduction (MBSR) on stress management and self-regulation have already been studied. We have developed a new mindfulness intervention tailored for students—the Mindfulness-Based Student Training (MBST). In this study, we present longitudinal results of the MBST evaluation. Biosignal analysis methods, including pulse wave variability (PWV), heart rate variability, and respiratory activity, were used to assess participants' state of autonomic regulation during the 12-week intervention and at follow-up. The progress of the intervention group (IGR, N = 31) up to 3 months after the end of MBST was compared with that of a control group (CON, N = 34). In addition, the long-term effect for IGR up to 1 year after intervention was examined. The analysis showed significant positive changes in PWV exclusively for IGR. This positive effect, particularly on vascular function, persists 1 year after the end of MBST. These results suggest a physiologically reduced stress level in MBST participants and a beneficial preventive health care program for University students.

A large portion of the elderly population are affected by cardiovascular diseases. The early prognosis of cardiomyopathies is still a challenge. The aim of this study was to classify cardiomyopathy patients by their etiology in function of significant indexes extracted from the characterization of the recurrence plot of the systems involved. Thirty-nine cardiomyopathy patients (CMP) classified as ischemic (ICM - 24 patients) and dilated (DCM-15 patients) were considered. In addition, thirty-nine control subjects (CON) were used as reference. The beat-to-beat (BBI) time series, from the electrocardiographic signal, the systolic (SBP), and diastolic (DBP) time series, from the blood pressure signal, and the respiratory time (FLW) from the respiratory flow signal, were extracted. The recurrence plot from each signal considered were calculated and characterized by a total of 12 indexes. The best classifiers were used to build support vector machine models. The optimal model to classify ICM versus DCM patients achieved 92.3% accuracy, 95.8% sensitivity, and 86.6% specificity. When comparing CMP patients and CON subjects, the best model achieved 85.8% accuracy, 92.3% sensitivity, and 80.1% specificity. Our results suggest a more deterministic behavior in DCM patients. Clinical Relevance - This study explores the recurrence plot for the classification of ICM and DCM patients.

The purpose of this exploratory study was to determine whether liver dysfunction can be generally classified using a wearable electronic nose based on semiconductor metal oxide (MOx) gas sensors, and whether the extent of this dysfunction can be quantified. MOx gas sensors are attractive because of their simplicity, high sensitivity, low cost, and stability. A total of 30 participants were enrolled, 10 of them being healthy controls, 10 with compensated cirrhosis, and 10 with decompensated cirrhosis. We used three sensor modules with a total of nine different MOx layers to detect reducible, easily oxidizable, and highly oxidizable gases. The complex data analysis in the time and non-linear dynamics domains is based on the extraction of 10 features from the sensor time series of the extracted breathing gas measurement cycles. The sensitivity, specificity, and accuracy for distinguishing compensated and decompensated cirrhosis patients from healthy controls was 1.00. Patients with compensated and decompensated cirrhosis could be separated with a sensitivity of 0.90 (correctly classified decompensated cirrhosis), a specificity of 1.00 (correctly classified compensated cirrhosis), and an accuracy of 0.95. Our wearable, non-invasive system provides a promising tool to detect liver dysfunctions on a functional basis. Therefore, it could provide valuable support in preoperative examinations or for initial diagnosis by the general practitioner, as it provides non-invasive, rapid, and cost-effective analysis results.

Background: In integrative medicine, complementary healing methods, such as external applications (massages, rhythmic rubs, and compresses), are part of the practice and clinical application and have proven their therapeutic effect in various fields. Objective: Aim of this exploratory, controlled, single-blinded study was to investigate the effects of three different warming chest compresses on cardiovascular regulation by analyzing heart rate variability (HRV) in healthy subjects. Methods: Over a period of 4 weeks, three different warming chest compresses (a hot water compress, a ginger powder compress, and a mustard flour compress) in 30 healthy subjects were analyzed. For all subjects, 48-h long-term electrocardiograms were recorded, and afterward, epochs of 5 min length extracted and analyzed by different linear and nonlinear HRV indices. Results: A moist chest compress did not result in any significant short- and long-term stimulation of the autonomic regulation, except for a short-term significant decrease in heart rate (meanNN, p < 0.05). Warm and moist chest compresses with ginger flour led to significantly increased HRV (sdNN, p < 0.05; symbolic dynamics2, p < 0.05) and its complexity (renyi4 entropy, p < 0.05) and a significant decrease in heart rate (meanNN, p < 0.00036), and thus to a short-term relaxation effect. In contrast, warm and moist chest compresses with mustard flour led to significantly decreased HRV and their complexity (time-, frequency-, and nonlinear dynamics domain, p < 0.00036), which can be interpreted as a stress reaction of the autonomous nervous system. Conclusions: The application of chest compresses led to short-term relaxation effects (ginger) as well as short-term stress effects (mustard) but not to any significant longer-term effect on HRV in healthy subjects.

Background:Liver compresses are commonly applied in complementary medicine during cancer treatment and are believed to have an energizing effect. We conducted a pilot study to investigate the influence of external application of yarrow liver compresses on the autonomous nervous system by analyzing the heart rate variability (HRV) in metastatic cancer patients undergoing radiation therapy and suffering from cancer-related fatigue (CRF). Methods:A randomized pilot trial was undertaken with patients suffering from CRF receiving palliative radiation therapy for bone or brain metastasis over 2 weeks. CRF patients were randomized into an intervention group receiving yarrow liver compresses and a control group receiving no external application. HRV was analyzed at the beginning (T1) and end (T2) period of the study during daytime (d) and nighttime (n) in both groups and quantified using time-, frequency-, and nonlinear dynamics domains. Results:A total of 39 patients were randomized between September 2017 and August 2019 and a total of 20 patients (10 per group) were available for analysis. For both groups, significant differences in HRV analyses were found in the comparison over the timeline between the first and second measurement (T1d -> T2d) during daytime. Specifically, the intervention group showed decreased HRV and complexity of heart rate regulation, indicating increased sympathetic activity at time T2d, whereas the control group showed increased HRV and complexity of heart rate regulation, indicating increased vagal activity at time T2d. Furthermore, the observed HRV analyses showed almost no significant differences between the 2 groups in a direct comparison at the beginning and the end of the study (exception: T2d). Conclusions:Yarrow liver compresses led to increased sympathetic activity during daytime in the intervention group, whereas in the control group, which did not receive any external application, increased parasympathetic activity was observed.

Background The scientific evaluation of mind-body-interventions (MBI), including yoga and meditation, has increased significantly in recent decades. However, evidence of MBI's efficacy on biological parameters is still insufficient. Objectives In this study, we used HRV analysis to evaluate a novel MBI as a treatment of outpatients with mild to moderate depressive disorder. The Meditation-Based Lifestyle Modification (MBLM) program incorporates all major elements of classical yoga, including ethical principles of yoga philosophy, breathing exercises, postural yoga, and meditation. Methods In this exploratory randomized controlled trial, we compared the changes in HRV indices of a MBLM group (N = 22) and a minimal treatment group (MINIMAL, drugs only, N = 17) with those of a multimodal treatment-as-usual group (TAU, according to best clinical practice, N = 22). Electrocardiogram (ECG) recordings were derived from a Holter monitoring device, and HRV indices have been extracted from nearly stationary 20-min periods. Results Short-term HRV analysis revealed statistically significant differences in the pre-to-post changes between MBLM and TAU. In particular, the vagal tone mediating RMSSD and the Rényi entropy of symbolic dynamics indicated HRV gains in MBLM participants compared with TAU. Almost no alterations were observed in the MINIMAL group. Conclusions Our results suggest a benefit in selected HRV parameters for outpatients with mild to moderate depression participating in the MBLM program. For further investigations, we propose analysis of complete 24-h HRV recordings and additional continuous pulse wave or blood pressure analysis to assess long-term modulations and cardiovascular effects.

Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° ( p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

PURPOSE:To clinically evaluate patients who underwent a biologic augmentation technique in revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated stem cells isolated from bone marrow aspirate (BMA) obtained from the proximal humerus.METHODS:This is a retrospective review of prospectively collected data from patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and BMA obtained from the proximal humerus between 2014 and 2015. Minimum follow-up was 12 months. Outcome measures were collected preoperatively and postoperatively including range of motion as well as American Shoulder and Elbow Surgeons Shoulder Form, Simple Shoulder Test, single assessment numeric evaluation, and visual analog score. In addition, BMA samples of each patient were assessed for the number of nucleated cells and colony-forming units. Regression analysis was performed to investigate whether the number of nucleated cells and colony-forming units had an influence on outcome and failure.RESULTS:Ten patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA obtained from the proximal humerus between 2014 and 2015 were included. The mean follow-up time was 30.7 (range: 12-49) months. Four patients were revised at final follow-up. Postoperative clinical scores improved significantly: American Shoulder and Elbow Surgeons (28.1 ± 5.4 to 60.9 ± 9.0; P < .01), single assessment numeric evaluation (6.6 ± 2.3 to 65.1 ± 10.9; P < .01), visual analog scale (7.2 ± 0.9 to 3.1 ± 0.9; P < .01), and Simple Shoulder Test (1.6 ± 0.5 to 10.3 ± 5.7; P < .01). Postoperative range of motion increased significantly with regard to flexion (97.0 ± 13.6 to 151.0 ± 12.2; P < .01) and abduction (88.0 ± 14.0 to 134.0 ± 15.1; P = .038) but not with external rotation (38.0 ± 5.7 to 50.5 ± 6.5; P = .16). Less pain was correlated to an increased number of nucleated cells (P = .026); however, there was no correlation between failure rate and number of nucleated cells (P = .430).CONCLUSIONS:Patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA demonstrated a significant improvement in shoulder function along with reduction of pain. However, the overall revision rate for this procedure was 40%.LEVEL OF EVIDENCE:Level IV, therapeutic case series.

Cardiomyopathies diseases affects a great number of the elderly population. An adequate identification of the etiology of a cardiomyopathy patient is still a challenge. The aim of this study was to classify patients by their etiology in function of indexes extracted from the characterization of the pulse transit time (PTT). This time series represents the time taken by the pulse pressure to propagate through the length of the arterial tree and corresponding to the time between R peak of ECG and the mid-point of the diastolic to systolic slope in the blood pressure signal. For each patient, the PTT time series was extracted. Thirty cardiomyopathy patients (CMP) classified as ischemic (ICM – 15 patients) and dilated (DCM – 15 patients) were analyzed. Forty-three healthy subjects (CON) were used as a reference. The PTT time series was characterized through statistical descriptive indices and the joint symbolic dynamics method. The best indices were used to build support vector machine models. The optimal model to classify ICM versus DCM patients achieved 89.6% accuracy, 78.5% sensitivity, and 100% specificity. When comparing CMP patients and CON subjects, the best model achieved 91.3% accuracy, 91.3% sensitivity, and 88.3% specificity. Our results suggests a significantly lower pulse transit time in ischemic patients.Clinical relevance— This study analyzed the suitability of the pulse transit time for the classification of ICM and DCM patients.

Idiopathic pulmonary fibrosis (IPF) is a chronic and restrictive disease characterized by fibrosis and inflammatory changes in lung tissue producing a reduction in diffusion capacity and leading to exertional chronic arterial hypoxemia and dyspnea. Furthermore, clinically, supplemental oxygen (SupplO2) has been prescribed to IPF patients to improve symptoms. However, the evidence about the benefits or disadvantages of oxygen supplementation is not conclusive. In addition, the impact of SupplO2 on the autonomic nervous system (ANS) regulation in respiratory diseases needs to be evaluated. In this study the interactions between cardiovascular and respiratory systems in IPF patients, during ambient air (AA) and SupplO2 breathing, are compared to those from a matched healthy group. Interactions were estimated by time series of successive beat-to-beat intervals (BBI), respiratory amplitude (RESP) at BBI onset, arterial systolic (SYS) and diastolic (DIA) blood pressures. The paper explores the Granger causality (GC) between systems in the frequency domain by the extended partial directed coherence (ePDC), considering instantaneous effects. Also, traditional linear and nonlinear markers as power in low (LF) and high frequency (HF) bands, symbolic dynamic indices as well as arterial baroreflex, were calculated. The results showed that for IPF during AA phase: 1) mean BBI and power of BBI-HF band, as well as mean respiratory frequency were significantly lower (p < 0.05) and higher (p < 0.001), respectively, indicating a strong sympathetic influence, and 2) the RESP → SYS interaction was characterized by Mayer waves and diminished RESP → BBI, i.e., decreased respiratory sinus arrhythmia. In contrast, during short-term SupplO2 phase: 1) oxygen might produce a negative influence on the systolic blood pressure variability, 2) the arterial baroreflex reduced significantly (p < 0.01) and 3) reduction of RSA reflected by RESP → BBI with simultaneous increase of Traube-Hering waves in RESP → SYS (p < 0.001), reflected increased sympathetic modulation to the vessels. The results gathered in this study may be helpful in the management of the administration of SupplO2.

ObjectivesThe present study examined the effects of a yoga and mindfulness-based programme on the autonomic nervous system of primary school children by using heart rate variability parameters.DesignA two-arm non-randomised controlled trial compared an integrated yoga and mindfulness-based programme (16 weeks) to conventional primary school lessons.SettingPrimary school classrooms and conference rooms.InterventionsParticipants were allocated to a 16-week integrated yoga-based programme or conventional school lessons. A subgroup was randomised to receive 24h electrocardiogram-recordings.Main outcome measuresHeart rate variability indices were measured, both linear (time and frequency domain) and non-linear (symbolic dynamics, compression entropy), calculated from 30-minute extracts of Holter-electrocardiogram-recordings. Assessments were conducted at baseline and at the end of intervention.Results40 participants (42.5% female) were included into the analysis of HRV. No significant changes in heart rate variability parameters were observed between the groups after 16 weeks. In the intervention group, a trend towards increased parasympathetic activity could be seen over time, although not significantly enhanced compared to the control group.ConclusionResults obtained here do not clearly show that children in German primary school settings benefit from an integrated yoga-based intervention. However, exploratory post-hoc analyses point interestingly to an increased nocturnal parasympathetic activity in the intervention group. Further studies are required with high-quality study designs, larger sample sizes and longer-term follow-ups.

This article reports the case of a patient with a massive rupture of the rotator cuff, which presented as a retracted complete rupture of the supraspinatus tendon and the cranial infraspinatus tendon. After 7 months of persisting pain and continued loss of function, the superior capsule was reconstructed within the framework of an arthroscopic intervention. The long biceps tendon was used as an autograft and linked to the cranial infraspinatus tendon. In this way it was possible to achieve a complete closure of the posterosuperior joint space.