Search Results (14)

Background/Objectives: Symptoms of autonomic dysfunction are common in infection-associated chronic conditions and illnesses (IACCIs), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This study aimed to evaluate autonomic symptoms and their impact on ME/CFS illness severity. Methods: Data came from a multi-site study conducted in seven ME/CFS specialty clinics during 2012–2020. Autonomic dysfunction was assessed using the Composite Autonomic Symptom Scale 31 (COMPASS-31), medical history, and a lean test originally described by the National Aeronautics and Space Administration (NASA). Illness severity was assessed using Patient-Reported Outcomes Measurement Information System measures, the 36-item short-form, as well as the CDC Symptom Inventory. This analysis included 442 participants who completed the baseline COMPASS-31 assessment, comprising 301 individuals with ME/CFS and 141 healthy controls (HC). Results: ME/CFS participants reported higher autonomic symptom burden than HC across three assessment tools (all p < 0.0001), including the COMPASS-31 total score (34.1 vs. 6.8) and medical history indicators [dizziness or vertigo (42.6% vs. 2.8%), cold extremities (38.6% vs. 5.7%), and orthostatic intolerance (OI, 33.9% vs. 0.7%)]. Among ME/CFS participants, 97% had at least one autonomic symptom. Those with symptoms in the OI, gastrointestinal, and pupillomotor domains had significantly higher illness severity than those without these symptoms. Conclusions: ME/CFS patients exhibit a substantial autonomic symptom burden that correlates with greater illness severity. Individualized care strategies targeting dysautonomia assessment and intervention may offer meaningful improvements in symptom management and quality of life for those with ME/CFS and similar chronic conditions. Full article

The increasing complexity and scale of service-oriented architectures in cloud computing have heightened the demand for intelligent, decentralized, and adaptive service composition techniques. This study proposes an advanced framework that integrates a Multi-Agent System (MAS) with a novel hybrid metaheuristic optimization method, the Integrated Particle-Ant Algorithm (IPAA), to achieve efficient, scalable, and Quality of Service (QoS)-aware service composition. The IPAA dynamically combines the global search capabilities of Particle Swarm Optimization (PSO) with the local exploitation strength of Ant Colony Optimization (ACO), thereby enhancing convergence speed and solution quality. The proposed system is structured into three logical layers—agent, optimization, and infrastructure—facilitating autonomous decision-making, distributed coordination, and runtime adaptability. Extensive simulations using a synthetic cloud service dataset demonstrate that the proposed approach significantly outperforms traditional optimization methods, including standalone PSO, ACO, and random composition strategies, across key metrics such as utility score, execution time, and scalability. Moreover, the framework enables real-time monitoring and automatic re-optimization in response to QoS degradation or Service-Level Agreement (SLA) violations. Through decentralized negotiation and minimal communication overhead, agents exhibit high resilience and flexibility under dynamic service availability. These results collectively suggest that the proposed IPAA-based framework provides a robust, intelligent, and scalable solution for service composition in complex cloud computing environments. Full article

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by both motor and non-motor symptoms, including autonomic dysfunction. Structural alterations in the vagus nerve (VN) may contribute to PD pathophysiology, though existing data remain inconsistent. Objective: This study aimed to evaluate morphological changes in the VN using high-resolution ultrasound (USVN) and to investigate associations with autonomic symptoms, heart rate variability (HRV), and clinical characteristics in PD patients. Methods: A cross-sectional study was conducted involving 60 PD patients and 60 age- and sex-matched healthy controls. USVN was performed to assess VN cross-sectional area (CSA), echogenicity, and homogeneity bilaterally. Autonomic symptoms were measured using the Composite Autonomic Symptom Scale 31 (COMPASS-31). HRV parameters—SDNN, RMSSD, and pNN50—were obtained via 24 h Holter monitoring. Additional clinical data included Unified Parkinson’s Disease Rating Scale (UPDRS) scores, transcranial sonography findings, and third ventricle width. Results: PD patients showed significantly reduced VN CSA compared to controls (right: 1.90 ± 0.19 mm² vs. 2.07 ± 0.18 mm²; left: 1.74 ± 0.21 mm² vs. 1.87 ± 0.22 mm²; p < 0.001 and p < 0.02). Altered echogenicity and decreased homogeneity were also observed. Right VN CSA correlated with body weight, third ventricle size, and COMPASS-31 scores. Left VN CSA was associated with body size parameters and negatively correlated with RMSSD (p = 0.025, r = −0.21), indicating reduced vagal tone. Conclusions: USVN detects structural VN changes in PD, correlating with autonomic dysfunction. These findings support its potential as a non-invasive biomarker for early autonomic involvement in PD. Full article

Aerial tracking is an important service for many Unmanned Aerial Vehicle (UAV) applications. Existing work has failed to provide robust solutions when handling target disappearance, viewpoint changes, and tracking drifts in practical scenarios with limited UAV resources. In this paper, we propose a closed-loop framework integrating three key components: (1) a lightweight adaptive detection with multi-scale feature extraction, (2) spatiotemporal motion modeling through Kalman-filter-based trajectory prediction, and (3) autonomous decision-making through composite scoring of detection confidence, appearance similarity, and motion consistency. By implementing dynamic detection-tracking coordination with quality-aware feature preservation, our system enables real-time operation through performance-adaptive frequency modulation. Evaluated on VOT-ST2019 and OTB100 benchmarks, the proposed method yields marked improvements over baseline trackers, achieving a 27.94% increase in Expected Average Overlap (EAO) and a 10.39% reduction in failure rates, while sustaining a frame rate of 23–95 FPS on edge hardware. The framework achieves rapid target reacquisition during prolonged occlusion scenarios through optimized protocols, outperforming conventional methods in sustained aerial surveillance tasks. Full article

Background: Following the Coronavirus Disease 2019 (COVID-19) pandemic, many patients have reported ongoing smell and taste issues. This study aims to investigate the prevalence of olfactory and gustatory dysfunction among patients with a history of COVID-19 and its association with autonomic dysfunction and disability. Patient and Methods: This case–control study included a COVID-19 group (n = 82) and a control group (n = 82). Olfactory dysfunction, including parosmia and taste problems, was explored using self-reports and the Quick Smell Identification Test (QSIT). The association between post-COVID-19 disability severity and taste and smell alterations was also analyzed. Moreover, autonomic function was evaluated using the Composite Autonomic Symptom Scale-31 (COMPASS-31) to assess the association between autonomic and olfactory dysfunction. Results: Significantly higher rates of ongoing smell (26.8%) and taste (14.6%) dysfunction were reported for the post-COVID-19 group compared to the control group. Post-COVID-19 patients reported 36.6 times more smell issues and 8.22 times more taste issues than controls. Parosmia scores were significantly worse in the post-COVID-19 group, while QSIT scores showed no significant difference between the groups. However, those with worse QSIT scores exhibited significantly more ongoing smell issues. No significant association was observed between disability and altered smell or taste. Higher secretomotor dysfunction scores were significantly associated with abnormal QSIT scores and worse parosmia scores; the other domains of the COMPASS-31 scale showed no significant associations. Conclusions: The findings indicated a potential link between autonomic and olfactory dysfunction. Further studies are needed to elucidate the mechanisms underlying persistent olfactory and autonomic dysfunction in post-COVID-19 patients. Full article

This study aimed to investigate whether baroreflex sensitivity (BRS) could serve as a reliable metric for assessing cardiovascular autonomic neuropathy (CAN) and concurrently act as a surrogate biomarker for evaluating the severity of arterial stiffness and CAN in individuals diagnosed with type 2 diabetes mellitus (T2DM). Participants underwent brachial–ankle pulse wave velocity (baPWV) as well as autonomic function evaluations encompassing the Sudoscan-based modified composite autonomic scoring scale (CASS), baroreflex sensitivity, and heart rate variability in time domains and frequency domains. Linear regression analysis was performed to evaluate the influence of independent variables on baPWV and modified CASS. Participants with higher baPWV values were older, with longer diabetes duration, lower body weight, body mass index, waist circumference, elevated systolic and diastolic blood pressure, and mean arterial blood pressure. They also exhibited a higher prevalence of retinopathy as the underlying disease and reduced estimated glomerular filtration rate. Multiple linear regression analysis revealed that age and BRS were significantly associated with baPWV while diabetes duration, UACR, and BRS were significantly associated with modified CASS. Our study confirms the significant association of BRS with baPWV and modified CASS in T2DM, highlighting its pivotal role in linking microvascular and macrovascular complications. This supports BRS as a surrogate marker for assessing both the severity of arterial stiffness and cardiovascular autonomic neuropathy in T2DM, enabling the early identification of complications. Full article

Autonomic dysfunction is a common complication of acute stroke, which impairs functional outcomes and increases mortality. There is a lack of well-established knowledge regarding the influence of autonomic dysfunction in patients with acute stroke. This study aims to investigate the impact of the severity of autonomic dysfunction on functional outcomes in patients with acute stroke. A retrospective analysis was conducted at a single center, involving 22 patients diagnosed with acute stroke. The severity of autonomic dysfunction was evaluated based on the Composite Autonomic Scoring Scale (CASS). The modified Barthel Index, Berg Balance Scale, Functional Ambulatory Category, and modified Rankin Scale were designated as functional outcome measures. The impact of the severity of autonomic dysfunction on functional outcomes was analyzed using one-way analysis of covariance (ANCOVA). A statistically significant difference was observed between the initial and follow-up functional outcomes based on the severity of autonomic dysfunction. This study presents evidence that the severity of autonomic dysfunction influences functional prognosis in patients with acute stroke. The findings will serve as additional considerations for the rehabilitation of patients with acute stroke. Full article

Existing evidence supports an association between chemerin levels and cardiovascular risk, while reduced thiol levels are linked to diabetes mellitus. It is hypothesized that chemerin may contribute to autonomic dysfunction and cardiovascular risk in type 2 diabetes mellitus (T2DM), potentially mediated by the antioxidant capacity of patients with well-controlled T2DM and prediabetes. Comprehensive cardiovascular autonomic testing and biomarker assessments were conducted for all participants. The severity of cardiovascular autonomic neuropathy (CAN) was evaluated using the composite autonomic scoring scale (CASS). A mediation model was employed to explore the potential relationships among chemerin levels, antioxidant capacity (indicated by thiol levels), and CAN severity (indicated by CASS values). A total of 184 participants were enrolled in this study, comprising 143 individuals with T2DM and 40 individuals with prediabetes. The findings reveal a significant negative association between thiols levels (r = −0.38, p < 0.0001) and the CASS values, while a positive association is observed between chemerin levels (r = 0.47, p < 0.0001) and the CASS values. Linear regression analysis identified chemerin and thiols as independent variables significantly associated with CASS values. Subsequent mediation analysis elucidated that thiols levels act as mediators in the relationship between elevated chemerin levels and an increased CASS value. This study shows that poor cardiovascular function, higher chemerin levels, and reduced antioxidant capacity coexist in individuals with T2DM and prediabetes. Mediation analysis suggests a pathophysiological link between high chemerin levels and low antioxidant capacity, adversely impacting CAN severity. Full article

The satisfaction of basic psychological needs leads students to engage in a sport modality on their own initiative. In the Spanish public educational system, mixed and heterogeneous, the gender and sport experience of students influence the teaching and motivation of invasion sports. This study investigated whether students’ gender and sport experience, and model influence the psychological variables (basic psychological needs and sport adherence) when teaching school soccer and basketball. Furthermore, correlations were calculated between these psychological variables. The study involved 165 fifth and sixth grade students (Mage, 11.27 ± 0.68 years old) from several Spanish state schools in the same autonomous community. A non-random convenience sample was used. The needs for autonomy, perceived competence and social relationships were measured using the Basic Psychological Needs in Physical Exercise Scale. Sport adherence was measured using the Measure of Intentionality to be Physically Active. A Confirmatory Factor Analysis, Cronbach’s Alpha, Average Variance Extracted and Composite Reliability were used to analyze the psychometric properties of the scales. Descriptive and inferential analyses were obtained after performing a Mixed Linear Model and a Bonferroni Post Hoc. There were significant differences in the autonomy need according to the students’ gender (boys > girls). In addition, boys who learned with the TGA model scored significantly higher than girls on this need. Attending to sport adherence, there were significant differences in favor of experienced students. Likewise, a regression analysis (structural equation model) revealed that the autonomy need showed low association with sport adherence. Higher perceived competence (β = 0.52) and social relationships (β = 0.36) were associated with greater adherence to sport (R² = 0.65). Teachers’ Knowledge and proper managing basic psychological needs will have educational, social and health benefits, as it will increase the likelihood of physical activity in and out of school. Full article

The Composite Autonomic Scoring Scale (CASS) is a quantitative scoring system that integrates the sudomotor, the cardiovagal, and the adrenergic subscores, and the Composite Autonomic Symptom Scale 31 (COMPASS 31) is based on a well-established comprehensive questionnaire designed to assess the autonomic symptoms across multiple domains. We tested the hypothesis that electrochemical skin conductance (Sudoscan) can be a substitute for the quantitative sudomotor axon reflex test (QSART) in the sudomotor domain and assessed its correlation with COMPASS 31 in patients with Parkinson’s disease (PD). Fifty-five patients with PD underwent clinical assessment and cardiovascular autonomic function tests and completed the COMPASS 31 questionnaire. We compared the modified CASS (integrating the Sudoscan-based sudomotor, adrenergic, and cardiovagal subscores) and CASS subscores (the sum of the adrenergic and cardiovagal subscores). The total weighted score of COMPASS 31 was significantly correlated with both the modified CASS and the CASS subscore (p = 0.007 and p = 0.019). The correlation of the total weighted score of COMPASS 31 increased from 0.316 (CASS subscores) to 0.361 (modified CASS). When we added the Sudoscan-based sudomotor subscore, the case numbers for autonomic neuropathy (AN) increased from 22 (40%, CASS subscores) to 40 (72.7%, modified CASS). The modified CASS not only better reflects the exact autonomic function, but also improves the characterization and quantification of AN in patients with PD. In areas in which a QSART facility is not easily available, Sudoscan could be a time-saving substitution. Full article

Background and aims. Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv) is caused by mutations in the TTR gene, leading to misfolded monomers that aggregate generating amyloid fibrils. The clinical phenotype is heterogeneous, characterized by a multisystemic disease affecting the sensorimotor, autonomic functions along with other organs. Patisiran is a small interfering RNA acting as a TTR silencer approved for the treatment of ATTRv. Punctual and detailed instrumental biomarkers are on demand for ATTRv to measure the severity of the disease and monitor progression and response to treatment. Methods. Fifteen patients affected by ATTRv amyloidosis (66.4 ± 7.8 years, six males) were evaluated before the start of therapy with patisiran and after 9-months of follow-up. The clinical and instrumental evaluation included body weight and height; Coutinho stage; Neuropathy Impairment Score (NIS); Karnofsky performance status (KPS); Norfolk QOL Questionnaire; Six-minute walking test (6 MWT); nerve conduction studies; handgrip strength (HGS); and bioimpedance analysis (BIA). Results. Body composition significantly changed following the 9-months pharmacological treatment. In particular, the patients exhibited an increase in fat free mass, body cell mass, and body weight with a decrease in fat mass. A significant increase after 9 months of treatment was observed for the 6 MWT. Coutinho stage, KPS, NIS, NIS-W, nerve conduction studies, Norfolk, COMPASS-31 scale, and HGS remained unchanged. Conclusions. BIA might represent a useful tool to assess the effects of multiorgan damage in ATTRv and to monitor disease progression and response to treatments. More evidence is still needed for HGS. Patisiran stabilizes polyneuropathy and preserves motor strength by increasing muscle mass after 9 months of treatment. Full article

Background: Although athletes’ experiences of autonomy, competence, and relatedness play in key role in their motivation, performance-related outcomes, and wellness, there is no evidence to date on measures of autonomy, competence, and relatedness in the Romanian sport context. Building upon self-determination theory, the objective of this research was to adapt the Need Satisfaction and Frustration Scale and analyze its psychometric properties in the Romanian sport context. Methods: The participants were 642 professional athletes (354 males and 288 females; M_age = 22.81, SD = 5.78) who competed at the international and/or national level. Results: The results from confirmatory factor analyses psychometrically supported a six-factor correlated model, which was invariant across gender, age, and sport. Convergent validity was met by average variance extracted values between 0.60 and 0.74. Discriminant validity was underpinned by values from −0.72 to 0.72 for a heterotrait–monotrait ratio of correlations among the six factors. Reliability was endorsed by Cronbach’s alpha scores between 0.75 and 0.89, and between 0.76 and 0.89 for Raykov’s composite reliability coefficient. Criterion validity was supported by positive relationships of autonomy, competence, and relatedness satisfaction to autonomous motivation, and positive associations of autonomy, competence, and relatedness frustration with controlled motivation and amotivation. Conclusions: The Need Satisfaction and Frustration Scale is shown to be a valid and reliable measure of need satisfaction and frustration in professional Romanian athletes. Full article

Autonomic disorders have been recognized as an important non-motor feature in Parkinson’s disease (PD). However, there is a paucity of information on the presence and severity of cardiovascular autonomic neuropathy (CAN) among different motor phenotypes. The aims of this study were to examine the feasibility of electrochemical skin conductance (ESC) measured by Sudoscan as a screening service for CAN in patients with PD and investigate the severity of CAN among different motor phenotypes. Design: This was a cross-sectional observational study that enrolled 63 patients with PD. Patients were divided into three phenotypes, postural instability/gait difficulty (PIGD), tremor-dominant (TD), and akinetic-rigid (AR), according to their motor symptoms. Cardiovascular autonomic function was measured, and the presence and severity of CAN was determined according to the composite autonomic scoring scale (CASS). Functional scores were measured by the Hoehn and Yahr (HY) stage and the Unified Parkinson’s Disease Rating Scale (UPDRS). The median HY stage was 2.0 [1.5, 3.0]. Median UPDRS total score was 23.0 (17.5, 30.5), 10.0 (6.0, 11.0) and 14.0 (6.3, 23.8) in groups of PIGD, TD and AR, respectively (p = 0.001). Mean CASS was 1.7 ± 1.3, 0.6 ± 0.4, and 1.8 ± 1.5 in groups of PIGD, TD and AR, respectively (p = 0.204). Although the ESC was not strongly associated with the cardiovascular autonomic parameters, the CAN risk score provided by Sudoscan significantly correlated with parameters of cardiovascular autonomic function, including heart rate response to deep breathing (HR_DB), Valsalva ratio (VR), and baroreflex sensitivity (BRS). By receiver-operating characteristic (ROC) analysis, if a patient’s CAN risk score is higher than 33.5 (%), it is recommended to be aware of the presence of CAN even in PD patients who are asymptomatic. The area under ROC curve was 0.704. Based on our results, CAN risk score may be used for screening of CAN in patients with PD before resorting to the more sophisticated and specific, but ultimately more time-consuming, complete autonomic function testing. Full article

Postural orthostatic tachycardia syndrome (POTS) is a multifactorial condition capable of chronically reducing the quality of life and the work ability of patients. The study aim was to assess the burden of autonomic symptoms in a cohort of POTS patients over 2 years. Patients’ clinical profiles were assessed by the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS 31) and a visual analog scale (VAS). One-way ANOVA for repeated measures followed by Dunnett’s post-hoc test were used to compare symptoms at baseline and at 1 and 2 years. Out of 42 enrolled patients, 25 had a 1-year follow-up and 12 had a 2-year follow-up. At baseline, the reported burden of autonomic symptoms was high (overall COMPASS 31 = 49.9 ± 14.3 /100). Main complaints were related to orthostatic intolerance according to both COMPASS 31 and VAS. Fourteen patients were rendered inactive because of symptoms. At 1-year follow-up, a statistically significant improvement in pupillomotor function and overall score was detected by the COMPASS 31. These findings were confirmed at 2 years, together with a significant reduction in quality of life impairment, assessed by VAS. However, these improvements did not change patients’ occupational status. Awareness of POTS diagnosis, patient monitoring, and tailored therapies can help to improve patients’ condition. Full article