Bipolar disorder (BD) is characterized by alterations in mood, energy levels and the ability to function. Accordingly, it is also associated with dysfunction of the autonomic nervous system (ANS), indexed by heart rate variability (HRV). Literature concerning differences in ANS functioning between mood states is still sparse. The main aim of the study was to investigate within-individual changes in HRV from manic to euthymic states in bipolar disorder (BD). This is the first study to do so using wrist-worn sensors. Seventeen patients with BD were equipped with photoplethysmography (PPG) sensor wristbands and provided 24-hour recordings both during a manic state and a euthymic state. We calculated mean heart rate and the commonly used HRV measures SDNN, RMSSD, HF, LF and Sample Entropy in 5-minute segments during rest at night. We compared HRV by mood state within individuals using paired t-tests and linear regression to control for age and sex. Recordings from 15 BD patients were analyzed. There were statistically significant increases in HRV measures SDNN, RMSSD, LF and Sample Entropy from mania to euthymia. Effect sizes were predominately large. Our findings reveal lower HRV in the manic state compared to the euthymic state. This indicates that HRV collected by wrist-worn PPG sensors is a possible biomarker for bipolar mood states. Movement artifacts were problematic and sampling during rest or in combination with actigraphy is recommended. Our findings can be further implemented to develop a monitoring device for bipolar patients.

(1) Background: Near-infrared fluorescence imaging is a technique capable of assessing tissue perfusion and has been adopted in various fields including plastic surgery, vascular surgery, coronary arterial disease, and gastrointestinal surgery. While the usefulness of this technique has been broadly explored, there is a large variety in the calculation of perfusion parameters. In this systematic review, we aim to provide a detailed overview of current perfusion parameters, and determine the perfusion parameters with the most potential for application in near-infrared fluorescence imaging. (2) Methods: A comprehensive search of the literature was performed in Pubmed, Embase, Medline, and Cochrane Review. We included all clinical studies referencing near-infrared perfusion parameters. (3) Results: A total of 1511 articles were found, of which, 113 were suitable for review, with a final selection of 59 articles. Near-infrared fluorescence imaging parameters are heterogeneous in their correlation to perfusion. Time-related parameters appear superior to absolute intensity parameters in a clinical setting. (4) Conclusions: This literature review demonstrates the variety of parameters selected for the quantification of perfusion in near-infrared fluorescence imaging.

Background: From August 2006–August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E‐MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civilians, including many children. Humanitarian aid accounted for a substantial part of the workload, necessitating medical, infrastructural, and logistical adaptations. Particularly pediatric care demanded specific expertise and equipment. In our pre‐deployment preparations this aspect had been undervalued. Because these experiences could be influential in future mission planning, we analyzed our data and compared them with international reports.Methods: This is a retrospective, descriptive study. Using the hospital’s electronic database, all pediatric cases, defined as patients <17 years of age, who were admitted between August 2006 and August 2010 to the Dutch R2E‐MTF at Multinational Base Tarin Kowt (MBTK), Urzugan, Afghanistan were analyzed.Results: Of the 2736 admissions, 415 (15.2 %) were pediatric. The majority (80.9 %, 336/415) of these admissions were for surgical, often trauma‐related, pathology and required 610 surgical procedures, being 26 % of all procedures. Mean length of stay was 3.1 days. The male to female ratio was 70:30. Girls were significantly younger of age than boys. In‐hospital mortality was 5.3 %.Conclusion: Pediatric patients made up a considerable part of the workload at the Dutch R2E‐MTF in Uruzgan, Afghanistan. This is in line with other reports from the recent conflicts in Iraq and Afghanistan, but used definitions in reported series are inconsistent, making comparisons difficult. Our findings stress the need for a comprehensive, prospective, and coalition‐wide patient registry with uniformly applied criteria. Civilian disaster and military operational planners should incorporate reported patient statistics in manning documents, future courses, training manuals, logistic planning, and doctrines, because pediatric care is a reality that cannot be ignored.

In this study, we target the hypoxia inducible factor-1 alpha (HIF-1-alpha) pathway by short hairpin RNA interference therapy targeting prolyl hydroxylase-2 (shPHD2). We use the minicircle (MC) vector technology as an alternative for conventional nonviral plasmid (PL) vectors in order to improve neovascularization after unilateral hindlimb ischemia in a murine model. Gene expression and transfection efficiency of MC and PL, both in vitro and in vivo , were assessed using bioluminescence imaging (BLI) and firefly luciferase ( Luc ) reporter gene. C57Bl6 mice underwent unilateral electrocoagulation of the femoral artery and gastrocnemic muscle injection with MC-shPHD2, PL-shPHD2, or phosphate-buffered saline (PBS) as control. Blood flow recovery was monitored using laser Doppler perfusion imaging, and collaterals were visualized by immunohistochemistry and angiography. MC-Luc showed a 4.6-fold higher in vitro BLI signal compared with PL-Luc. BLI signals in vivo were 4.3×10 ⁵ ±3.3×10 ⁵ (MC-Luc) versus 0.4×10 ⁵ ±0.3×10 ⁵ (PL-Luc) at day 28 ( p =0.016). Compared with PL-shPHD2 or PBS, MC-shPHD2 significantly improved blood flow recovery, up to 50% from day 3 until day 14 after ischemia induction. MC-shPHD2 significantly increased collateral density and capillary density, as monitored by alpha-smooth muscle actin expression and CD31 ⁺ expression, respectively. Angiography data confirmed the histological findings. Significant downregulation of PHD2 mRNA levels by MC-shPHD2 was confirmed by quantitative polymerase chain reaction. Finally, Western blot analysis confirmed significantly higher levels of HIF-1-alpha protein by MC-shPHD2, compared with PL-shPHD2 and PBS. This study provides initial evidence of a new potential therapeutic approach for peripheral artery disease. The combination of HIF-1-alpha pathway targeting by shPHD2 with the robust nonviral MC plasmid improved postischemic neovascularization, making this approach a promising potential treatment option for critical limb ischemia.