Displaying publications 1 - 20 of 262 in total

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  1. Gujjar KR, van Wijk A, Kumar R, de Jongh A
    J Anxiety Disord, 2019 03;62:100-108.
    PMID: 30717830 DOI: 10.1016/j.janxdis.2018.12.001
    BACKGROUND: Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia.

    METHOD: A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up.

    RESULTS: Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps 

    Matched MeSH terms: Heart Rate
  2. Nur Khairunisa Abu Talip, Zulkifli Abdul Kadir
    MyJurnal
    Resistance training (RT) refers to a method of physical conditioning of complex programming which consists of progressive and various training techniques to achieve the desired training goals. An appropriate programme design is the key to success; where exercise selection is one of the critical factors. The selection of exercise will expose different stimulation as in the application of the specific adaptation on imposed demand principle. The option of choosing either bilateral (BI) or unilateral (UNI) exercise is an important decision to perform in the construction of any strength or RT programme. This study aimed to investigate the physiological responses of unilateral versus bilateral acute RT on heart rate (HR), blood pressure (BP) and rate of perceived exertion (RPE). Sixteen (n = 16) trained women with mean age of 23.31 (SD = 1.35) years old went through a total body exercise session for each unilateral and bilateral protocols which both consisted of major muscles group for 80% 1RM, 10 repetitions to maximal effort for 3 sets. The results revealed that all variables examined including HR, systolic blood pressure (SBP), diastolic blood pressure (DBP) and RPE were statistically changed (p < .001) across the times. Apart from that, unilateral and bilateral RT imposed significantly different stimulus on SBP (p < .05).
    Matched MeSH terms: Heart Rate
  3. Azrina, M.R., Saedah Ali, Mohd Nikman Ahmad, Nik Abdullah, N.M., Ziyadi Mohd Ghazali
    MyJurnal
    Introduction and Objectives: The intensive care unit (ICU) is an uncomfortable and stressful environment for patients. The use of adequate sedation and analgesia is important to reduce stress to patients. The aim of this study was to compare a relatively new sedative agent, dexmedetomidine to current sedative agent used, propofol in the provision of sedation and analgesia, their effects on haemodynamic and respiratory parameters and cost involved on post open heart surgery patients. Materials and Methods: A prospective, randomized single-blinded trial was conducted on post open heart surgery patients in the ICU of the Hospital Universiti Sains Malaysia (HUSM). Thirty two patients were randomized to dexmedetomidine or propofol groups. Analgesic requirement, haemodynamic and respiratory parameters, and extubation time were measured and compared. Mean rate of infusion to achieve adequate sedation were used to calculate the cost involved in the use of these two agents. Results: Patients sedated with dexmedetomidine required significantly lower dose of morphine compared to propofol [mean (sd): 12.80 (2.61) versus 15.86 (1.87) mg/kg/min, p=0.00]. Mean heart rate was also significantly lower in dexmedetomidine group compared to propofol group [mean (CI): 74.48 (70.38,78.59) versus 83.85 (79.61,88.09) per minutes, p=0.00]. However there were no significant differences in the other parameters between the two groups. Cost involved the use of dexmedetomidine was slightly higher compared to propofol (RM 9.57 versus RM8.94 per hour). Discussion and Conclusions: Dexmedetomidine is comparable to propofol in the provision of sedation, and its effect on haemodynamic and respiratory parameters. However it has added advantages in the provision of analgesia, and caused a significant reduction in heart rate. This is beneficial in these patients by reducing myocardial oxygen demand, and hence subsequent ischaemia and infarction. However, further larger studies are needed to evaluate the effect of dexmedetomidine on perioperative cardiac morbidity and mortality.
    Matched MeSH terms: Heart Rate
  4. Horiguchi T, Masui Y, Zan MSD
    Sensors (Basel), 2019 Mar 27;19(7).
    PMID: 30934806 DOI: 10.3390/s19071497
    Distributed strain and temperature can be measured by using local Brillouin backscatter in optical fibers based on the strain and temperature dependence of the Brillouin frequency shift. The technique of analyzing the local Brillion backscatter in the time domain is called Brillouin optical time domain reflectometry (BOTDR). Although the best spatial resolution of classic BOTDR remains at around 1 m, some recent BOTDR techniques have attained as high as cm-scale spatial resolution. Our laboratory has proposed and demonstrated a high-spatial-resolution BOTDR called phase-shift pulse BOTDR (PSP-BOTDR), using a pair of probe pulses modulated with binary phase-shift keying. PSP-BOTDR is based on the cross-correlation of Brillouin backscatter and on the subtraction of cross-correlations obtained from the Brillouin scatterings evoked by each phase-modulated probe pulse. Although PSP-BOTDR has attained 20-cm spatial resolution, the spectral analysis method of PSP-BOTDR has not been discussed in detail. This article gives in-depth analysis of the Brillouin backscatter and the correlations of the backscatters of the PSP-BOTDR. Based on the analysis, we propose new spectral analysis methods for PSP-BOTDR. The analysis and experiments show that the proposed methods give better frequency resolution than before.
    Matched MeSH terms: Heart Rate
  5. Odhah MN, Abdullah Jesse FF, Teik Chung EL, Mahmood Z, Haron AW, Mohd Lila MA, et al.
    Microb Pathog, 2019 Oct;135:103628.
    PMID: 31325572 DOI: 10.1016/j.micpath.2019.103628
    Caseous lymphadenitis is an infectious disease of almost all animals, particularly small ruminants that are caused by Corynebacterium pseudotuberculosis. The organism causes the formation of suppurative abscesses in superficial and visceral lymph nodes and in visceral organs. This current study was designed to elucidate the clinicopathological responses and PCR detection of the aetiological agent in the vital organs of goats challenged with C. pseudotuberculosis and its immunogenic mycolic acid extract. A total of twelve clinically healthy crossbred Boer female goats were divided into three groups: A, B, and C (four goats per group). Group A was inoculated intradermally with 2 ml of sterile phosphate buffered saline (PBS) pH 7 as a control group. Group B was inoculated intradermally with 2 ml of mycolic acid extract (1 g/ml), while group C was inoculated intradermally with 2 ml of 10⁹ colony-forming unit (cfu) of live C. pseudotuberculosis. The experimental animals were observed for clinical responses for 90 days post-inoculation and the clinical signs were scored according to the severity. The clinical signs observed in this study were temperature, heart rate, respiratory rate, rumen motility, enlargement of lymph nodes, and body condition score. The experimental animals were euthanised and tissue samples from different anatomical regions of the vital organs were collected in 10% buffered formalin, processed, sectioned, and stained with H&E. Results of both C. pseudotuberculosis and mycolic acid treated groups indicated a significant difference (p Heart rate in group C showed a significant increase between week 1 (93.35 ± 0.42 bpm) and week 11 (86.52 ± 1.32 bpm), and the mean heart rate of group B showed a significant increase (p 
    Matched MeSH terms: Heart Rate
  6. Ramalingam A, Budin SB, Mohd Fauzi N, Ritchie RH, Zainalabidin S
    Front Pharmacol, 2019;10:1493.
    PMID: 31920673 DOI: 10.3389/fphar.2019.01493
    Increased exposure to nicotine contributes to the development of cardiac dysfunction by promoting oxidative stress, fibrosis, and inflammation. These deleterious events altogether render cardiac myocytes more susceptible to acute cardiac insults such as ischemia-reperfusion (I/R) injury. This study sought to elucidate the role of angiotensin II type I (AT1) receptors in cardiac injury resulting from prolonged nicotine administration in a rat model. Male Sprague-Dawley rats were given nicotine (0.6 mg/kg ip) for 28 days to induce cardiac dysfunction, alone or in combination with the AT1 receptor antagonist, irbesartan (10 mg/kg, po). Vehicle-treated rats were used as controls. Rat hearts isolated from each experimental group at study endpoint were examined for changes in function, histology, gene expression, and susceptibility against acute I/R injury determined ex vivo. Rats administered nicotine alone exhibited significantly increased cardiac expression of angiotensin II and angiotensin-converting enzyme (ACE) in addition to elevated systolic blood pressure (SBP) and heart rate. Furthermore, nicotine administration markedly reduced left ventricular (LV) performance with concomitant increases in myocardial oxidative stress, fibrosis, and inflammation. Concomitant treatment with irbesartan attenuated these effects, lowering blood pressure, heart rate, oxidative stress, and expression of fibrotic and inflammatory genes. Importantly, the irbesartan-treated group also manifested reduced susceptibility to I/R injury ex vivo. These findings suggest that AT1 receptors play an important role in nicotine-induced cardiac dysfunction, and pharmacological approaches targeting cardiac AT1 receptors may thus benefit patients with sustained exposure to nicotine.
    Matched MeSH terms: Heart Rate
  7. Ng CG, Lai KT, Tan SB, Sulaiman AH, Zainal NZ
    J Palliat Med, 2016 09;19(9):917-24.
    PMID: 27110900 DOI: 10.1089/jpm.2016.0046
    BACKGROUND: Palliative cancer patients suffer from high levels of distress. There are physiological changes in relation to the level of perceived distress.

    OBJECTIVE: To study the efficacy of 5 minutes of mindful breathing (MB) for rapid reduction of distress in a palliative setting. Its effect to the physiological changes of the palliative cancer patients was also examined.

    METHODS: This is a randomized controlled trial. Sixty palliative cancer patients were recruited. They were randomly assigned to either 5 minutes of MB or normal listening arms. The changes of perceived distress, blood pressure, pulse rate, breathing rate, galvanic skin response, and skin surface temperature of the patients were measured at baseline, after intervention, and 10 minutes post-intervention.

    RESULTS: There was significant reduction of perceived distress, blood pressure, pulse rate, breathing rate, and galvanic skin response; also, significant increment of skin surface temperature in the 5-minute MB group. The changes in the 5-minute breathing group were significantly higher than the normal listening group.

    CONCLUSION: Five-minute MB is a quick, easy to administer, and effective therapy for rapid reduction of distress in palliative setting. There is a need for future study to establish the long-term efficacy of the therapy.

    Matched MeSH terms: Heart Rate
  8. Krupa BN, Mohd Ali MA, Zahedi E
    Physiol Meas, 2009 Aug;30(8):729-43.
    PMID: 19550027 DOI: 10.1088/0967-3334/30/8/001
    Cardiotocograph (CTG) is widely used in everyday clinical practice for fetal surveillance, where it is used to record fetal heart rate (FHR) and uterine activity (UA). These two biosignals can be used for antepartum and intrapartum fetal monitoring and are, in fact, nonlinear and non-stationary. CTG recordings are often corrupted by artifacts such as missing beats in FHR, high-frequency noise in FHR and UA signals. In this paper, an empirical mode decomposition (EMD) method is applied on CTG signals. A recursive algorithm is first utilized to eliminate missing beats. High-frequency noise is reduced using EMD followed by the partial reconstruction (PAR) method, where the noise order is identified by a statistical method. The obtained signal enhancement from the proposed method is validated by comparing the resulting traces with the output obtained by applying classical signal processing methods such as Butterworth low-pass filtering, linear interpolation and a moving average filter on 12 CTG signals. Three obstetricians evaluated all 12 sets of traces and rated the proposed method, on average, 3.8 out of 5 on a scale of 1(lowest) to 5 (highest).
    Matched MeSH terms: Heart Rate, Fetal/physiology
  9. Ibrahimy MI, Ahmed F, Mohd Ali MA, Zahedi E
    IEEE Trans Biomed Eng, 2003 Feb;50(2):258-62.
    PMID: 12665042
    An algorithm based on digital filtering, adaptive thresholding, statistical properties in the time domain, and differencing of local maxima and minima has been developed for the simultaneous measurement of the fetal and maternal heart rates from the maternal abdominal electrocardiogram during pregnancy and labor for ambulatory monitoring. A microcontroller-based system has been used to implement the algorithm in real-time. A Doppler ultrasound fetal monitor was used for statistical comparison on five volunteers with low risk pregnancies, between 35 and 40 weeks of gestation. Results showed an average percent root mean square difference of 5.32% and linear correlation coefficient from 0.84 to 0.93. The fetal heart rate curves remained inside a +/- 5-beats-per-minute limit relative to the reference ultrasound method for 84.1% of the time.
    Matched MeSH terms: Heart Rate/physiology; Heart Rate, Fetal/physiology*
  10. Atif Abbas S, Sharma JN, Pauzi A, Yusof M
    Gen. Pharmacol., 1999 Sep;33(3):243-7.
    PMID: 10480657
    The present study was conducted to examine the effect of bradykinin and bradykinin 2 receptor antagonist on survival time in rats with coronary artery ligation for 15 min and continuously. We also evaluated the heart rate and blood pressure responses in the presence and absence of bradykinin and its antagonist. Bradykinin treatment (4 microg and 8 microg/kg IV) significantly (p < 0.05) increased the survival time of rats compared with saline-treated rats with coronary artery ligation for 15 min and continuously. The heart rate and blood pressure responses were significantly (p < 0.001) altered in the presence of coronary artery ligation. Bradykinin antagonist treatment (4 microg/kg IV) abolished the effect of bradykinin and thus reduced the survival time of rats with coronary artery ligation. The mean value of survival time between saline-treated and bradykinin antagonist- plus bradykinin-treated rats did not differ significantly (p > 0.05).
    Matched MeSH terms: Heart Rate/drug effects
  11. Poznanski RR, Cacha LA, Al-Wesabi YMS, Ali J, Bahadoran M, Yupapin PP, et al.
    Sci Rep, 2017 May 31;7(1):2746.
    PMID: 28566682 DOI: 10.1038/s41598-017-01849-3
    A model of solitonic conduction in neuronal branchlets with microstructure is presented. The application of cable theory to neurons with microstructure results in a nonlinear cable equation that is solved using a direct method to obtain analytical approximations of traveling wave solutions. It is shown that a linear superposition of two oppositely directed traveling waves demonstrate solitonic interaction: colliding waves can penetrate through each other, and continue fully intact as the exact pulses that entered the collision. These findings indicate that microstructure when polarized can sustain solitary waves that propagate at a constant velocity without attenuation or distortion in the absence of synaptic transmission. Solitonic conduction in a neuronal branchlet arising from polarizability of its microstructure is a novel signaling mode of electrotonic signals in thin processes (<0.5 μm diameter).
    Matched MeSH terms: Heart Rate/physiology
  12. Rajendra Acharya U, Faust O, Adib Kadri N, Suri JS, Yu W
    Comput Biol Med, 2013 Oct;43(10):1523-9.
    PMID: 24034744 DOI: 10.1016/j.compbiomed.2013.05.024
    Diabetes mellitus (DM) affects considerable number of people in the world and the number of cases is increasing every year. Due to a strong link to the genetic basis of the disease, it is extremely difficult to cure. However, it can be controlled to prevent severe consequences, such as organ damage. Therefore, diabetes diagnosis and monitoring of its treatment is very important. In this paper, we have proposed a non-invasive diagnosis support system for DM. The system determines whether or not diabetes is present by determining the cardiac health of a patient using heart rate variability (HRV) analysis. This analysis was based on nine nonlinear features namely: Approximate Entropy (ApEn), largest Lyapunov exponet (LLE), detrended fluctuation analysis (DFA) and recurrence quantification analysis (RQA). Clinically significant measures were used as input to classification algorithms, namely AdaBoost, decision tree (DT), fuzzy Sugeno classifier (FSC), k-nearest neighbor algorithm (k-NN), probabilistic neural network (PNN) and support vector machine (SVM). Ten-fold stratified cross-validation was used to select the best classifier. AdaBoost, with least squares (LS) as weak learner, performed better than the other classifiers, yielding an average accuracy of 90%, sensitivity of 92.5% and specificity of 88.7%.
    Matched MeSH terms: Heart Rate/physiology*
  13. Quiroz JC, Geangu E, Yong MH
    JMIR Ment Health, 2018 Aug 08;5(3):e10153.
    PMID: 30089610 DOI: 10.2196/10153
    BACKGROUND: Research in psychology has shown that the way a person walks reflects that person's current mood (or emotional state). Recent studies have used mobile phones to detect emotional states from movement data.

    OBJECTIVE: The objective of our study was to investigate the use of movement sensor data from a smart watch to infer an individual's emotional state. We present our findings of a user study with 50 participants.

    METHODS: The experimental design is a mixed-design study: within-subjects (emotions: happy, sad, and neutral) and between-subjects (stimulus type: audiovisual "movie clips" and audio "music clips"). Each participant experienced both emotions in a single stimulus type. All participants walked 250 m while wearing a smart watch on one wrist and a heart rate monitor strap on the chest. They also had to answer a short questionnaire (20 items; Positive Affect and Negative Affect Schedule, PANAS) before and after experiencing each emotion. The data obtained from the heart rate monitor served as supplementary information to our data. We performed time series analysis on data from the smart watch and a t test on questionnaire items to measure the change in emotional state. Heart rate data was analyzed using one-way analysis of variance. We extracted features from the time series using sliding windows and used features to train and validate classifiers that determined an individual's emotion.

    RESULTS: Overall, 50 young adults participated in our study; of them, 49 were included for the affective PANAS questionnaire and 44 for the feature extraction and building of personal models. Participants reported feeling less negative affect after watching sad videos or after listening to sad music, P

    Matched MeSH terms: Heart Rate
  14. Chauhan A, Mazlee AM, Azhar NA, Ng Bansing SA, Qing CS, Sidhu DS, et al.
    J Oral Biol Craniofac Res, 2020 09 17;10(4):670-673.
    PMID: 32995257 DOI: 10.1016/j.jobcr.2020.09.003
    Objective: High intensity workout stimulates the sympathetic nervous system and causes changes in the salivary composition. We hypothesized that activity of caries-causing bacteria in saliva may differ before and after workout. The objective of the study was to investigate if there is any difference in the oral microbial activity before and after HIIT (High Intensity Interval Training) workout.

    Methods: Unstimulated saliva was collected before and after HIIT workout (n = 35). The workout was performed until the participant's heart rate reached 70-80% of maximum heart rate. The microbial activity of saliva was estimated using Oratest.

    Results: The participants belonged to 4 ethnities- Indian, Malays, Chinese and Others (18-22 years). The post-workout salivary microbial activity was higher than the pre-workout levels, being statistically significant (P = 0.010). The increase in the post-workout microbial activity among females was found to be higher when compared to males. We also found significant different according to the ethnicities.

    Conclusion: We conclude that caries activity increases immediately after a vigorous workout and remains high at least for 15 min. Further studies are needed to validate the findings. Workout enthusiast should be aware of this so that they can take necessary precautions and be more regular with their dental check-ups.

    Matched MeSH terms: Heart Rate
  15. Jawis MN, Singh R, Singh HJ, Yassin MN
    Br J Sports Med, 2005 Nov;39(11):825-9; discussion 825-9.
    PMID: 16244191
    OBJECTIVES: Anthropometric and physiological profiles of national sepak takraw players were determined.
    METHODS: Thirty nine players, specialising in the three playing positions (tekong/server, feeder, and killer/spiker) were divided into three age categories of under 15 (U15), under 18 (U18), and under 23 (U23) years of age. Height, weight, percent body fat (%bf), maximum oxygen consumption (Vo(2max)), range of motion (ROM), back and leg strength, and heart rate, for the estimation of oxygen consumption during matches, were recorded. Statistical analysis was performed using one way ANOVA for independent measurements and data are presented as mean+/-standard deviation.
    RESULTS: The U23 players were significantly taller and heavier with significantly better ROM of the neck, trunk, and ankle joints and back and leg strength than the U15 players. No significant difference was found in %bf between the three age categories. Mean maximum heart rate during exercise was significantly higher in the U15 group when compared to the U18 and U23 groups (p<0.05). Mean Vo2max was similar between the three groups. Estimated oxygen consumption during matches was 69.1%, 68.5%, and 56.4% of Vo2max in the killer, tekong, and the feeder groups, respectively.
    CONCLUSIONS: The mean height, body weight, and cardiopulmonary capacities of the players were within the Malaysian population norms, but were somewhat lower than those of players of other court games from other countries. %bf was also lower in these players. This study provides the much needed anthropometric and physiological data of sepak takraw players for further development of this sport.
    Matched MeSH terms: Heart Rate/physiology
  16. Wu M, Lu Y, Yang W, Wong SY
    Front Comput Neurosci, 2020;14:564015.
    PMID: 33469423 DOI: 10.3389/fncom.2020.564015
    Cardiovascular diseases (CVDs) are the leading cause of death today. The current identification method of the diseases is analyzing the Electrocardiogram (ECG), which is a medical monitoring technology recording cardiac activity. Unfortunately, looking for experts to analyze a large amount of ECG data consumes too many medical resources. Therefore, the method of identifying ECG characteristics based on machine learning has gradually become prevalent. However, there are some drawbacks to these typical methods, requiring manual feature recognition, complex models, and long training time. This paper proposes a robust and efficient 12-layer deep one-dimensional convolutional neural network on classifying the five micro-classes of heartbeat types in the MIT- BIH Arrhythmia database. The five types of heartbeat features are classified, and wavelet self-adaptive threshold denoising method is used in the experiments. Compared with BP neural network, random forest, and other CNN networks, the results show that the model proposed in this paper has better performance in accuracy, sensitivity, robustness, and anti-noise capability. Its accurate classification effectively saves medical resources, which has a positive effect on clinical practice.
    Matched MeSH terms: Heart Rate
  17. Chang P, Koh YK, Geh SL, Soepadmo E, Goh SH, Wong AK
    J Ethnopharmacol, 1989 Apr;25(2):213-5.
    PMID: 2747255
    Matched MeSH terms: Heart Rate/drug effects
  18. Aimie-Salleh N, Malarvili MB, Whittaker AC
    Med Biol Eng Comput, 2019 Jun;57(6):1229-1245.
    PMID: 30734153 DOI: 10.1007/s11517-019-01958-3
    Adverse childhood experiences have been suggested to cause changes in physiological processes and can determine the magnitude of the stress response which might have a significant impact on health later in life. To detect the stress response, biomarkers that represent both the Autonomic Nervous System (ANS) and Hypothalamic-Pituitary-Adrenal (HPA) axis are proposed. Among the available biomarkers, Heart Rate Variability (HRV) has been proven as a powerful biomarker that represents ANS. Meanwhile, salivary cortisol has been suggested as a biomarker that reflects the HPA axis. Even though many studies used multiple biomarkers to measure the stress response, the results for each biomarker were analyzed separately. Therefore, the objective of this study is to propose a fusion of ANS and HPA axis biomarkers in order to classify the stress response based on adverse childhood experience. Electrocardiograph, blood pressure (BP), pulse rate (PR), and salivary cortisol (SCort) measures were collected from 23 healthy participants; 11 participants had adverse childhood experience while the remaining 12 acted as the no adversity control group. HRV was then computed from the ECG and the HRV features were extracted. Next, the selected HRV features were combined with the other biomarkers using Euclidean distance (ed) and serial fusion, and the performance of the fused features was compared using Support Vector Machine. From the result, HRV-SCort using Euclidean distance achieved the most satisfactory performance with 80.0% accuracy, 83.3% sensitivity, and 78.3% specificity. Furthermore, the performance of the stress response classification of the fused biomarker, HRV-SCort, outperformed that of the single biomarkers: HRV (61% Accuracy), Cort (59.4% Accuracy), BP (78.3% accuracy), and PR (53.3% accuracy). From this study, it was proven that the fused biomarkers that represent both ANS and HPA (HRV-SCort) able to demonstrate a better classification performance in discriminating the stress response. Furthermore, a new approach for classification of stress response using Euclidean distance and SVM named as ed-SVM was proven to be an effective method for the HRV-SCort in classifying the stress response from PASAT. The robustness of this method is crucial in contributing to the effectiveness of the stress response measures and could further be used as an indicator for future health. Graphical abstract ᅟ.
    Matched MeSH terms: Heart Rate/physiology*
  19. Blair GW, Appleton JP, Flaherty K, Doubal F, Sprigg N, Dooley R, et al.
    EClinicalMedicine, 2019 04 24;11:34-43.
    PMID: 31317131 DOI: 10.1016/j.eclinm.2019.04.001
    Background: Lacunar stroke, a frequent clinical manifestation of small vessel disease (SVD), differs pathologically from other ischaemic stroke subtypes and has no specific long-term secondary prevention. Licenced drugs, isosorbide mononitrate (ISMN) and cilostazol, have relevant actions to prevent SVD progression.

    Methods: We recruited independent patients with clinically confirmed lacunar ischaemic stroke without cognitive impairment to a prospective randomised clinical trial, LACunar Intervention-1 (LACI-1). We randomised patients using a central web-based system, 1:1:1:1 with minimisation, to masked ISMN 25 mg bd, cilostazol 100 mg bd, both ISMN and cilostazol started immediately, or both with start delayed. We escalated doses to target over two weeks, sustained for eight weeks. Primary outcome was the proportion achieving target dose. Secondary outcomes included symptoms, safety (haemorrhage, recurrent vascular events), cognition, haematology, vascular function, and neuroimaging. LACI-1 was powered (80%, alpha 0.05) to detect 35% (90% versus 55%) difference between the proportion reaching target dose on one versus both drugs at 55 patients. Registration ISRCTN12580546.

    Findings: LACI-1 enrolled 57 participants between March 2016 and August 2017: 18 (32%) females, mean age 66 (SD 11, range 40-85) years, onset-randomisation 203 (range 6-920) days. Most achieved full (64%) or over half (87%) dose, with no difference between cilostazol vs ISMN, single vs dual drugs. Headache and palpitations increased initially then declined similarly with dual versus single drugs. There was no between-group difference in BP, pulse-wave velocity, haemoglobin or platelet function, but pulse rate was higher (mean difference, MD, 6.4, 95%CI 1.2-11.7, p = 0.02), platelet count higher (MD 35.7, 95%CI 2.8, 68.7, p = 0.03) and white matter hyperintensities reduced more (Chi-square p = 0.007) with cilostazol versus no cilostazol.

    Interpretation: Cilostazol and ISMN are well tolerated when the dose is escalated, without safety concerns, in patients with lacunar stroke. Larger trials with longer term follow-up are justified.

    Funding: Alzheimer's Society (AS-PG-14-033).

    Matched MeSH terms: Heart Rate
  20. Chiu CL, Jaais F, Wang CY
    Br J Anaesth, 1999 May;82(5):757-60.
    PMID: 10536557
    We have compared the effect of rocuronium and succinylcholine on intraocular pressure (IOP) during rapid sequence induction of anaesthesia using propofol and fentanyl, in a randomized double-blind study. We studied 30 adult patients, allocated to one of two groups. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol until loss of verbal response. This was followed by succinylcholine 1.5 mg kg-1 (group S; n = 15) or rocuronium 0.9 mg kg-1 (group R; n = 15). Laryngoscopy was performed 60 s later. IOP, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, immediately before intubation and every minute after intubation for 5 min. A Keeler Pulsair air impulse tonometer was used to measure IOP and the mean of two readings obtained in the right eye at each measurement time was recorded. Intubating conditions were evaluated according to a simple scoring system. IOP in the succinylcholine group was significantly greater than that in the rocuronium group (mean 21.6 (SEM 1.4) mm Hg vs 13.3 (1.4) mm Hg; P < 0.001). Intubating conditions were equally good in both groups. We conclude that with rapid sequence induction of anaesthesia using propofol and fentanyl, rocuronium did not cause as great an increase in IOP as succinylcholine and may be an alternative in open eye injury cases.
    Matched MeSH terms: Heart Rate/drug effects
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