Authors/Task Force Members: Michele Brignole* (Chairperson) (Italy), Angel Moya* (Co-chairperson) (Spain), Frederik J. de Lange (The Netherlands), Jean-Claude Deharo (France), Perry M. Elliott (UK), Alessandra Fanciulli (Austria), Artur Fedorowski (Sweden), Raffaello Furlan (Italy), Rose Anne Kenny (Ireland), Alfonso Mart ın (Spain), Vincent Probst (France), Matthew J. Reed (UK), Ciara P. Rice (Ireland), Richard Sutton (Monaco), Andrea Ungar (Italy), and J. Gert van Dijk (The Netherlands)

2018 ESC Guidelines for the diagnosis and management of syncope

Since the nanogenerator (NG) was invented in 2006, it has been successfully developed and utilized to harvest various forms of mechanical energy in vivo. The NGs promote the progress of self-powered biomedical devices. Moreover, NGs can also be used as sensors to detect a variety of important physiological signals, which brings us closer to real-time, high-fidelity monitoring of physical and pathological information. This paper summarizes the in vivo applications of NGs as biomedical sensors, including in cardiac sensors, respiration sensors, blood pressure sensors, gastrointestinal sensors and bladder sensors. However, there are still many challenges in using NGs as sensors in vivo. For example, how can we minimize and encapsulate the NGs, how can we increase the stability and reliability during long-term detection, and how can we establish a corresponding relationship between the NG’s electrical output and the physiological signals. It is also critical to follow the medical principles more closely in the development of self-powered sensors in the future. We believe that the self-powered sensors would promote the development of the next-generation healthcare monitoring systems.

Recent progress of nanogenerators acting as biomedical sensors in vivo

Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.

Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update

Purpose: To improve the metoprolol therapeutic effectiveness, we aimed to explore whether baseline heart rate variability (HRV) indicators before metoprolol treatment were useful for predicting its efficacy for postural tachycardia syndrome (POTS). Methods: We recruited 45 children with POTS who received metoprolol and 17 healthy controls. All children underwent a standing test or basic head-up tilt test and 24-hr dynamic electrocardiography before treatment. After 3 months of metoprolol, therapeutic responsiveness was evaluated. The usefulness of baseline HRV parameters in predicting the effectiveness of metoprolol was studied and the long-term cumulative symptom rate was analyzed. Results: The baseline HRV frequency domain indicators for power, ultra-low frequency, very-low frequency, low frequency (LF), high frequency (HF), high frequency normalized units and total power (TP) as well as time domain indicators were significantly lower for responders than non-responders to metoprolol; however, low-frequency normalized units and LF/HF ratio were markedly greater for responders than non-responders. On series-parallel analysis, combined baseline triangular (TR) index ≤ 33.7 and standard deviation of all normal-to-normal intervals (SDNN) index ≤ 79.0 ms as cut-off values yielded sensitivity, specificity and accuracy of 85.3%, 81.8% and 84.4%, respectively, to predict therapeutic responsiveness to metoprolol. On long-term follow-up, the cumulative symptom rate was significantly higher with TR index > 33.7 and SDNN index ≤ 79.0 ms, TR index ≤ 33.7 and SDNN index > 79.0 ms or TR index > 33.7 and SDNN index > 79.0 ms than TR index ≤ 33.7 and SDNN index ≤ 79.0 ms (P<0.05). Conclusion: Combined TR index ≤ 33.7 and SDNN index ≤ 79.0 ms were useful preliminary measures to predict therapeutic response to metoprolol in pediatric POTS.

Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome.

Background: Postural tachycardia syndrome (POTS) is a severe health problem in children. Short-term β-blockers are recommended for pharmaceutical treatment. However, there have been contradictory data about its efficacy among pediatric patients. Methods and Results: Eight studies comparing β-blockers to conventional treatments for children with POTS were selected, where 497 cases of pediatric POTS were included. The efficacy of β-blockers was evaluated using the effective rate, the change of symptom score, the change of heart rate difference and adverse events. The results were stated as relative ratio (RR) and mean difference (MD) with a 95% confidence interval (95% CI). A random-effects meta-analysis for the effective rate indicated that β-blockers were more effective in treating pediatric POTS than controlled treatment (79.5 vs. 57.3%, RR = 1.50, 95%CI: 1.15-1.96, P < 0.05). A fixed-effects model analysis showed that β-blockers were more effective in lowering the symptom score and the heart rate increment during standing test than controlled treatment with a mean difference of 0.81 (95% CI: 0.44-1.18, P < 0.05) and 3.78 (95% CI: 2.10-5.46, P < 0.05), respectively. There were no reported severe adverse events in included studies. Conclusion: β-blockers are effective in treating POTS in children and adolescents, alleviating orthostatic intolerance, and improving hemodynamic abnormalities.

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Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis.

Syncope belongs to the transient loss of consciousness (TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association (CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association (CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association (CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association (BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and head-up tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

摘要: 地温梯度如何影响砂岩成岩演化和储层物性变化是地学界的热点问题. 以具有高变地温梯度特征的白云深水区为例，通过分析大量不同地温梯度地区的样品，以地温梯度0.1~0.2 ℃/100 m为递进间隔，对比分析了不同地温梯度区间内不同粒度砂岩储层渗透率随埋藏深度变化的趋势，建立了砂岩渗透率的定量地质预测模型，展示了砂岩渗透率与地温梯度之间的内在联系. 结果表明，一定埋深范围内，随地温梯度升高，渗透率每下降一个数量级，砂岩埋深下限差异呈台阶式减少；相同地温梯度区间内，高成分成熟度、低塑性岩屑含量的含砾砂岩、粗粒砂岩、中粒砂岩和细粒砂岩的渗透率下降程度不同，相邻粒径砂岩等效渗透率埋深下限差异相近，随地温梯度增加，相邻粒径砂岩等效渗透率下限埋深差异呈规律性减小；低渗与特低渗砂岩储层的地层深度段随地温梯度升高而明显变小，粗粒砂岩特低渗储层的埋深下限可作为白云深水区常规油气勘探的极限深度. 研究成果对于揭示地温梯度对砂岩成岩演化作用的影响及物性演变效应具有重要的意义，对油气勘探有积极的指导作用. 关键词: 高变地温梯度 / 砂岩成岩作用 / 渗透率 / 定量预测 / 白云深水区 / 海洋地质学 

南海北部白云深水区高变地温梯度砂岩渗透率定量预测

Mechanism investigation of Shi-Xiao-San in treating blood stasis syndrome based on network pharmacology, molecular docking and in vitro/vivo pharmacological validation.

Hui Yan

Papers

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

南海北部白云深水区高变地温梯度砂岩渗透率定量预测

Mechanism investigation of Shi-Xiao-San in treating blood stasis syndrome based on network pharmacology, molecular docking and in vitro/vivo pharmacological validation.