Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL

Insulin resistance is hypothesized to contribute to increases in blood pressure (BP) through both the renin-angiotensin-aldosterone and sympathetic nervous systems. Prior large-scale studies examining this association are confounded by overt diabetes, obesity, and antihypertensive medication use. In a cross-sectional analysis of 10 810 HCHS/SOL (Hispanic Community Health Study/Study of Latinos) participants without diabetes and not taking antihypertensive medications, we examined the associations of insulin resistance, quantified by homeostasis model assessment of insulin resistance (HOMA-IR), with systolic BP (SBP) and diastolic BP overall and stratified by sex and prediabetes status in unadjusted and adjusted analyses. The total sample included 52% women; mean (SD) age, 37.2 (13.4) years; 39% of participants had prediabetes (mean [SD] HOMA-IR, 2.8 [2.2]). Stage 1 or 2 hypertension was present in 26% of participants (mean [SD] SBP, 116.8 [15] mm Hg and diastolic BP, 71.0 [10.4] mm Hg). Overall, there was a significant linear association between HOMA-IR and both SBP (β, 2.64±0.44) and diastolic BP (β, 1.49±0.35). We found a significant interaction with sex and the association between HOMA-IR and SBP; the association was linear in men and nonlinear in women. There was no statistically significant interaction between prediabetes status and the associations between HOMA-IR and BP. In conclusion, in a large community-based sample of Hispanic/Latino adults of diverse national backgrounds not taking antihypertensive medications and free from diabetes, insulin resistance was positively associated with both SBP and diastolic BP. Future longitudinal studies, with adequate power to examine sex-specific differences, are needed to examine the independent contribution of insulin resistance to the development of hypertension.

Primitive neuroectodermal tumor of the pericardium: a case report and literature review

Background The primitive neuroectodermal tumors (PNETs) are a family of highly malignant tumors with a multidirectional differential potential. The tumors are characterized by aggressive small round tumor cells that originate from the spinal cord of the central and sympathetic nervous systems. Cases involving the pericardium are extremely rare. Herein, we present a case of peripheral primitive neuroectodermal tumor (pPNET) that originated in the pericardium. Case presentation A 23-year-old woman presented with cough and progressive dyspnea for 1 month, followed by eyelid and facial edema for 10 days, without any apparent cause. Significantly elevated tumor markers were detected in her blood. A cardiac ultrasound revealed a 74 mm × 61 mm spherical mass that was attached to the left pericardium, as well as massive pericardial effusion. Positron emission tomography-CT (PET-CT) showed focal hypermetabolism in the left pericardium. Via histopathology and immunohistochemistry, the spherical mass was identified as PNETS. The patient was successfully treated with a combination of surgical resection via thoracotomy and postoperative chemotherapy, and she was disease-free for 7 years at follow-up. Unfortunately, at 7 years after the treatment, the patient’s pPNET recurred. Positron emission tomography-MRI (PET-MRI) and 64-slice coronary CTA revealed that the aorta and multiple coronary arteries were involved. Subsequently, the patient refused a heart transplant and voluntarily left the hospital. Conclusions This paper reports on a rare and recurrent case of PNET in the parietal pericardium. With respect to the different biologic characteristics and prognoses of pPNETs (compared to other known pericardium tumors), it is essential to consider this entity as a differential diagnosis in pericardium tumors.

Time-Dependent Effects of Individual and Combined Treatments With Nebivolol, Lisinopril, and Valsartan on Blood Pressure and Vascular Reactivity to Angiotensin II and Norepinephrine

Clinical guidelines suggest the combination of 2 drugs as a strategy to treat hypertension. However, some antihypertensive combinations have been shown to be ineffective. Therefore, it is necessary to determine whether differences exist between the results of monotherapy and combination therapy by temporal monitoring of the responses to angiotensin II and norepinephrine, which are vasoconstrictors involved in the development of hypertension. Thus, the purpose of this work was to determine the vascular reactivity to angiotensin II and norepinephrine in spontaneously hypertensive rat (SHR) aortic rings after treatment with valsartan, lisinopril, nebivolol, nebivolol-lisinopril, and nebivolol-valsartan for different periods of time. In this study, male SHR and Wistar Kyoto normotensive (WKY) rats were divided into 7 groups treated for 1, 2, and 4 weeks: (1) WKY + vehicle, (2) SHR + vehicle; (3) SHR + nebivolol; (4) SHR + lisinopril; (5) SHR + valsartan; (6) SHR + nebivolol-lisinopril; and (7) SHR + nebivolol-valsartan. Blood pressure was measured by the tail-cuff method, and vascular reactivity was determined from the concentration-response curve to angiotensin II and norepinephrine in aortic rings. The results showed that the combined and individual treatments reduced mean blood pressure at all times evaluated. All treatments decreased vascular reactivity to angiotensin II; however, in the case of lisinopril and nebivolol-lisinopril, the effect observed was significant up to 2 weeks. All treatments decreased the reactivity to norepinephrine up to week 4. These results show a time-dependent difference in vascular reactivity between the pharmacological treatments, with nebivolol-valsartan and nebivolol-lisinopril being both effective combinations. Additionally, the results suggest crosstalk between the renin-angiotensin and sympathetic nervous systems to reduce blood pressure and to improve treatment efficacy.

An Outline of Renal Artery Stenosis Pathophysiology—A Narrative Review

Renal artery stenosis (RAS) is conditioned mainly by two disturbances: fibromuscular dysplasia or atherosclerosis of the renal artery. RAS is an example of renovascular disease, with complex pathophysiology and consequences. There are multiple pathophysiological mechanisms triggered in response to significant renal artery stenosis, including disturbances within endothelin, kinin–kallikrein and sympathetic nervous systems, with angiotensin II and the renin–angiotensin-aldosterone system (RAAS) playing a central and key role in the pathogenesis of RAS. The increased oxidative stress and the release of pro-inflammatory mediators contributing to pathological tissue remodelling and renal fibrosis are also important pathogenetic elements of RAS. This review briefly summarises these pathophysiological issues, focusing on renovascular hypertension and ischemic nephropathy as major clinical manifestations of RAS. The activation of RAAS and its haemodynamic consequences is the primary and key element in the pathophysiological cascade triggered in response to renal artery stenosis. However, the pathomechanism of RAS is more complex and also includes other disturbances that ultimately contribute to the development of the diseases mentioned above. To sum up, RAS is characterised by different clinical pictures, including asymptomatic disorders diagnosed in kidney imaging, renovascular hypertension, usually characterised by severe course, and chronic ischemic nephropathy, described by pathological remodelling of kidney tissue, ultimately leading to kidney injury and chronic kidney disease.

Relationships Between Music and Empathic Decision Making in Healthy Young Adults

Music and empathy are components of social experience. Similar and adjacent functional brain systems are required in the production and understanding of music, the processing of emotion, and engagement in social behavior. Activity in these brain systems is often reflected in autonomic features, including dynamic behavior of the parasympathetic and sympathetic nervous systems. Music may influence prosocial behavior and this effect may be reflected by the behavior of the autonomic nervous system. This experiment was designed to evaluate these relationships. Healthy undergraduate students ( N = 60) participated in Cyberball, a task sensitive to differences in prosocial behavior, while listening to or not listening to different types of music. Results indicated that music positively affects prosocial behavior, but autonomic activity does not reflect the degree of music’s effect on prosocial behavior.

The Physiological Substrate of Forgiveness

Previous research demonstrates the health benefits of both intrapersonal and interpersonal forgiveness as indicated by various markers of physiological activity. Specifically, evidence suggests that forgiveness can help regulate the body’s stress response and increase an individual’s ability to relax after exposure to an acute stressor. This review identifies specific outcomes associated with the health benefits of forgiveness and its effects on cardiovascular functioning, as well as hyperarousal in the hypothalamic-pituitary-adrenal axis and sympathetic nervous systems. In addition to its health benefits, the findings suggest that activity in the hypothalamic-pituitary-gonadal axis may influence the types of forgiveness that individuals communicate.

A case report of neonatal orbital peripheral primitive neuroectodermal tumor and literature review

Primitive neuroectodermal tumors are rare malignant neoplasms from primitive neural crest cells. Most primitive neuroectodermal tumors occur in the central and sympathetic nervous systems. We report a Chinese newborn patient presenting a huge unilateral proptosis after birth, diagnosed as orbital peripheral primitive neuroectodermal tumor by histopathology and immunohistochemistry. Our case is the first reported case of orbital peripheral primitive neuroectodermal tumor diagnosed in the newborn period. The clinical manifestations, radiological findings, histopathologic, and immunohistochemistry results are described in detail. We also conducted a literature search focusing on primitive neuroectodermal tumor of the orbit. To the best of our knowledge, all articles with English abstracts were reviewed here.

Parasympathetic and Sympathetic Nervous System Monitoring and Anxiety-Like Symptoms: Improved Differentiation and Improved Outcomes

Anxiety disorders (DSM-5) and disorders having anxiety laden symptoms (e.g., PTSD and attention disorders) often include several physiologic symptoms which involve the Parasympathetic and Sympathetic nervous systems (P&S). Our research has identified four P&S disorders that are associated with these symptoms: 1) Sympathetic Excess (SE) secondary to Parasympathetic Excess (PE) as an abnormal stress response, 2) Sympathetic Withdrawal (SW) upon assuming headup posture (standing) associated with Orthostatic Dysfunction, 3) SE upon standing associated with Syncope, and 4) Autonomically mediated cardiac arrhythmia, including Sinus Arrhythmia. All four disorders involve poor brain profusion which is known to contribute to Anxiety-like symptoms. They also contribute to (sub-clinical) depression, another frequent co-morbidity. Resting and challenge P&S responses were assessed noninvasively using the ANSAR Medical Technologies, Inc. (Philadelphia, PA) software (ANX 3.0 autonomic function monitor). Patients diagnosed with Anxiety or Anxiety-like symptoms from a large cardiology practice serving both urban and rural areas were followed with more than one assessment over four years (an average of 3.3 assessments per patient; 50.5% Female; average age of 57 years). Patients diagnosed with Anxiety or Anxiety-like symptoms, with one of the four P&S disorders were also treated for their P&S disorder. Relieving P&S dysfunction within this cohort reduced Anxiety or Anxiety-like symptoms by over 45%. P&S guided therapy for patients with Anxiety or Anxiety-like symptoms, may reduce the burden of Anxiety, improve patient outcomes and quality of life, reduce the risk of suicide, aid the psychiatrist in focusing on the etiology of Anxiety, and reduce healthcare costs.

Objective Measurement of Sustained Pupillary Constriction: A Pilot Study Using an App-Based Pupilometer

Background: The pupillary reaction is controlled by the two main branches of the autonomic nervous system, namely the parasympathetic and sympathetic nervous systems. New discoveries in pupil research has identified that intrinsically photosensitive retinal ganglion cells have an impact on pupillary constriction, particularly sustained pupillary constriction. In the current paper, an objective measurement of sustained pupillary constriction versus the inability to maintain sustained pupillary constriction are observed. The variability in the sustained pupillary constriction, i.e. Alpha Omega pupil, can be objectively identified with the use of modern technology. Case Examples: Two female subjects were adapted to dim illumination, and then two objective pupil measurements of the right eye using Reflex – PLR Analyzer by BrightLamp© (Indianapolis, IN, USA) with sustained illumination were obtained. Subject 1, a 25 year-old-female, demonstrated normal ability of the pupil to constrict and sustain constriction for 10 seconds. She was used as a control for subject 2. Subject 2, a 27 year-old-female, demonstrated the inability to sustain pupillary constriction. She reported being under great psychological stress. Her pupil began to re-dilate between 2 and 3 seconds after the initial constriction. Conclusion: Objective pupillometry can be used to assist in many diagnoses and provides the clinician invaluable information on the state of the individual, and qualifications of sustained pupillary constriction can now be assessed in an objective manner.