AEVD荷兰心脏基金会（DHF-2007B103）的支持。笔者想感谢所有母亲和孩子在阿姆斯特丹出生的孩子和他们的发展（ABCD）的研究，以及整个开发和维护团队的VU-AMS系统司仪表 - ，心理生理学系（VU大学，阿姆斯特丹，荷兰）。

1。准备工作:启动<ol><li>您需要: <ul><li>一个VU AMS5fs的动态记录装置（包括红外接口电缆连接到一台PC或RS232串口到USB端口）。 </li><li> 7的电极（用CONMED 1690-003）。 </li><li> 2充电的AA电池。 </li><li>一个空的CF记忆卡（已经得到了广泛的VU-AMS5fs的测试与1GB 80X CF卡从创见（TS1GCF80），但其他CF卡应该也可以工作）。 </li><li>笔记本电脑或PC安装闪存卡读卡器和数据分析管理软件（DAMS）套件。 </li><li>秒表。 </li><li>与孩子们的故事，耳机和一个小的自充气床垫的音乐播放器是可选的。 </li></ul></li><li>检查笔记本电脑/ PC上的时间和日期设置，因为这些东西会被记录为您的文件的元数据。将空的内存卡和全电池在VU-AMS设备（就业成功标志着由TRIPLË哔声）。当设备处于待机状态时，绿色指示灯将闪烁两次，每十秒钟。这表明它已准备就绪，但没有记录。现在将设备连接到笔记本电脑使用提供的电缆，并启动水坝计划。启动通信设备（选择标签的设备，并选择合适的连接方式，红外数据线或蓝牙）。 </li><li>有参与者脱下他/她的上身磨损。将被放置在电极的地方，用酒精擦拭物的清洁皮肤，放置7个电极上的胸部和背部（ 图1）。然后附加导线的配色方案，并将它们连接到设备。 </li><li>检查电池类型和电池电压指示（这应该是碱性，约2.4 V的可充电镍氢电池约3.4 V）。填写标识字段。图中（ 图2）所示的典型的采样频率。 </li><li>测量距离between胸部电极以毫米为单位，并在该领域的ICG-V距离"，填补了这一点。然后点击"发送设置设备发送当前设置/ ID。 </li><li>现在，"联机"选项的程序应该被用来显示心电图，ΔZ（这是呼吸）和dZ / dt的（这是在ICG）。 ΔZ信号反映整个胸部的基极阻抗，可以使用适当的过滤后的提取呼吸信号具有高保真7。 DZ / dt信号是随着时间的推移ΔZ分化，并反映快速变化ΔZ链接到喷射的血液从心室进入主动脉。 <ol><li>一个明确的QRST复杂的心电图检测。 R波是向上的，它应该是在任一方向的最大振幅（绝对值）中的峰值。 </li><li> ΔZ-1和+1之间的时间和dZ / dt的，应在-0.5和0.5ΩΩ/秒。 </li><li> Z 0 ALWA的YS留8〜20Ω范围内。该变化反映胸廓阻抗信号的测量电极孩子的身高的函数，和在&#39;湿润&#39;胸廓列包含由测量电极，身体组成的差异（ 例如，身体质量指数之间的距离取决于）可以影响的DZ / dt信号（含脂肪的质量少水比肌肉）的幅度。也反映在个体差异的绝对Z 0振幅ΔZ信号，但是这并不影响收缩的时间间隔，这是独立于振幅的测定。 </li><li> ΔZ信号应反映的主题清楚深呼吸（指导孩子采取了缓慢的深呼吸，慢慢呼气）。 </li><li>在ICG反映心脏射血期的典型的上升波形应该清楚地检测到。轻运动的主体不应该扭曲DZ / dt信号。如果这些条件得不到满足，R电子清洁皮肤，并重新连接的电极，直到得到满意的信号。 </li></ol></li><li>当达到良好的信号，开始数据记录，按&#39;开始&#39;按钮。您将听到蜂鸣声，确认开始记录和绿色指示灯将开始闪烁每三秒钟一次。现在已经开始登记。关闭VU水坝计划。现在，您可以从接口电缆断开设备。 </li></ol> 2。报名时间<ol><li>一旦注册已经开始，让孩子躺下第一实验条件。当孩子已经在两分钟仰卧的姿势（无抬头倾斜），你在短期内（&lt;2秒）按设备顶部的黑色小按钮。按下此按钮，标志着一个特殊的事件，稍后会帮你识别这种情况开始在您的数据。 </li><li>四分钟后，再次按"事件"按钮。这标志着结束躺着状态。现在的孩子坐起来，并重复上述步骤，这第二个条件。按下按钮，等待四分钟，并再次按下按钮。在这些条件下，孩子们安静地休息。 </li><li>停止测量，按住按钮至少3秒。指示灯会闪烁，每10秒，以表明它已经停止，是&#39;站&#39;模式。一旦设备已停止，你可以断开的导线插头连接器和导线的电极。 </li><li>取出电池和闪存卡的形式的VU-AMS设备，将闪存卡读取单元。将所获取的文件移动到指定的目录（通常的目录名称是相同的被摄对象的标识符，用于标识字段）。 </li></ol> 3。处理数据<ol><li>与VU-DAMS程序打开数据后，数据将被自动转换成原始数据格式（扩展名。5FS）&lt;/ em&gt;的一种新的格式（扩展。amsdata）。这是VU水坝的数据文件将在接下来的步骤中使用。 </li><li>首先从心电图信号中提取间垮掉的间隔时间序列。选择检测R波峰标签。自动算法将在心电图信号检测所有的R峰和选择（如果存在）具有非常低的心电图质量搬迁期间。在左上角蓝（正确的），黄色（中等可疑）或红色（非常可疑）表示。按&#39;。&#39; （DOT）的光标移动到下一个可疑的R-峰值，并且用户可以删除或添加标记为R波的手。建议，至少所有高度可疑的节拍目视检查。 </li><li>的主要目的是为了获得一个平均值的心脏速率，弹射前准备期（PEP）呼吸性窦性心律不齐（RSA，HF，RMSSD）横跨实验条件和措施。因此继续表示期间原始数据中的对应这些条件。这个过程被称为"数据标签"。选择" 标签 " 数据 "选项卡。两个面板显示的心率信号和运动信号，以及记录的实际时间。 </li><li>将鼠标光标放置在顶部栏，它说:"单击并拖动添加标签"左右你的第一个条件的起始时间，并拖动鼠标到结束的时间，条件。这些时间获得书面记录开始和停止时间（即记下在数据收集过程），或者您可以使用启动和停止按下按钮，在开始和结束的每个条件获得的标记，这是垂直在整个人力资源和运动图线运行。 </li><li>每个标签都可以得到一个（唯一）标识符信号特定的条件。在我们的例子中，我们有我们的标签只有一类:实验条件。此类别有两个值:躺着坐起来。 </li><li> VU-DAMS需要意识到的实验技术TAL设计一个所谓的标签配置文件（label.cfg）。这是一个ASCII文件，可以打开大多数文本编辑器，例如，看起来像这样: ＃exp_condition 10躺着 11坐起来</li><li>通过放置的label.cfg文件目录。amsdata文件，它会被自动加载由VU水坝程序。一旦已经取得了一个标签，弹出屏幕会出现的类别/值中列出label.cfg文件。选择&#39;躺着&#39;的第一个标签，"坐起来，"第二个标签。 </li><li>标签后，选择"阻抗得分"标签，将比分PEP阻抗心动。对于每个条件合奏平均DZ / dt的波形显示，时间锁定的心电图R峰。合奏平均呈列如下DZ / DT波形的心电图。放置在正确的位置的四个垂直光标:心电图Q波发病（电活动的开始），ICG B-点（射血期的开始），ICG DZ / DT分钟的（最大弹射速度），和ICG X点（主动脉瓣关闭 - 射血期结束）。 </li><li>接下来，选择"呼吸打分"选项卡，将比分峰谷RSA使用呼吸和心电图信号。现在可以进行检查呼吸间隔最短期间的interbeat间隔灵感和interbeat最长间隔期间届满的自动呼吸呼吸得分。通常情况下，自动检测算法不应该超过15％的偏差呼吸分类 - ，检查呼吸信号的检测算法需要调整的参数。 目视检查心电图，ICG和呼吸的信号和交互式PEP和RSA得分的准则，可以发现在VU-AMS的网站， <a href="http://www.vu-ams.nl" target="_blank">www.vu ams.nl</a> 。 </li></ol><ol start="10"><li>最后，选择" 标签 " 信息 "选项卡。 A表后出现的结果计算。每一行代表AVerage值的一系列的生理参数（心率，PEP，RSA，RR）为每个标记的时间段。第一列的的的主题标识符（Label_ID）。最后一列表示标签（这里只有一个类别的"实验条件"有两个值期间使用的所有类别的值，坐起来&#39;和&#39;躺着&#39;）。光谱权力的interbeat间隔时间序列标签最小长度为4分钟（否则缺少的代码显示）。进一步的统计分析，在此展出的电子表格可以导出到ASCII或EXCEL。 </li></ol>

<ol>
	<li>de Geus, E. J., Willemsen, G. H., Klaver, C. H., van Doornen, L. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ambulatory+measurement+of+respiratory+sinus+arrhythmia+and+respiration+rate.">Ambulatory measurement of respiratory sinus arrhythmia and respiration rate.</a> Biol. Psychol. 41, 205-227 (1995).</li><li>Goedhart, A. D., van der, S. S., Houtveen, J. H., Willemsen, G., de Geus, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+time+and+frequency+domain+measures+of+RSA+in+ambulatory+recordings.">Comparison of time and frequency domain measures of RSA in ambulatory recordings.</a> Psychophysiology. 44, 203-215 (2007).</li><li>Goedhart, A. D., Kupper, N., Willemsen, G., Boomsma, D. I., de Geus, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporal+stability+of+ambulatory+stroke+volume+and+cardiac+output+measured+by+impedance+cardiography.">Temporal stability of ambulatory stroke volume and cardiac output measured by impedance cardiography.</a> Biol. Psychol. 72, 110-117 (2006).</li><li>Riese, H., Groot, P. F. C., van den Berg, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Large-scale+ensemble+averaging+of+ambulatory+impedance+cardiograms.">Large-scale ensemble averaging of ambulatory impedance cardiograms.</a> Behavior Research Methods Instruments &amp; Computers. 35, 467-477 (2003).</li><li>Willemsen, G. H., de Geus, E. J., Klaver, C. H., van Doornen, L. J., Carroll, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ambulatory+monitoring+of+the+impedance+cardiogram.">Ambulatory monitoring of the impedance cardiogram.</a> Psychophysiology. 33, 184-193 (1996).</li><li>van Dijk, A. E., van Eijsden, M., Stronks, K., Gemke, R. J., Vrijkotte, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prenatal+stress+and+balance+of+the+child's+cardiac+autonomic+nervous+system+at+age+5-6+years.">Prenatal stress and balance of the child's cardiac autonomic nervous system at age 5-6 years.</a> PLoS ONE. 7, e30413 (2012).</li><li>Houtveen, J. H., de Groot, P. F., de Geus, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+variation+in+posture+and+respiration+on+RSA+and+pre-ejection+period.">Effects of variation in posture and respiration on RSA and pre-ejection period.</a> Psychophysiology. 42, 713-719 (2005).</li><li>Goedhart, A. D., Willemsen, G., Houtveen, J. H., Boomsma, D. I., De Geus, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparing+low+frequency+heart+rate+variability+and+preejection+period:+two+sides+of+a+different+coin.">Comparing low frequency heart rate variability and preejection period: two sides of a different coin.</a> Psychophysiology. 45, 1086-1090 (2008).</li><li>van Dijk, A. E., van Eijsden, M., Stronks, K., Gemke, R. J., Vrijkotte, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardio-metabolic+risk+in+5-year-old+children+prenatally+exposed+to+maternal+psychosocial+stress:+the+ABCD+study.">Cardio-metabolic risk in 5-year-old children prenatally exposed to maternal psychosocial stress: the ABCD study.</a> BMC Public Health. 10, 251 (2010).</li><li>van Lien, R., Goedhart, A., Kupper, N., Boomsma, D., Willemsen, G., de Geus, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Underestimation+of+cardiac+vagal+control+in+regular+exercisers+by+24-hour+heart+rate+variability+recordings.">Underestimation of cardiac vagal control in regular exercisers by 24-hour heart rate variability recordings.</a> Int. J. Psychophysiol. 81, 169-176 (2011).</li></ol>

<p class="jove_content"我们什么都没有透露。</p

我们使用了一个动态记录装置，测量心脏自主控制在3097名儿童，年龄介乎5年和7年。 7个电极足以测量心电图和ICG心脏速率，心率变异性和收缩时间间隔提取。心脏呼吸频率带的心率变异性（RSA）是副交感神经活动的有效指标。收缩时间间隔，PEP，反映心脏收缩，心脏交感神经活动的有效指标。获得人力资源，PEP和RSA的平均值，姿势变化的影响，男孩和女孩之间的差异将有望从文献。 由于动态监测去掉在实验室评估的必要性，我们的录音，可以在不同的地点（ 如学校，体育中心，科普馆）进行信号记录质量无差异。然而，它是至关重要的姿势和身体负荷的主题比较规范之内或之间，，负荷和预紧效果可以共同确定的PEP心脏交感神经驱动7没有任何变化。我们得出结论，门诊记录的心电图和ICG在大样本的儿童是非常可行的，并提出了当前标准化研究一个有用的模板设计，为今后的评估心脏自主控制儿童。

<table border="1">
		<tbody>
		 <tr>
			<td>Name of Reagent/Material</td>
			<td>Company</td>
			<td>Catalogue Number</td>
			<td>Comments</td>
		 </tr>
		 <tr>
			<td>VU-AMS5fs ambulatory recording device &amp; infrared interface cable</td>
			<td>VU University Amsterdam</td>
			<td>n/a</td>
			<td><a href="http://www.vu-ams.nl" target="_blank">http://www.vu-ams.nl</a></td>
		 </tr>
		 <tr>
			<td>Electrodes</td>
			<td>ConMed</td>
			<td>1690-003</td>
			<td></td>
		 </tr>
		 <tr>
			<td>AA-batteries</td>
			<td></td>
			<td></td>
			<td></td>
		 </tr>
		 <tr>
			<td>CompactFlash memory card</td>
			<td></td>
			<td></td>
			<td></td>
		 </tr>
		 <tr>
			<td>Laptop/pc with flash card reader</td>
			<td></td>
			<td></td>
			<td></td>
		 </tr>
		 <tr>
			<td>VU-DAMS software suite</td>
			<td>VU University Amsterdam</td>
			<td>&nbsp;</td>
			<td>free download, <a href="http://www.vu-ams.nl" target="_blank">http://www.vu-ams.nl</a></td>
		 </tr>
		 <tr>
			<td>Stopwatch</td>
			<td></td>
			<td></td>
			<td></td>
		 </tr>
		 <tr>
			<td>Music player &amp; headphones</td>
			<td></td>
			<td></td>
			<td>optional</td>
		 </tr>
		 <tr>
			<td>Self-inflatable air mattress</td>
			<td></td>
			<td></td>
			<td>optional</td>
		 </tr>
		</tbody>
 </table>

measuring cardiac autonomic nervous system (ans) activity in children

自主神经系统（ANS）控制所从事的动态平衡，如心率，消化，呼吸率，流涎，出汗，肾功能主要是自动的身体机能。 ANS有两个主要分支:在危险和压力的时候采取行动，准备对人体的交感神经系统，而副交感神经系统，调节人体的静止状态。 ANS活性可侵入性地测量，例如放射性示踪剂技术或微电极记录从表面的神经，或它可以被测量的非侵入性通过使用器官的响应的变化作为ANS活性的变化的代理，例如汗腺或心脏。入侵测量有​​效性最高的，，但很差大规模样本的非侵入性的措施是首选的方法是可行的。植物神经对心脏的影响能可靠地量化记录，结合阻抗心动图（ICG），这反映了在胸廓阻抗的变化响应呼吸和喷射的血液从心室进入主动脉的心电图（ECG）。呼吸性窦性心律不齐从呼吸和ECG信号，可以提取作为衡量心脏副交感控制。从ECG和左室射血分数信号的，可以提取作为衡量心脏交感神经控制弹射前准备期。心电图和ICG录音大多是在实验室环境中完成。然而，主题报告实验室生态效度大大降低，并不总是可行的，在大规模流行病学研究，可以恐吓幼儿。门诊心电图和ICG设备，同时解决了这三个问题。 在这里，我们提出了一个儿童心脏自主控制的一种微创和快速评估研究设计，使用经过验证的AMB监管上装置1-5，VU大学（VU-AMS，阿姆斯特丹，荷兰<a href="http://www.vu-ams.nl" target="_blank">www.vu ams.nl的</a> ）动态监测系统。

在阿姆斯特丹出生的儿童及其发展的研究中，荷兰的前瞻性，纵向出生队列，测量协议，开始在3,097名儿童6。从学术医学中心医学伦理委员会，VU大学医学中心医学伦理委员会和阿姆斯特丹的注册委员会获得批准。所有参赛的母亲了知情同意书，为自己和自己的孩子。 由于显示器是轻量级和不显眼的，孩子容忍这些测量结果非常好。我们不拒绝率的数据，但经验告诉我们，只有少数儿童抵制电极的位置，从而阻碍进一步的评估。 3,097注册的，0.7％的人失去了应有的任一设备出现故障或遗失文件。 3,074注册左，98.7％的儿童完成了整个协议组（n = 3,056）。内EACH标记的时间段（我们原来标记的四个时间段，但后来概括为两个），我们遇到不清楚的ICG的信号，这意味着无法确定PEP。这导致了1.5％，率先走出四个标记的时期，2.4％，第二，第三和2.8％，4.1％，在第四个期间的损失。 PEP在所有时间段的完整数据2797案件（91.5％，8.5％的损失由于不清楚ICG信号）。心脏心率（HR），射血前期（PEP）和呼吸性窦性心律不齐（RSA），以及性别和年龄上的完整数据，可从2,761名儿童，在这最后的一步，1.3％发生数据丢失，由于原因不明。总体而言，89.2％，开始注册完整的主题数据。孩子的平均年龄为5.7岁（SD 0.5;四分范围5.0:6.5），和他们的体重指数（BMI）为15.5公斤/米2（SD 1.5;四分范围13.9:17.2）。 主要成果变量HR，PEP，和RSA AR的平均值Ë 表1中给出，并生动地描绘在图3中 ，分别为男孩和女孩。 HR（躺下和坐起来）和PEP（只坐起来）均高于女生比男生（姿势）。 RSA是较低的女孩比男孩（姿势）。 HR在女孩的高值可能会造成较低的迷走神经（副交感神经）的心脏控制。没有什么不同，甚至更低比男孩（坐）在他们的心脏交感神经控制。 在两性中，人力资源是坐起来时，相比躺着，而RSA是低坐起来时。这反映了较低的坐起来时，迷走神经控制。 PEP是短躺着然后坐起来。这种效应也如预期，它反映的是交感神经活性较低（延长PEP），而结果相反的过程:躺着增加预压（缩短PEP）7。 <table border="1" class="jove_content_small" fo:keep-together.with页="总是"&gt; <tbody><tr><td rowspan="3"></td><td colspan="6"> 男孩 </td><td colspan="5"> 女孩 </td></tr><tr><td colspan="3"> 平躺 </td><td colspan="3"> 坐起来 </td><td colspan="2"> 平躺 </td><td colspan="3"> 坐起来 </td></tr><tr><td> 意味着 </td><td colspan="2"> SD </td><td> 意味着 </td><td> SD </td><td></td><td> 意味着 </td><td> SD </td><td> 意味着 </td><td> SD </td><td></td></tr><tr><td>心脏率（BPM） </td><td> 83.9 </td><td> 9.5 </td><td> * </td><td> 89.1 </td><td> 10 </td><td> *† </td><td> 86.9 </td><td> 10.1 </td><td> 92.4 </td><td> 10.4 </td><td> † </td></tr><tr><td>射血前期（毫秒） </td><td>76.9 </td><td> 11.8 </td><td></td><td> 78.5 </td><td> 12.2 </td><td> *† </td><td> 77.7 </td><td> 10.3 </td><td> 81 </td><td> 11.7 </td><td> † </td></tr><tr><td>呼吸性窦性心律心律失常（毫秒） </td><td> 127.0 </td><td> 60.4 </td><td> * </td><td> 115.7 </td><td> 55.8 </td><td> *† </td><td> 121.7 </td><td> 56.8 </td><td> 108.7 </td><td> 51.9 </td><td> † </td></tr></tbody></table> 表1中。男孩和女孩的心脏自主神经系统的措施，通过姿势姿势差异，P &lt;0.05为一个样本T检验性别差异。 †P &lt;0.05配对样本T检验。 <img alt="图1" src="/files/ftp_upload/50073/50073fig1.jpg" /> 图1。在参与者的胸部和背部的7个电极应放在第一ECG电极（V-）的地方。ð略低于右锁骨4厘米的右侧胸骨。第二ECG电极（V +）被放置在上面的水平的突xiphodius中的胸部约在左侧的侧缘的心脏在第9个肋的顶点。第三个ECG电极（GND）的接地电极，放置在右侧，右腹部较低的两个肋之间。第一ICG测量电极（V 1）被放置在胸骨的上端，套环骨头的尖端之间。第二ICG测量电极被放置在胸骨的剑突络合物，肋相交。电流的两个电极被放置在背面:我-上通过颈椎椎体C4的脊柱，至少3厘米（1英寸）以上的ICG测量电极V，和我+之间胸椎椎体T8和T9对脊柱至少3厘米（1英寸）低于ICG的测量电极V 2。ICG电极放置考虑左心室驱动程序中最大的一部分被抓获的胸骨上切迹之间的列和突xiphoideus的胸廓阻抗变化。 <img alt="图2" fo:content-width="5in" fo:src="/files/ftp_upload/50073/50073fig2highres.jpg" src="/files/ftp_upload/50073/50073fig2.jpg" /> 图2。 DAMS软件所显示的连接到VU-AMS5fs的设备后，记录用于典型的设置， <a href="https://www.jove.com/files/ftp_upload/50073/50073fig2large.jpg" target="_blank">点击这里查看大图</a> 。 <img alt="图3" src="/files/ftp_upload/50073/50073fig3.jpg" fo:content-width="3.5in" fo:src="/files/ftp_upload/50073/50073fig3highres.jpg"/> 图3。男孩和女孩的心脏自主神经系统的措施，通过姿势。*表示P &lt;0.05为一个样本T检验性别差异。 ＃表示配对样本T检验姿势差异P &lt;0.05。

Watch this Scientific Journal Video about Measuring Cardiac Autonomic Nervous System ANS Activity in Children at JoVE.com

Measuring Cardiac Autonomic Nervous System ANS Activity in Children

自主神经系统活性的测量通常限制了研究者和参与者的实验室，可提供给孩子一个令人生畏的环境。 VU大学动态监测系统（VU-AMS）设备可以在任何环境下记录心脏自主控制。 VU-AMS证明非常适合于儿童的测试。

测量心脏自主神经系统（ANS）儿童活动

The autonomic nervous system (ANS) controls mainly automatic bodily functions that are engaged in homeostasis, like heart rate, digestion, respiratory ...

measuring-cardiac-autonomic-nervous-system-ans-activity-in-children

Research

JoVE Journal

Medicine

Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children

20.7K 次观看.  Academic Medical Center - University of Amsterdam. 自主神经系统活性的测量通常限制了研究者和参与者的实验室，可提供给孩子一个令人生畏的环境。 VU大学动态监测系统（VU-AMS）设备可以在任何环境下记录心脏自主控制。 VU-AMS证明非常适合于儿童的测试。

视频: Measuring Cardiac Autonomic Nervous System ANS Activity in Children

Quantitative Autonomic Testing

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be invaluable tool for evaluation of these disorders, both in clinic and research. There are number of autonomic tests, however, only few were validated clinically or are quantitative. Here, fully quantitative and clinically validated protocol for testing of autonomic functions is presented. As a bare minimum the clinical autonomic laboratory should have a tilt table, ECG monitor, continuous noninvasive blood pressure monitor, respiratory monitor and a mean for evaluation of sudomotor domain. The software for recording and evaluation of autonomic tests is critical for correct evaluation of data. The presented protocol evaluates 3 major autonomic domains: cardiovagal, adrenergic and sudomotor. The tests include deep breathing, Valsalva maneuver, head-up tilt, and quantitative sudomotor axon test (QSART). The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores (CASS). Detailed protocol is provided highlighting essential aspects of testing with emphasis on proper data acquisition, obtaining the relevant parameters and unbiased evaluation of autonomic signals. The normative data and CASS algorithm for interpretation of results are provided as well.

Standardized, comprehensive and fully quantitative testing of autonomic functions is described. The autonomic tests consist of evaluation of all three major autonomic domains including cardiovagal, adrenergic and sudomotor. The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores.

定量自主测试

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be ...

科研

医学

Measuring Cardiac Autonomic Nervous System (ANS) Activity in Toddlers - Resting and Developmental Challenges

The autonomic nervous system (ANS) consists of two branches, the parasympathetic and sympathetic nervous systems, and controls the function of internal organs (e.g., heart rate, respiration, digestion) and responds to everyday and adverse experiences 1. ANS measures in children have been found to be related to behavior problems, emotion regulation, and health 2-7. Therefore, understanding the factors that affect ANS development during early childhood is important. Both branches of the ANS affect young children&#8217;s cardiovascular responses to stimuli and have been measured noninvasively, via external monitoring equipment, using valid and reliable measures of physiological change 8-11. However, there are few studies of very young children with simultaneous measures of the parasympathetic and sympathetic nervous systems, which limits understanding of the integrated functioning of the two systems. In addition, the majority of existing studies of young children report on infants&#8217; resting ANS measures or their reactivity to commonly used mother-child interaction paradigms, and less is known about ANS reactivity to other challenging conditions. We present a study design and standardized protocol for a non-invasive and rapid assessment of cardiac autonomic control in 18 month old children. We describe methods for continuous monitoring of the parasympathetic and sympathetic branches of the ANS under resting and challenge conditions during a home or laboratory visit and provide descriptive findings from our sample of 140 ethnically diverse toddlers using validated equipment and scoring software. Results revealed that this protocol can produce a range of&#160;physiological responses to both resting and developmentally challenging conditions, as indicated by changes in heart rate and indices of parasympathetic and sympathetic activity. Individuals demonstrated&#160;variability in resting levels, responses to challenges, and challenge reactivity, which provides additional evidence that this protocol is useful for the examination of ANS individual differences for toddlers.

Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges

We describe the methods for continuous monitoring of the autonomic nervous system under resting and challenge conditions with 18 month old children. Results revealed that this protocol can produce meaningful physiological responses in both branches of the autonomic nervous system and elicit significant individual variability in patterns of responses.

测量心脏自主神经系统（ANS）活性的幼儿 - 安静和发展挑战

The autonomic nervous system (ANS) consists of two branches, the parasympathetic and sympathetic nervous systems, and controls the function of internal ...

Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal model to investigate bladder remodeling in pBOO are female rodents undergoing partial obstruction at the proximal urethra. Variability in the degree of obstruction and animal mortality are major concerns with proximal obstruction. Furthermore, dissecting around the proximal urethra and bladder neck jeopardizes bladder innervation.
We developed a nerve-sparing mid-urethral obstruction (NeMO) model for pBOO avoiding the disadvantages of the traditional model. We approached the urethra just inferior to the pubic symphysis, which obviated the need for laparotomy as well as for dissection in this area; also, the striated urethral sphincter remained untouched. We performed NeMO in female Sprague-Dawley rats (12 obstructions, 6 sham animals) as well as in female C57/bl6 mice (20 obstructions, 18 sham animals). After two weeks, we evaluated bladder function, bladder mass, and body mass.
We had no mortalities among obstructed- or sham-operated female rats; as described for the traditional proximal pBOO-method, we tied the suture around the proximal urethra and a temporarily placed 0.9 mm metal rod. NeMO induced an 85% increase in bladder mass after two weeks, average residual urine volume was 0.4 mL in partially obstructed rats while only 0.03 mL in sham animals. In mice, we tested 3 sizes of cannulas that we placed along the urethra when tying the suture. We found that using a 27-gauge cannula resulted in over 50% animal mortality; placing the 25-gauge cannula did not yield the desired response in increasing bladder mass; utilizing a 26-gauge cannula yielded favorable results with minimal animal mortality (1/8) yet a significant 2-fold increase in bladder mass.

Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents

Traditional modeling of partial bladder outlet obstruction in rodents is fraught with animal mortality. A denervation injury from dissection around the proximal urethra and bladder neck is also of major concern. We developed and evaluated a safe and reliable mid-urethral obstruction model, avoiding the shortcomings of the traditional model.

在女小鼠害保留神经的中期尿道梗阻（NEMO）

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal ...

Cardiac Magnetic Resonance Imaging at 7 Tesla

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher magnetic field strengths and potentially provides improved signal contrast and spatial resolution. While promising results have been achieved, ultra-high field CMR is challenging due to energy deposition constraints and physical phenomena such as transmission field non-uniformities and magnetic field inhomogeneities. In addition, the magneto-hydrodynamic effect renders the synchronization of the data acquisition with the cardiac motion difficult. The challenges are currently addressed by explorations into novel magnetic resonance technology. If all impediments can be overcome, ultra-high field CMR may generate new opportunities for functional CMR, myocardial tissue characterization, microstructure imaging or metabolic imaging. Recognizing this potential, we show that multi-channel radio frequency (RF) coil technology tailored for CMR at 7 Tesla together with higher order B0 shimming and a backup signal for cardiac triggering facilitates high fidelity functional CMR. With the proposed setup, cardiac chamber quantification can be accomplished in examination times similar to those achieved at lower field strengths. To share this experience and to support the dissemination of this expertise, this work describes our setup and protocol tailored for functional CMR at 7 Tesla.

The sensitivity gain inherent to ultrahigh field magnetic resonance holds promise for high spatial resolution imaging of the heart. Here, we describe a protocol customized for functional cardiovascular magnetic resonance (CMR) at 7 Tesla using an advanced multi-channel radio-frequency coil, magnetic field shimming and a triggering concept.

7号特斯拉的心脏磁共振成像

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher ...

A Drosophila In Vivo Injury Model for Studying Neuroregeneration in the Peripheral and Central Nervous System

The regrowth capacity of damaged neurons governs neuroregeneration and functional recovery after nervous system trauma. Over the past few decades, various intrinsic and extrinsic inhibitory factors involved in the restriction of axon regeneration have been identified. However, simply removing these inhibitory cues is insufficient for successful regeneration, indicating the existence of additional regulatory machinery. Drosophila melanogaster, the fruit fly, shares evolutionarily conserved genes and signaling pathways with vertebrates, including humans. Combining the powerful genetic toolbox of flies with two-photon laser axotomy/dendriotomy, we describe here the Drosophila sensory neuron &#8211; dendritic arborization (da) neuron injury model as a platform for systematically screening for novel regeneration regulators. Briefly, this paradigm includes a) the preparation of larvae, b) lesion induction to dendrite(s) or axon(s) using a two-photon laser, c) live confocal imaging post-injury and d) data analysis. Our model enables highly reproducible injury of single labeled neurons, axons, and dendrites of well-defined neuronal subtypes, in both the peripheral and central nervous system.

A Drosophila In Vivo Injury Model for Studying Neuroregeneration in the Peripheral and Central Nervous System

Here, we present a protocol using the Drosophila sensory neuron - dendritic arborization (da) neuron injury model, which combines in vivo live imaging, two-photon laser axotomy/dendriotomy, and the powerful fly genetic toolbox, as a platform for screening potential promoters and inhibitors of neuroregeneration.

一种研究外周和中枢神经系统 Neuroregeneration 的果蝇体内损伤模型

The regrowth capacity of damaged neurons governs neuroregeneration and functional recovery after nervous system trauma. Over the past few decades, various ...

Impact of Intracardiac Neurons on Cardiac Electrophysiology and Arrhythmogenesis in an Ex Vivo Langendorff System

Since its invention in the late 19th century, the Langendorff ex vivo heart perfusion system continues to be a relevant tool for studying a broad spectrum of physiological, biochemical, morphological, and pharmacological parameters in centrally denervated hearts. Here, we describe a setup for the modulation of the intracardiac autonomic nervous system and the assessment of its influence on basic electrophysiology, arrhythmogenesis, and cyclic adenosine monophosphate (cAMP) dynamics. The intracardiac autonomic nervous system is modulated by the mechanical dissection of atrial fat pads-in which murine ganglia are located mainly&#8212;or by the usage of global as well as targeted pharmacological interventions. An octapolar electrophysiological catheter is introduced into the right atrium and the right ventricle, and epicardial-placed multi-electrode arrays (MEA) for high-resolution mapping are used to determine cardiac electrophysiology and arrhythmogenesis. F&#246;rster resonance energy transfer (FRET) imaging is performed for the real-time monitoring of cAMP levels in different cardiac regions. Neuromorphology is studied by means of antibody-based staining of whole hearts using neuronal markers to guide the identification and modulation of specific targets of the intracardiac autonomic nervous system in the performed studies. The ex vivo Langendorff setup allows for a high number of reproducible experiments in a short time. Nevertheless, the partly open nature of the setup (e.g., during MEA measurements) makes constant temperature control difficult and should be kept to a minimum. This described method makes it possible to analyze and modulate the intracardiac autonomic nervous system in decentralized hearts.

Impact of Intracardiac Neurons on Cardiac Electrophysiology and Arrhythmogenesis in an Ex Vivo Langendorff System

Here, we present a protocol for the modulation of the intracardiac autonomic nervous system and the assessment of its influence on basic electrophysiology, arrhythmogenesis, and cAMP dynamics using an ex vivo Langendorff setup.

心内神经元对体外 Langendorff 系统心脏电生理和心脏交感神经的影响

Since its invention in the late 19th century, the Langendorff ex vivo heart perfusion system continues to be a relevant tool for studying a broad spectrum ...

A Flow Cytometry-based Assay for Measuring Mitochondrial Membrane Potential in Cardiac Myocytes After Hypoxia/Reoxygenation

Timely and efficient reperfusion of the occluded coronary artery is the best strategy for decreasing myocardial infarct size in patients with a ST-segment elevated myocardial infarction. However, reperfusion per se can result in further cardiomyocyte death, a phenomenon known as reperfusion injury. The opening of the mitochondrial permeability transition pore (mPTP), with the decrease of the mitochondrial membrane potential (MMP), or mitochondrial depolarization, is universally recognized as the final step of reperfusion injury and is responsible for mitochondrial and cardiomyocyte death. JC-1 is a lipophilic cationic dye that accumulates in mitochondria depending on the value of MMP. The higher the MMP is, the more JC-1 accumulates in the mitochondria. The increasing amounts of JC-1 in mitochondria can be reflected by a fluorescence emission shift from green (~530 nm) to red (~590 nm). Therefore, the reduction of the red/green fluorescence intensity ratio can indicate the depolarization of mitochondria. Here, we take advantage of JC-1 to measure MMP, or the opening of mPTP in human cardiac myocytes after hypoxia/reoxygenation, detected by flow cytometry.

Here, we present a protocol that uses JC-1 dye to assess the mitochondrial membrane potential of cells after being exposed to hypoxia/reoxygenation with or without a protective agent.

流式细胞仪测定缺氧/复氧后心肌细胞线粒体膜电位的实验研究

Timely and efficient reperfusion of the occluded coronary artery is the best strategy for decreasing myocardial infarct size in patients with a ST-segment ...

Semi-Minimal Invasive Method to Induce Myocardial Infarction in Rats and the Assessment of Cardiac Function by an Isolated Working Heart System

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily and highly reproducible MI induction procedure is required to obtain further insight and better understanding of the underlying pathological changes. This procedure can also be used to evaluate the effects or potency of new and promising treatments (as drugs or interventions) in acute MI, subsequent remodeling and heart failure (HF). After intubation and pre-operative preparation of the animal, an anesthetic protocol with isoflurane was performed, and the surgical procedure was conducted&#160;quickly. Using a minimally invasive approach, the left anterior descending artery (LAD) was located and occluded by a ligature. The occlusion can be performed acutely for subsequent reperfusion (ischemia/reperfusion injury). Alternatively, the vessel can be ligated permanently to investigate the development of chronic MI, remodeling or HF. Despite common pitfalls, the drop-out rates are minimal. Various treatments such as remote ischemic conditioning can be examined for their cardioprotective potential pre-, peri- and post-operatively. The post-operative recovery was quick as the anesthesia was precisely controlled and the duration of the operation was short. Post-operative analgesia was administered for three days. The minimally invasive procedure reduces the risk of infection and inflammation. Furthermore, it facilitates rapid recovery. The &#8220;working heart&#8221; measurements were performed ex vivo and enabled precise control of preload, afterload and flow. This procedure requires specific equipment and training for adequate performance. This manuscript provides a detailed step-by-step introduction for conducting these measurements.

This article presents an efficient method to perform myocardial ischemia and subsequent chronic reperfusion in rats using a minimally invasive approach. In addition, left ventricular hemodynamic function of rats is assessed by echocardiography and isolated working heart methods.&#160;

诱导大鼠心肌梗死的半微创方法及独立工作心脏系统对心脏功能的评估

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily ...

How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules. A probe placed on the skin emits light that is absorbed, scattered, and reflected by the underlying tissue. Detectors in the probe sense the amount of reflected light: this reflects the organ-specific ratio of oxygen supply and consumption - independent of pulsatile flow. Modern devices enable the simultaneous monitoring at different body sites. A rise or dip in the rSO2 curve visualizes changes in oxygen supply or demand before vital signs indicate them. The evolution of rSO2 values in relation to the starting point is more important for interpretation than are absolute values.
A routine clinical application of NIRS is the surveillance of somatic and cerebral oxygenation during and after cardiac surgery. It is also administered in preterm infants at risk for necrotizing enterocolitis, newborns with hypoxic ischemic encephalopathy and a potential risk of impaired tissue oxygenation. In the future, NIRS could be increasingly used in multimodal neuromonitoring, or applied to monitor patients with other conditions (e.g., after resuscitation or traumatic brain injury).

This protocol is designed to assist clinicians to measure regional tissue oxygenation at different body sites in infants and children. It can be used in situations where tissue oxygenation is potentially compromised, particularly during cardiopulmonary bypass, when using non-pulsatile cardiac-assist devices, and in critically ill neonates, infants and children.

如何管理危重新生儿、婴儿和儿童近红外光谱

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated ...

In vitro Assessment of Cardiac Reprogramming by Measuring Cardiac Specific Calcium Flux with a GCaMP3 Reporter

Cardiac reprogramming has become a potentially promising therapy to repair a damaged heart. By introducing multiple transcription factors, including Mef2c, Gata4, Tbx5 (MGT), fibroblasts can be reprogrammed into induced cardiomyocytes (iCMs). These iCMs, when generated in situ in an infarcted heart, integrate electrically and mechanically with the surrounding myocardium, leading to a reduction in scar size and an improvement in heart function. Because of the relatively low reprogramming efficiency, purity, and quality of the iCMs, characterization of iCMs remains a challenge. The currently used methods in this field, including flow cytometry, immunocytochemistry, and qPCR, mainly focus on cardiac-specific gene and protein expression but not on the functional maturation of iCMs. Triggered by action potentials, the opening of voltage-gated calcium channels in cardiomyocytes leads to a rapid influx of calcium into the cell. Therefore, quantifying the rate of calcium influx is a promising method to evaluate cardiomyocyte function. Here, the protocol introduces a method to evaluate iCM function by calcium (Ca2+) flux. An &#945;MHC-Cre/Rosa26A-Flox-Stop-Flox-GCaMP3 mouse strain was established by crossing Tg(Myh6-cre)1Jmk/J (referred to as Myh6-Cre below) with Gt(ROSA)26Sortm38(CAG-GCaMP3)Hze/J (referred to as Rosa26A-Flox-Stop-Flox-GCaMP3 below) mice. Neonatal cardiac fibroblasts (NCFs) from P0-P2 neonatal mice were isolated and cultured in vitro, and a polycistronic construction of MGT was introduced to NCFs, which led to their reprogramming to iCMs. Because only successfully reprogrammed iCMs will express GCaMP3 reporter, the functional maturation of iCMs can be visually assessed by Ca2+ flux with fluorescence microscopy. Compared with un-reprogrammed NCFs, NCF-iCMs showed significant calcium transient flux and spontaneous contraction, similar to CMs. This protocol describes in detail the mouse strain establishment, isolation and selection of neonatal mice hearts, NCF isolation, production of retrovirus for cardiac reprogramming, iCM induction, the evaluation of iCM Ca2+ flux using our reporter line, and related statistical analysis and data presentation. It is expected that the methods described here will provide a valuable platform to assess the functional maturation of iCMs for cardiac reprogramming studies.

We describe here, the establishment and application of an Tg(Myh6-cre)1Jmk/J /Gt(ROSA)26Sortm38(CAG-GCaMP3)Hze/J (referred to as &#945;MHC-Cre/Rosa26A-Flox-Stop-Flox-GCaMP3 below) mouse reporter line for cardiac reprogramming assessment. Neonatal cardiac fibroblasts (NCFs) isolated from the mouse strain are converted into induced cardiomyocytes (iCMs), allowing for convenient and efficient evaluation of reprogramming efficiency and functional maturation of iCMs via calcium (Ca2+) flux.

使用GCaMP3报告器测量心脏特异性钙通量，对心脏重编程进行体外评估

Cardiac reprogramming has become a potentially promising therapy to repair a damaged heart. By introducing multiple transcription factors, including ...