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

Advanced researches on connected vehicles have recently targeted to the integration of vehicle-to-everything (V2X) networks with Machine Learning (ML) tools and distributed decision making. Federated learning (FL) is emerging as a new paradigm to train machine learning (ML) models in distributed systems, including vehicles in V2X networks. Rather than sharing and uploading the training data to the server, the updating of model parameters (e.g., neural networks' weights and biases) is applied by large populations of interconnected vehicles, acting as local learners. Despite these benefits, the limitation of existing approaches is the centralized optimization which relies on a server for aggregation and fusion of local parameters, leading to the drawback of a single point of failure and scaling issues for increasing V2X network size. Meanwhile, in intelligent transport scenarios, data collected from onboard sensors are redundant, which degrades the performance of aggregation. To tackle these problems, we explore a novel idea of decentralized data processing and introduce a federated learning framework for in-network vehicles, C-DFL(Consensus based Decentralized Federated Learning), to tackle federated learning on connected vehicles and improve learning quality. Extensive simulations have been implemented to evaluate the performance of C-DFL, that demonstrates C-DFL outperforms the performance of conventional methods in all cases.

Jie Tian

Papers

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

Enhanced Decentralized Federated Learning based on Consensus in Connected Vehicles