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Journal ArticleOpen access

Evaluation of the autonomic nervous system in patients with essential tremor

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Abstract Background Essential tremor (ET) is a prevalent movement disorder that may be linked to neurodegenerative changes. It is marked by a mix of motor and non-motor symptoms, which include disturbances in the autonomic nervous system. Aim of the study: We aimed to assess autonomic dysfunction in individuals with essential tremor. Thirty patients with essential tremor (Group 1) and 30 age and sex-matched healthy subjects a…

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Abstract Background Essential tremor (ET) is a prevalent movement disorder that may be linked to neurodegenerative changes. It is marked by a mix of motor and non-motor symptoms, which include disturbances in the autonomic nervous system. Aim of the study: We aimed to assess autonomic dysfunction in individuals with essential tremor. Thirty patients with essential tremor (Group 1) and 30 age and sex-matched healthy subjects as the control group (Group 2) were recruited. Comprehensive medical and neurological examinations were conducted on all participants, followed by electrophysiological assessments of autonomic function, including heart rate variability (HRV) tests (E/I ratio, Valsalva ratio, 30:15 ratio), adrenergic tests (blood pressure responses to active standing and sustained hand grip), and sympathetic skin response (SSR) tests. Finally, the results of these tests were classified according to the Ewing classification of autonomic failure. Results: The study revealed significant differences between ET patients and the control group. Heart rate variability tests showed a marked difference between the groups. Adrenergic tests, measuring sympathetic innervation, also displayed a significant difference. The sudomotor function test exhibited noteworthy differences in onset latencies and amplitudes in the palm and sole, with ET patients showing prolonged onset latencies and decreased amplitudes. Moreover, the study found a significant correlation between disease severity and autonomic function test results and the Ewing score. Conclusion: The study highlights the presence of autonomic dysfunction in essential tremor patients, with disease severity being associated with the level of autonomic affection, as evidenced by various autonomic function tests and the Ewing score.

Essential tremorAutonomic function testsHeart rate variabilitySympathetic skin responseNeurosciences. Biological psychiatry. Neuropsychiatry
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Journal ArticleOpen access

Autonomic synchrony induced by hyperscanning interoception during interpersonal synchronization tasks

Frontiers in Human Neuroscience

According to previous research, people influence each other’s emotional states during social interactions via resonance mechanisms and coordinated autonomic rhythms. However, no previous studies tested if the manipulation of the interoceptive focus (focused attention on the breath for a given time interval) in hyperscanning during synchronized tasks may have an impact on autonomic synchrony. Thus, this study aims to assess th…

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According to previous research, people influence each other’s emotional states during social interactions via resonance mechanisms and coordinated autonomic rhythms. However, no previous studies tested if the manipulation of the interoceptive focus (focused attention on the breath for a given time interval) in hyperscanning during synchronized tasks may have an impact on autonomic synchrony. Thus, this study aims to assess the psychophysiological synchrony through autonomic measures recording during dyadic linguistic and motor synchronization tasks performed in two distinct interoceptive conditions: the focus and no focus on the breath condition. 26 participants coupled in 13 dyads were recruited. Individuals’ autonomic measures [electrodermal: skin conductance level and response (SCL, SCR); cardiovascular indices: heart rate (HR) and HR variability (HRV)] was continuously monitored during the experiment and correlational coefficients were computed to analyze dyads physiological synchrony. Inter-subject analysis revealed higher synchrony for HR, HRV, SCL, and SCR values in the focus compared to no focus condition during the motor synchronization task and in general more for motor than linguistic task. Higher synchrony was also found for HR, SCL, and SCR values during focus than no focus condition in linguistic task. Overall, evidence suggests that the manipulation of the interoceptive focus has an impact on the autonomic synchrony during distinct synchronization tasks and for different autonomic measures. Such findings encourage the use of hyperscanning paradigms to assess the effect of breath awareness practices on autonomic synchrony in ecological and real-time conditions involving synchronization.

social interoceptionautonomic synchronyinterpersonal physiologyphysiological synchronyhyperscanning
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Journal ArticleOpen access

Muscular Contraction Mode Differently Affects Autonomic Control During Heart Rate Matched Exercise

Frontiers in Physiology

The precise contributions of afferent feedback to cardiovascular and respiratory responses to exercise are still unclear. Aim of this crossover study was to assess whether and how autonomic cardiovascular and respiratory control differed in response to dynamic (DYN) and isometric contractions (ISO) at a similar, low heart rate (HR) level. Therefore, 22 healthy males (26.7 ± 3.6 yrs) performed two kinds of voluntary exercises …

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The precise contributions of afferent feedback to cardiovascular and respiratory responses to exercise are still unclear. Aim of this crossover study was to assess whether and how autonomic cardiovascular and respiratory control differed in response to dynamic (DYN) and isometric contractions (ISO) at a similar, low heart rate (HR) level. Therefore, 22 healthy males (26.7 ± 3.6 yrs) performed two kinds of voluntary exercises at similar HR: ISO and DYN of the right quadriceps femoris muscle. Although HR was eqivalent (82 ± 8 bpm for DYN and ISO, respectively), rating of exertion, blood pressures, and rate pressure product were higher, whereas breathing frequency, minute ventilation, oxygen uptake and carbon dioxide output were significantly lower during ISO. Tidal volume, end-tidal partial pressures of O2 and CO2, respiratory exchange ratio and capillary blood lactate concentration were comparable between both contraction modes. Heart rate variability (HRV) indicators, SDNN, HF-Power and LF-Power, representing both vagal and sympathetic influences, were significantly higher during ISO. Sample entropy, a nonlinear measure of HRV was also significantly affected by contraction mode. It can be concluded that, despite the same net effect on HR, the quality of cardiovascular control during low intensity exercise is significantly different between DYN and ISO. HRV analysis indicated a sympatho-vagal coactivation during ISO. Whether mechanoreceptor feedback alone, a change in central command, or the interaction of both mechanisms is the main contributor of the distinct autonomic responses to the different exercise modes remains to be elucidated.

Autonomic Nervous SystemBlood PressureHeart rate variabilityCirculationExercise physiology
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Journal ArticleOpen access

Direct and indirect effects of adiposity on markers of autonomic nervous system activity in older adults.

PLoS ONE

Several cardiovascular disease (CVD) risk factors (e.g., hypertension, poor glycemic control) can affect and be affected by autonomic nervous system (ANS) activity. Since excess adiposity can influence CVD development through its effect on hypertension and diabetes mellitus, it is important to determine how adiposity and altered ANS activity are related. The present study employed structural equation modeling to investigate t…

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Several cardiovascular disease (CVD) risk factors (e.g., hypertension, poor glycemic control) can affect and be affected by autonomic nervous system (ANS) activity. Since excess adiposity can influence CVD development through its effect on hypertension and diabetes mellitus, it is important to determine how adiposity and altered ANS activity are related. The present study employed structural equation modeling to investigate the relation between adiposity and ANS activity both directly and indirectly through biological variables typically associated with glycemic impairment and cardiac stress in older adults. Utilizing the Atherosclerosis Risk in Communities (ARIC) dataset, 1,145 non-smoking adults (74±4.8 yrs, 62.8% female) free from known CVD, hypertension, and diabetes and not currently taking beta-blockers were evaluated for fasting blood glucose (FBG), insulin, and HbA1c concentrations, waist circumference (WC), blood pressure (BP), and markers of ANS activity. WC was recorded just above the iliac crest and was used to reflect central adiposity. Resting 2-minute electrocardiograph recordings, pulse wave velocity, and ankle-brachial index data were used to assess the root mean square of successive differences in RR intervals (RMSSD) and the pre-ejection period (PEP), markers of parasympathetic and sympathetic activity, respectively. FBG, insulin, and HbA1c inferred a latent variable termed glycemic impairment (GI), whereas heart rate and diastolic BP inferred a latent variable termed cardiac stress (CS). The structural equation model fit was acceptable [root mean square error of approximation = 0.050 (90% CI = .036, .066), comparative fit index = .970, Tucker Lewis Index = 0.929], with adiposity having both significant direct (β = 0.208, p = 0.018) and indirect (β = -.217, p = .041) effects on PEP through GI. Adiposity displayed no significant direct effect on RMSSD. CS displayed a significant pathway (β = -0.524, p = 0.035) on RMSSD, but the indirect effect of WC on RMSSD through CS did not reach statistical significance (β = -0.094, p = 0.137). These results suggest that adiposity's relation to ANS activity is multifaceted, as increased central adiposity had opposing direct and indirect effects on markers of sympathetic activity in this population of older adults.

MedicineScience
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Hemodynamic, morphometric and autonomic patterns in hypertensive rats - renin-angiotensin system modulation

Clinics

BACKGROUND: Spontaneously hypertensive rats develop left ventricular hypertrophy, increased blood pressure and blood pressure variability, which are important determinants of heart damage, like the activation of renin-angiotensin system. AIMS: To investigate the effects of the time-course of hypertension over 1) hemodynamic and autonomic patterns (blood pressure; blood pressure variability; heart rate); 2) left ventricular hy…

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BACKGROUND: Spontaneously hypertensive rats develop left ventricular hypertrophy, increased blood pressure and blood pressure variability, which are important determinants of heart damage, like the activation of renin-angiotensin system. AIMS: To investigate the effects of the time-course of hypertension over 1) hemodynamic and autonomic patterns (blood pressure; blood pressure variability; heart rate); 2) left ventricular hypertrophy; and 3) local and systemic Renin-angiotensin system of the spontaneously hypertensive rats. METHODS: Male spontaneously hypertensive rats were randomized into two groups: young (n=13) and adult (n=12). Hemodynamic signals (blood pressure, heart rate), blood pressure variability (BPV) and spectral analysis of the autonomic components of blood pressure were analyzed. LEFT ventricular hypertrophy was measured by the ratio of LV mass to body weight (mg/g), by myocyte diameter (μm) and by relative fibrosis area (RFA, %). ACE and ACE2 activities were measured by fluorometry (UF/min), and plasma renin activity (PRA) was assessed by a radioimmunoassay (ng/mL/h). Cardiac gene expressions of Agt, Ace and Ace2 were quantified by RT-PCR (AU). RESULTS: The time-course of hypertension in spontaneously hypertensive rats increased BPV and reduced the alpha index in adult spontaneously hypertensive rats. Adult rats showed increases in left ventricular hypertrophy and in RFA. Compared to young spontaneously hypertensive rats, adult spontaneously hypertensive rats had lower cardiac ACE and ACE2 activities, and high levels of PRA. No change was observed in gene expression of Renin-angiotensin system components. CONCLUSIONS: The observed autonomic dysfunction and modulation of Renin-angiotensin system activity are contributing factors to end-organ damage in hypertension and could be interacting. Our findings suggest that the management of hypertensive disease must start before blood pressure reaches the highest stable levels and the consequent established end-organ damage is reached.

SHRHypertensionBlood pressure variabilityRASLVH
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Journal ArticleAbstract only

Autonomic Function in Chronic Fatigue Syndrome With and Without Painful Temporomandibular Disorder

Newcastle University

Background: Chronic fatigue syndrome (CFS) is heterogeneous in nature, yet noclear subclassifications currently exist. There is evidence of dysautonomia in almost90% of patients and CFS is often co-morbid with conditions associated withautonomic nervous system (ANS) dysfunction, such as temporomandibulardisorders (TMD). The present study examined the point prevalence of TMD in asample of people with CFS and explored whether c…

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Background: Chronic fatigue syndrome (CFS) is heterogeneous in nature, yet noclear subclassifications currently exist. There is evidence of dysautonomia in almost90% of patients and CFS is often co-morbid with conditions associated withautonomic nervous system (ANS) dysfunction, such as temporomandibulardisorders (TMD). The present study examined the point prevalence of TMD in asample of people with CFS and explored whether co-morbidity between theconditions is associated with greater ANS dysfunction than CFS alone. Method:Fifty-one patients and 10 controls underwent screening for TMD. Theycompleted a self-report measure of ANS function (COMPASS-31) and objectiveassessment of heart rate variability during rest and standing (derived usingspectral analysis). Frequency densities in the high-frequency (HF) and lowfrequency(LF) band were calculated. Results: Patients with CFS were dividedinto those who screened positive for TMD (n = 16, 31%; CFS + TMD) and thosewho did not (n = 35, 69%; CFS − TMD). Both CFS groups had significantlyhigher self-rated ANS dysfunction than controls. CFS + TMD scored higher thanCFS − TMD on the orthostatic and vasomotor subscales. The CFS + TMD grouphad significantly higher HF and significantly lower LF at rest than the other twogroups. In discriminant function analysis, self-report orthostatic intolerance andHF units correctly classified 75% of participants. Conclusions: Almost one-thirdof CFS patients screened positive for TMD and this was associated with greaterevidence of parasympathetic dysfunction. The presence of TMD shows potentialas an effective screen for patients with CFS showing an autonomic profile andcould help identify subgroups to target for treatment.

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Brain oxygenation responses to autonomic challenge: a quantitative fMRI investigation of the Valsalva manoeuvre

Newcastle University

In late age the autonomic nervous system (ANS) has diminished ability to maintain physiological homeostasis in the brain in response to challenges such as to systemic blood pressure changes caused by standing. We devised an fMRI experiment aiming to map the cerebral effects of an ANS challenge (Valsalva manoeuvre; VM). We used dual-echo fMRI to measure the effective transverse relaxation rate (R2*, which is inversely proporti…

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In late age the autonomic nervous system (ANS) has diminished ability to maintain physiological homeostasis in the brain in response to challenges such as to systemic blood pressure changes caused by standing. We devised an fMRI experiment aiming to map the cerebral effects of an ANS challenge (Valsalva manoeuvre; VM). We used dual-echo fMRI to measure the effective transverse relaxation rate (R2*, which is inversely proportional to brain tissue oxygenation levels) in 45 elderly subjects (median age: 80 years old, total range: 75-89) during performance of the VM. In addition we collected Fluid Attenuation Inversion Recovery (FLAIR) data from which we quantified white matter hyperintensity (WMH) volumes. We conducted voxelwise analysis of the dynamic changes in R2* during the VM to determine the distribution of oxygenation changes due to the autonomic stressor. In white matter we observed significant decreases in oxygenation levels. These effects were predominantly located in posterior white matter and to a lesser degree in the right anterior brain, both concentrated around the border zones (watersheds) between cerebral perfusion territories. These areas are known to be particularly vulnerable to hypoxia and are prone to formation of white matter hyperintensities. Although we observed overlap between localization of WMH and triggered deoxygenation on the group level we did not find significant association between these independent variables using subject-wise statistics. This could suggest other than recurrent transient hypoxia mechanisms causing/contributing to the formation of WMH.

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Cardiovascular and autonomic responses to whole-body cryostimulation in essential hypertension

Newcastle University

Over recent years, a considerable increase in the popularity of cryostimulation and whole body cryotherapy (WBC) procedures has occurred both among healthy individuals and in various groups of patients, including those with primary untreated hypertension. The aim of this study was to compare the effects of WBC on the functional parameters of cardiovascular system in normotensive and primarily hypertensive individuals.The stud…

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Over recent years, a considerable increase in the popularity of cryostimulation and whole body cryotherapy (WBC) procedures has occurred both among healthy individuals and in various groups of patients, including those with primary untreated hypertension. The aim of this study was to compare the effects of WBC on the functional parameters of cardiovascular system in normotensive and primarily hypertensive individuals.The study included 26 young male volunteers with normal blood pressure range (NormoBP) and 13 with essential arterial hypertension (HyperBP). Each subject was exposed to cryotherapeutic factor (whole-body cryotherapy/cryostimulation, WBC) at a temperature of approximately -115 degrees C to 125 degrees C for a period of 3 min. The cardiovascular and autonomic parameters were measured noninvasively with Task Force Monitor. Measurements in a supine position and tilt test were performed 'before WBC' and 'after WBC'.Our study revealed that cryogenic temperatures exert strong modulatory effect on the cardiovascular system. Both groups showed adaptive changes of myocardial and vascular parameters in response to rapid cooling of virtually the whole body surface. While the profiles of some of these changes were similar in both the groups, also several considerable intergroup differences were documented. Consequently, the cryostimulation and cryotherapy treatment should be prescribed carefully to individuals who present with cardiovascular failure of any degree. (C) 2014 Elsevier Inc. All rights reserved.

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Journal ArticleOpen access

Dysregulation of G protein-coupled receptors of the autonomic nervous system, adrenergic and muscarinic acetylcholine receptors, in patients with autoimmune dysautonomic-related disorders

Brain, Behavior, & Immunity - Health

Functional autoantibodiesMuscarinic receptorAdrenergic receptorG protein-coupled receptorsAutonomic nervous system
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Autonomic and Redox Imbalance Correlates With T-Lymphocyte Inflammation in a Model of Chronic Social Defeat Stress

Frontiers in Behavioral Neuroscience

Patients diagnosed with post-traumatic stress disorder (PTSD) are at a significantly elevated risk of developing comorbid inflammatory conditions, but the mechanisms underlying this predilection remain unclear. Our previous work has shown that T-lymphocytes exposed to elevated levels of norepinephrine (NE) displayed a pro-inflammatory signature reminiscent of an autoreactive phenotype. With this, we hypothesized that the incr…

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Patients diagnosed with post-traumatic stress disorder (PTSD) are at a significantly elevated risk of developing comorbid inflammatory conditions, but the mechanisms underlying this predilection remain unclear. Our previous work has shown that T-lymphocytes exposed to elevated levels of norepinephrine (NE) displayed a pro-inflammatory signature reminiscent of an autoreactive phenotype. With this, we hypothesized that the increased sympathetic tone observed during psychological trauma may be promoting pro-inflammatory T-lymphocytes, which causes a predisposition to comorbid inflammatory conditions. Here, we examined the consequences of psychological trauma on splenic T-lymphocytes using a mouse model of repeated social defeat stress. Social defeat led to anxiety-like and depression-like behavior as has been previously described. The spleens of socially-defeated mice showed significant elevations of NE, tyrosine hydroxylase (TH), and acetylcholinesterase (ACHE) levels, which appeared to be due in part to increased expression within T-lymphocytes. Additionally, T-lymphocytes from stressed animals showed higher levels of pro-inflammatory cytokines and mitochondrial superoxide. Interestingly, in this model system, close associations exist within splenic T-lymphocytes amid the autonomic, inflammatory, and redox environments, but these only weakly correlate with individual behavioral differences among animals suggesting the psychological and physiological manifestations of trauma may not be tightly coupled. Last, we describe, for the first time, elevations in calprotectin levels within T-lymphocytes and in circulation of psychologically stressed animals. Calprotectin correlated with both behavioral and physiological changes after social defeat, suggesting the potential for a new biological marker and/or therapeutic target for psychological trauma and its inflammatory comorbidities.

post-traumatic stress disorderPTSDbehaviornorepinephrineimmune
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Journal ArticleOpen access

Altered Central Hemodynamics in Individuals with Down Syndrome

Artery Research

Background: Individuals with Down Syndrome (DS) have autonomic dysfunction impacting regulation of heart rate, Blood Pressure (BP), and peripheral vasoconstriction. This may alter central hemodynamics through different wave reflections. We investigated central hemodynamics including wave reflection during rest and a sympathoexcitatory stimulus [Lower Body Negative Pressure (LBNP)] in individuals with DS and controls. Methods:…

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Background: Individuals with Down Syndrome (DS) have autonomic dysfunction impacting regulation of heart rate, Blood Pressure (BP), and peripheral vasoconstriction. This may alter central hemodynamics through different wave reflections. We investigated central hemodynamics including wave reflection during rest and a sympathoexcitatory stimulus [Lower Body Negative Pressure (LBNP)] in individuals with DS and controls. Methods: Radial applanation tonometry was performed on participants with and without DS before and during 5-min LBNP stimulus of −20 mmHg. Waveforms were calibrated to mean and diastolic BP. Generalized transfer function was used to estimate aortic pressures [Systolic Blood Pressure (aSBP), Diastolic Blood Pressure (aDBP), mean pressure (aMAP), pulse pressure (aPP)], Augmentation Index (AIx), augmentation index normalized for HR (AIx@75), Augmentation Pressure (AP), Reflection Index (RIx), Time to Reflection (Tr), forward and reflected wave magnitude (Pf and Pb). Results: Fifteen individuals with DS (male n = 12, age 24 ± 4 years, BMI 28 ± 5 kg/m2) and 16 control participants (male n = 12, age 24 ± 4 years, BMI 25 ± 5 kg/m2) participated. Baseline differences showed greater AP, higher AIx and AIx@75, a greater RIx, shorter Tr and larger Pb in individuals with DS (p < 0.05). In response to LBNP, interaction effects were observed for AIx, AIx@75, AP, RIx and Pb, due to reductions in the outcomes in response to LBNP for individuals with DS with no change in the controls. Conclusion: These results show that central hemodynamics and wave reflections are different in individuals with DS at rest and in response to LBNP, probably as a result of anatomical differences and reduced peripheral vasoconstrictive control during LBNP. HIGHLIGHTS •Individuals with DS exhibit greater central hemodynamic load at rest. •Individuals with DS have greater indices of wave reflections at rest. •Individuals with DS maintained blood pressure during LBNP with reduced wave reflection.

Down syndromevascular functionsympathetic stimulusautonomic nervous systemSpecialties of internal medicine
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Cardiovascular Autonomic Neuropathy in Charcot-Marie-Tooth Disease: A Genotype-Stratified Study of PMP22 Duplication and GJB1 Mutation Carriers.

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Neurovascular Unit Dysfunction and Neural Barrier Pathology in Dysautonomia: Molecular Links to Cardiovascular Autonomic Failure.

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Utility and best practices for clinical diagnostic testing of the autonomic nervous system: A Consensus Statement Endorsed by the American Autonomic Society and the American Association of Neuromuscular & Electrodiagnostic Medicine.

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Diagnostic accuracy of the Arabic composite autonomic symptom score 31 (COMPASS-31) for detecting autonomic neuropathy in SLE: a cross-sectional validation study.

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Autonomic Storm in a Patient With Amyotrophic Lateral Sclerosis in a Home-Care Setting.

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Coexisting Postural Orthostatic Tachycardia Syndrome on Autonomic Reflex Testing in Functional Neurologic Disorder.

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Acute effects of binge drinking following aerobic exercise on autonomic and hemodynamic recovery in young men: a randomized crossover trial.

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Interleukin-17A Links Obesity-Induced Inflammation to Behavioral Disorders and Autonomic Imbalance.

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Sleep-Autonomic Interactions in Parkinson's Disease and Multiple System Atrophy: A Comparative Study Using Structural Equation Modeling.

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Cardiovascular Autonomic Dysfunction in Late-Stage Lyme Disease: A Comprehensive Autonomic Assessment.

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Autonomic Cardiovascular Dysregulation After Acute Cervical Spinal Cord Injury: Insights From Linear and Nonlinear Heart Rate Variability.

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Interpreting heart rate variability in clinical context: a framework for understanding a multidimensional autonomic biomarker.

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Bethanechol-associated hyperinsulinemic hypoglycemia in a child with autonomic instability.

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