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Altered heart rate variability (HRV), an index of autonomic nervous system function, has been reported in generalized anxiety disorder (GAD), but the results have been mixed. Thus, the present study, using a large sample size and better methodology, aims to examine whether GAD is associated with impaired HRV, both at rest and in response to posture challenges.
In total, 1832 participants were recruited in this study, consisting of 682 patients with GAD (including 326 drug- and comorbidity-free GAD patients) and 1150 healthy controls. Short-term HRV was measured during the supine-standing-supine test (5-min per position). Propensity score matching (PSM), a relatively novel method, was used to control for potential confounders.
After PSM algorithm, drug- and comorbidity-free GAD patients had reductions in resting (baseline) high-frequency power (HF), an index for parasympathetic modulation, and increases in the low-frequency/HF ratio (LF/HF), an index for sympathovagal balance as compared to matched controls. Furthermore, the responses of HF and LF/HF to posture changes were all attenuated when compared with matched controls. Effect sizes, given by Cohen's d, for resting HF and HF reactivity were 0.42 and 0.36–0.42, respectively.
GAD is associated with altered sympathovagal balance, characterized by attenuation in both resting vagal modulation and vagal reactivity, with an almost medium effect size (Cohen's d ≈ 0.4), regardless of medication use or comorbidity status.
The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.
We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.
Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65–15.05).
The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.
Differential sensitivity to paraquat was observed between cucumber cultivars and leaf age. Physiological responses to paraquat, including antioxidative enzyme activity, were investigated in leaf age classes of cucumber to identify mechanisms of paraquat tolerance. Leaf injury for ‘Naeseosamcheok’, ‘Daehandadagi’, ‘Baekgwangdadagi’, ‘Sangrokheukjinju’, and ‘Eunseongbaekdadagi’ cultivars was less than that of six other cultivars tested, averaged over leaf age and herbicide rate. The level of foliar injury caused by paraquat was Leaf 1 > 2 > 3 > 4 in seven of 11 cultivars used, where 4 was the youngest leaf. There was a positive correlation between leaf age and its relative susceptibility to paraquat, regardless of growth stage. Lipid peroxidation was less in the youngest leaf (Leaf 4) than in the older leaves at all herbicide concentrations. The youngest leaf had higher values for apparent photosynthesis than the oldest leaf. Differential leaf response to paraquat was partially correlated with the change in superoxide dismutase, ascorbate peroxidant, and glutathione reductase activities in treated leaves. Enzyme activity of ascorbate peroxidase (APX) was higher in Leaf 4 than in Leaves 1, 2, or 3 in untreated plants and after exposure to paraquat. APX isozymes were more abundant in treated than in untreated leaves and produced in higher amounts in younger than in older leaves. Application of ascorbate and glutathione before paraquat treatment protected cucumber leaves from paraquat injury.