Pulmonary arterial hypertension (PAH) is a rare multifactorial disease with an unfavorable prognosis. Sildenafil therapy can improve functional capacity and pulmonary hemodynamics in PAH patients. Nowadays, it is increasingly recognized that the effects of sildenafil are pleiotropic and may also involve changes of the pro-/antioxidant balance, lipid peroxidation and autonomic control. In present study we aimed to assess the effects of sildenafil on the fatty acids (FAs) status, level of hydroxynonenal (HNE) and heart rate variability (HRV) in PAH patients. Patients with PAH were characterized by an increase in HNE and changes in the FAs composition with elevation of linoleic, oleic, docosahexanoic acids in phospholipids as well as reduced HRV with sympathetic predominance. Sildenafil therapy improved exercise capacity and pulmonary hemodynamics and reduced NT-proBNP level in PAH. Antioxidant and anti-inflammatory effects of sildenafil were noted from the significant lowering of HNE level and reduction of the phopholipid derived oleic, linoleic, docosahexanoic, docosapentanoic FAs. That was also associated with some improvement of HRV on account of the activation of the neurohumoral regulatory component. Incomplete recovery of the functional metabolic disorders in PAH patients may be assumed from the persistent increase in free FAs, reduced HRV with the sympathetic predominance in the spectral structure after treatment comparing to control group. The possibilities to improve PAH treatment efficacy through mild stimulation of free radical reactions and formation of hormetic reaction in the context of improved NO signaling are discussed.
Background/AimsChanges in autonomic regulation and psychological distress play an important role in the pathobiology of irritable bowel syndrome (IBS). The aim of the current study is to evaluate the autonomic function and to link it to the levels of somatization in adolescents with IBS.
MethodsWe enrolled 30 adolescents with various types of IBS and 35 healthy controls. Time and frequency domain indexes of heart rate variability (HRV) were measured in supine (baseline) and standing (orthostasis) positions using short-term electrocardiographic recordings. The somatic symptoms index was assessed with the modified Screening for Somatoform Symptoms questionnaire.
ResultsAdolescents with IBS showed no differences of HRV parameters in the supine position compared to healthy control. In orthostasis, a decrease in the standard deviation of normal RR intervals as well as main spectral index total power (TP) were observed. The reduction of TP was attributed to the reduced activities of the high-and low frequency components. Increased somatic symptoms index in IBS patients negatively correlated with TP in orthostasis (r = -0.485, P = 0.007). A subgroup analysis revealed that adolescents with IBS with TP values either < 2500 msec 2 or > 5500 msec 2 in the supine position demonstrated significantly reduced activity of the low frequency component.
ConclusionsAdolescents with IBS showed signs of autonomic dysfunction only during the orthostatic test, which were associated with increased somatization scores. Further research is needed to establish the links between emotional wellbeing and autonomic function in this population.
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