Cervical Trunk Research Articles

Imaging measurement and analysis of related indexes of variation of femoral head rotation center

To provide guidance for hip replacement by analyzing the variation of femoral head rotation center in different hip diseases. A total of 5 459 patients were collected from March 2016 to June 2021, who took positive and proportional plain films of both hips for various reasons. The relative position between the rotation center of the femoral head and the apex of the greater trochanter was measured. The positive variation is more than 2 mm above the top of the great trochanter, and the negative variation is more than 2 mm below the top of the great trochanter. A total of 831 patients with variation of femoral head rotation center were collected and were divided into 4 groups according to different diseases, and the variation was counted respectively. There were 15 cases in the normal group involving 10 cases of positive variation and 5 cases of negative variation. There were 145 cases of avascular necrosis of femoral head involving 25 cases of positive variation and 120 cases of negative variation. There were 346 cases of congenital hip dysplasia involving 225 cases of positive variation(including 25 cases of typeⅠ, 70 cases of type Ⅱ, 115 cases of type Ⅲ and 15 cases of type Ⅳ), and 121 cases of negative variation(including 50 cases of crowe typeⅠ, 60 cases of typeⅡ, 10 cases of type Ⅲ and 1 case of type Ⅳ). There were 325 cases of hip osteoarthritis group involving 45 cases of positive variation and 280 cases of negative variation. There was significant difference in variation of femoral head rotation center among the four groups(P<0.05). There was significant difference in variation of femoral head rotation center among different types of congenital hip dysplasia(P<0.05). There were significant differences in cervical trunk angle and eccentricity among different variations of femoral head rotation center(P<0.05). The variation of femoral head rotation center is related to cervical trunk angle and eccentricity. The variation of femoral head rotation center is an important factor in hip diseases. The variation of femoral head rotation center is different in different hip diseases. Avascular necrosis of the femoral head and osteoarthritis of the hip were mostly negative variations. With the aggravation of congenital hip dysplasia, the variation of femoral head rotation center gradually changed from negative variation to positive variation.The variation of femoral head rotation center should be paid attention to in the preoperative planning of hip arthroplasty. It is of great significance to select the appropriate prosthesis and place the prosthesis accurately.

Abstract Number ‐ 103: Revascularization of a Persistently Occluded Left Vertebral Artery with Ongoing Symptoms and Poor Collaterals

Introduction Ischemic stroke presents a significant burden to health globally, with those in the posterior circulation accounting for 20% of all strokes. [1]. Efforts to attempt endovascular revascularization in a chronically occluded vertebral artery is not prevalent but has been increasing abroad. In a single center in China, 22 subjects had attempted revascularization, with successful revascularization was achieved in 86.36% of patients using balloon dilation combined with stenting in 14 subjects. Improving technology and techniques have made these attempts more feasible. Objective: This report demonstrates a unique case of symptomatic vertebral artery revascularization 3 days after the initial onset of vertebral artery occlusion symptoms using balloon angioplasty and stenting in the proximal portion of the left vertebral artery. Methods Case report Results 58‐year‐old man with history of hypertension, hyperlipidemia, and smoking presented to the Wilson Hospital ER with an abrupt onset syncopal episode. He was found crawling on the highway by EMS. Initial workup included MRI and CTA that were consistent with cerebellar strokes, a hypoplastic right vertebral artery, and occlusion of the left vertebral artery. Three days elapsed between recognition of the vertebral pathology and indication of appropriate endovascular intervention and angiography. Angiography revealed an acute occlusion of the left vertebral artery with significant reduction of anterograde flow. Initial blood flow transit time from VAO to left posterior circulation took 6 seconds compared to 2 seconds in the right posterior circulation. Inadequate vertebral collateral flow was appreciated from costocervical cervical trunk branches. An urgent stenting of the left vertebral artery was performed after informed consent from patient. Before the procedure, the patient was prepared with both aspirin (325mg), Plavix (150mg), and IV heparin to achieve 1.5‐2 times the baseline activated clotting time. Angioplasty was performed with a 2.5×20mm Maverick balloon loaded over a choice PT 14 compatible microwire. Integrilin (5mg) was delivered prior to catheterization to reversibly inhibit GPllb/llla. The left vertebral artery was catheterized, and angioplasty was performed two times with balloon inflation at 12 atmospheres. Using fluoroscopic guidance, a drug‐eluting stent measuring 4×22 was placed across stenotic vertebral artery via the existing vertebral wire. In placement, the balloon was inflated up to 10 atmospheric pressures to obtain an intraluminal diameter of 4.0. Post‐procedure angiogram showed that the lesion decreased from a near complete occlusion to less than 10% occlusion. Additionally, post‐procedure transit time was reduced to 2 seconds. Patient was asymptomatic at discharge and was given aspirin (325mg), clopidogrel (75mg), and was recommended to follow‐up after 4–6 weeks Conclusions This case study gives greater support to endovascular intervention in a delayed setting with revascularization with balloon dilation combined with stent implantation on a case‐by‐case basis. Further investigation of inclusion criteria is needed, as this patient was exceptional in collaterals and anatomy.

Restoration of Neck Extension after Severe Oncological Surgery of the Posterior Cervical Trunk.

SummaryReconstruction of posterior cervical trunk defects secondary to tumor resection carries significant morbidity when vertebral hardware or the spinal cord is exposed, and neck extension is interrupted. Complete reconstruction includes the coverage and obliteration of dead spaces, but functional outcomes are necessary to prevent the head dropping. This report documents the first known technique, using a free latissimus dorsi neurovascular flap to provide neck extension after ablative oncological surgery affecting trapezium and paraspinal muscles of the neck. The author explains the method by using a branch of the accessory nerve as the donor nerve. While keeping the head in a neutral position, the tendinous part of the neurovascular flap was firmly attached to the occipital periosteum and to the cephalad remnants of the trapezius, splenius capitis, and semispinalis muscles. At the caudal portion of the defect, cardinal notches were used to set the muscle at rest, avoiding excessive fiber tension. The maximal length of the muscle at rest was measured before flap elevation, calculated via the anatomical 3D print model. The thoracodorsal nerve was stimulated until the muscle shortened its length to 50%. Head extension was tested several times via neurostimulation and electromyographic control. The described procedure may provide neck extension and circumvent the problem with donor nerve providing synergy to the desired function.

Clinical analysis of reconstruction of lateral wall and femoral moment in the treatment of Evans Jensen type V intertrochanteric fracture

To investigate the clinical effect of proximal femoral nail anti rotation (PFNA) and titanium plate in the treatment of Evans Jensen type V intertrochanteric fractures. From October 2013 to March 2016, 30 patients with Evans Jensen type V intertrochanteric fractures were analyzed. According to the operation methods, they were divided into two groups:16 cases of closed reduction and PFNA internal fixation;14 cases of small incision incision reconstruction of titanium plate reconstruction of femoral moment and lateral wall PFNA internal fixation. The operation (blood loss, operation duration), postoperative rehabilitation (postoperative ambulation time, bone healing time), operation related complications (internal fixation fracture, withdrawal, spiral blade cutting out) were observed and compared between the two groups. Harris score of hip joint function was performed 12 months after operation, and the loss degree of cervical trunk angle was observed and compared. All the 30 patients were followed up for 12 to 18 months. The blood loss and operation duration of open reduction group were significantly greater than those of closed reduction group (P<0.05). The postoperative ambulation time, bone healing time, operation related complications, Harris score of hip joint function and loss of cervical trunk angle in the open reduction group were better than those in the closed reduction group(P<0.05). Evans Jensen was treated with PFNA intramedullary fixation through reduction and fixation of femoral moment and lateral wall with reconstruction titanium plate Vtype intertrochanteric fracture can restore the support of femoral moment and lateral wall to femoral head and neck, improve the stability of fracture end and internal fixation after operation, and reduce the risk of fracture end displacement, internal fixation loosening, cutting out and even fracture after treatment with PFNA alone. To shorten the bed time of elderly patients and reduce the operation related complications, it provides a new idea and method for the treatment of Evans Jensen type V intertrochanteric fracture.

Application of retroauricular sulcus incision in surgery of parotid gland tumor

Objective: To investigate the application of retroauricular sulcus incision in surgery for benign tumor in superficial lobe of parotid gland. Methods: A total of 20 patients were reviewed who underwent the resection of benign tumor in the superficial lobe of parotid gland with retroauricular sulcus incision at the Department of Otorhinolaryngology, the Linyi City People Hospital between May 2015 and March 2017. There were 12 males and 8 females with an age range of 12-66 years old, including 15 cases with mixed tumor and 5 cases with adenolymphoma. Surgical procedure included facial never dissection from the main trunk to facial never cervical trunk, temporal trunk and peripheral branches. After resection of tumor and superficial lobe of parotid gland, and sternocleidomastoid muscle flap was used to fill the defect in parotid area. All patients were postoperatively followed up after surgery. Results: Surgeries were successfully operated in all patients. Follow-up for 2 years showed there was no presence of recurrence, salivary fistula, Frey syndrome, scar affecting facial appearance, or significant deformity in the surgical area. Conclusion: Surgery for superficial lobe of parotid gland and facial nerve dissection through retroauricular sulcus incision have some advantages such as incision concealment, simple procedure for facial nerve dissection, simultaneous repair of tissue defects with sternocleidomastoid muscle flap, and less complications.

Ramos colaterais do arco aórtico e suas principais ramificações em nutria (Myocastor coypus)

Background: Nutria (Myocastor coypus), also known as Swamp Beaver, is a medium-sized semiaquatic rodent that belongs to the Capromyidae family. Originally from the southernmost part of South America, the species is distributed in several parts worldwide such as Europe and United States, where it has been used for commercial purposes due to the excellent quality of its fur and meat. Information about the nutria morphology is rare. Only a few articles about its abdominal aorta branches can be found, but nothing exists regarding its aortic arch. Consequently, other rodents such as chinchillas, agoutis, guinea pigs capybaras, pacas and rats will be used in the discussion. Therefore, this study aims to obtain morphological information that could justify such discussions in a functional point of view, and that could result in support for a better understanding of the physiology of this animal. Materials, Methods & Results: Thirty-two Myocastor coypus were used in the study, originated from a breeding facility in the town of Caxias do Sul, RS and authorized by IBAMA. The animals were put to sleep by means of an anesthetic overdose administrated intraperitoneally, and kept in formaldehyde for seven days to be subsequently dissected. After having their arterial system flushed with saline solution, the aorta of thirty specimens received an injection containing latex 603 through the left ventricle, for later observation of the arteries of the cranial mediastinal space and neck. Dental resin was injected in two specimens, for subsequent manufacture of molds by means of maceration. Schematic drawings of all parts were made with the help of a magnifying glass, for posterior composition of results. The brachiocephalic trunk and the subclavian artery arose in sequence from the aortic arch of the nutria in 60% of the samples, whereas the brachiocephalic trunk, left common carotid artery and left subclavian artery arose from the arch in 40% of the samples. The branching sequence of the collateral branches of the subclavian arteries showed a great variation, presenting isolated vessels and forming trunks among the arteries identified (according to the tables). The thoracic vertebral, vertebral, internal thoracic, dorsal scapular arteries and the superficial-deep cervical trunk aroused medially from the right subclavian artery towards a lateral direction, as main collateral branches of highest prevalence. On the other hand, the left subclavian artery also gave off the vertebral artery as its first vessel, followed by the internal thoracic and thoracic vertebral arteries, and its last collateral branch was a common trunk between the dorsal scapular artery and the superficial-deep cervical trunk. Discussion: Other rodents in the study presented the same aortic arch sequence as observed in nutrias i.e., the brachiocephalic trunk and the left subclavian artery. But the branches of these main vessels showed remarkable differences, with the formation of several common trunks among the arteries. Additionally, the origin sequence of these vessels was different in the rodents studied. Therefore, the aortic arch of nutrias has two model patterns for its branching. In 60% of the samples, the aortic arch gives off the brachiocephalic trunk and the left subclavian artery as collateral branches. In 40% of the samples, however, the branching sequence is composed of the brachiocephalic trunk, the common left carotid artery and the left subclavian artery.

Non-invasive vagus nerve stimulation reduces sympathetic preponderance in patients with tinnitus

Conclusion: Transcutaneous vagal nerve stimulation (tVNS) might offer a targeted, patient-friendly, and low-cost therapeutic tool for tinnitus patients with sympathovagal imbalance.Objectives: Conventionally, VNS has been performed to treat severe epilepsy and depression with an electrode implanted to the cervical trunk of vagus nerve. This study investigated the acute effects of tVNS on autonomic nervous system (ANS) imbalance, which often occurs in patients with tinnitus-triggered stress.Methods: This study retrospectively analysed records of 97 patients who had undergone ANS function testing by heart rate variability (HRV) measurement immediately before and after a 15–60 min tVNS stimulation.Results: The pre-treatment HRV recording showed sympathetic preponderance/reduced parasympathetic activity in about three quarters (73%) of patients. Active tVNS significantly increased variability of R-R intervals in 75% of patients and HRV age was decreased in 70% of patients. Either the variability of R-R intervals was increased or the HRV age decreased in 90% of the patients. These results indicate that tVNS can induce a shift in ANS function from sympathetic preponderance towards parasympathetic predominance. tVNS caused no major morbidity, and heart rate monitoring during the tVNS treatment showed no cardiac or circulatory effects (e.g. bradycardia) in any of the patients.

ERB’S PALSY: DO SOMETHING TODAY THAT YOUR FUTURE COULD THANK YOU FOR…

It has been observed that in developing countries, there is small number of hospitals, who understand the child’s problems and implement proper rehabilitation. Unluckily, they only focus on inpatients care. In addition, Communal- based, observational studies in developing countries provide an estimated prevalence of juvenile disabilities ranging from 0.4-12.7% 1. Similarly,the leading cause of increasing number of Erb’s palsy is due to birth defects and lack of awareness of physical therapy. Which in turn highlight the neglected aspect of this disability. Erb’s palsy may occur due to breech delivery, prolong labor leading to injury at the time of birth in case it is not handled with care. Moreover, forceful pulling of head and neck of infant when passes through birth canal, fetal macrosomia2, stretching or pressure on shoulder of infant that may lead to major and complex brachial plexus injuries.These commonly involves upper cervical trunk (C5-C6) that requires special care and handling.

Method of intra-arterial chemotherapy of esophageal cancer

Esophagus it is an organ that takes blood from the different sources. Anatomic features of nourishment of esophageal tumors did not allow study them with the help of angiography like the tumors of other organs. In this connection intra-arterial way of chemotherapy drug administration for treating esophageal tumors is practically not studied.Methodology. For creating the maximal concentration of chemotherapy drug in esophageal tumor in the scientific department of the thorax tumors was elaborated the methodology of intra-arterial chemotherapy of esophageal cancer. Patients with cancer of the upper third of esophagus underwent catheterization of the clypeate cervical trunk or lower clypeate artery, middle third – left lower diaphragmatic artery, lower third – left gastric artery. Catheterization of the own esophageal arteries was not realized in any case.Results. At randomized research 34 patients underwent catheterization of esophageal arteries. Locally spread esophageal tumors have the dominant source of the blood supply and several secondary branches. The tumors growth results in hypertrophy of afferent preexisting vessels and development of neovascularization in the injury nidus. Conclusion. The use of intra-arterial chemotherapy in patients with esophageal cancer combined with the radiotherapy can be the method of choice for non-adjunctive and conservative treatment

Probabilistic mapping of the cervical sympathetic trunk ganglia

The goal of this study was to create a heat map indicating the probabilistic location of major ganglia of the cervical sympathetic trunk (CST). Detailed dissections of human cadaveric specimens, followed by spatial registration and analysis of the cervical sympathetic ganglia in the neck and upper thorax regions (C1-T1) were performed in 104 neck specimens (both sides from 52 cadavers). Unbiased parametric mapping, visualized with a heat map, revealed a general pattern of two major ganglia located on both sides of the neck: The superior cervical ganglion (SCG) was located 80-90 mm superior to the point at which the vertebral artery entered the transverse foramen (VA-TF); the stellate ganglion (SG) was located approximately 10 mm inferior to the VA-TF in 80% of our sample, or surrounding the VA-TF in the remaining 20% of our sample. In between these ganglia, a highly variable number of smaller and less prevalent ganglia were present on either side of the neck. The middle ganglia on the right side of the neck were located closer to the SCG, possibly indicative of the middle cervical ganglion. On the left side the middle ganglia were located closer to the SG, perhaps indicative of the vertebral ganglion or the inferior cervical ganglion. Individual specimens could be classified into one of seven different patterns of cervical trunks. The results may help surgeons and anesthesiologists more accurately target and preserve these structures during medical procedures.

Autonomic deficit not the cause of death in West Nile virus neurological disease

IntroductionSome West Nile virus (WNV)-infected patients have been reported to manifest disease signs consistent with autonomic dysfunction. Moreover, WNV infection in hamsters causes reduced electromyography amplitudes of the gastrointestinal tract and diaphragm, and they have reduced heart rate variability (HRV), a read-out for the parasympathetic autonomic function.MethodsHRV was measured in both hamsters and mice using radiotelemetry to identify autonomic deficits. To identify areas of WNV infection within the medulla oblongata mapping to the dorsal motor nucleus of vagus (DMNV) and the nucleus ambiguus (NA), fluorogold dye was injected into the cervical trunk of the vagus nerve of hamsters. As a measurement of the loss of parasympathetic function, tachycardia was monitored contiguously over the time course of the disease.ResultsDecrease of HRV did not occur in all animals that died, which is not consistent with autonomic function being the mechanism of death. Fluorogold-stained cells in the DMNV were not stained for WNV envelope protein. Fourteen percent of WNV-stained cells were co-localized with fluorogold-stained cells in the NA. These data, however, did not suggest a fatal loss of autonomic functions because tachycardia was not observed in WNV-infected hamsters.ConclusionParasympathetic autonomic function deficit was not a likely mechanism of death in WNV-infected rodents and possibly in human patients with fatal WN neurological disease.

Jaw-opening and -closing premotoneurons in the nucleus of the solitary tract making contacts with laryngeal and pharyngeal afferent terminals in rats

This study clarified the neural mechanisms underlying jaw movements in pharyngolaryngeal reflexes such as swallowing in rats. After retrograde tracer injections into the ventromedial division (Vmovm) of the trigeminal motor nucleus (Vmo) containing jaw-opening (JO) motoneurons or into the dorsolateral division (Vmodl) of Vmo containing jaw-closing (JC) motoneurons, JO and JC premotoneurons were labeled with an ipsilateral predominance in the medial and intermediate subnuclei of the rostrocaudal middle two-thirds of the nucleus of the solitary tract (Sol); JC premotoneurons were also in the lateral subnucleus of Sol. After anterograde tracer injections into the Sol, axons were labeled with an ipsilateral predominance in the Vmovm and Vmodl, prominently in the ipsilateral Vmovm. After transganglionic tracer applications to the superior laryngeal nerve (SLN) or the cervical trunk of the glossopharyngeal nerve (GpN-ct), labeled afferents were seen in the medial, intermediate, lateral and interstitial subnuclei of Sol at the rostral three-fourths of Sol, indicating considerable overlap with the JO and JC premotoneurons in the Sol. Double labeling experiments demonstrated contacts between the afferent terminals and the JO and JC premotoneurons. The present study has for the first time revealed the differential distribution of JO and JC premotoneurons in the Sol and features of their projections from the Sol, as well as their connections with SLN and GpN-ct afferent inputs. The JO and JC premotoneurons in the Sol may play an important role in generation and organization of jaw movements in pharyngolaryngeal reflexes evoked by SLN and GpN-ct inputs, such as swallowing.

Vagal nerve stimulation during early reperfusion limits infarct size and no-reflow

Purpose: Infarct Size (IS) and No-Reflow (NR) are important clinical prognosticators of left ventricular (LV) remodeling and dysfunction after acute myocardial infarction (AMI) and both represent important therapeutic targets. Vagal nerve stimulation (VNS) may offer a novel cardioprotective treatment strategy for additional infarct size limitation during reperfusion therapy. VNS was recently shown to limit infarct size in rodents when started prior to, or at the very onset of ischemia. However, its effects on infarct size and no-reflow, have not been investigated in a translational ischemia-reperfusion model. Accordingly, we validated the effects of VNS on infarct size and no-reflow in a porcine model using a translational protocol with treatment starting just prior to reperfusion. Methods: Anesthetized pigs (10 Control, 13 VNS) underwent mid LAD occlusion for 45 min followed by reperfusion. All pigs received a cuff electrode around the left and right cervical vagal trunk but only in VNS pigs, stimulation was started 5 min prior to reperfusion and continued for 20 min. After 120 min of reperfusion, infarct size (% area at risk) and no-reflow (% IS) were assessed using tetrazolium and thioflavin S staining, respectively. Hemodynamics, metabolic and regional function were evaluated as well. Results: VNS decreased heart rate (19±2%, p=0.001) and cardiac output (19±2%, p=0.02) compared with controls, without increasing adverse cardiac events. At the end of the reperfusion period, VNS did not affect systemic hemodynamics, myocardial metabolism or global and regional LV function. The areas at risk were comparable between Control and VNS (26±1% and 27±1% of LV, p=0.60). VNS significantly reduced infarct size compared with controls (67±2% and 54±5% of IS, p=0.03). In addition, VNS was associated with a significant reduction of no-reflow (from 54±6% to 32±6% of IS; p=0.03). No correlation was observed between infarct size or no-reflow reductions and decrease in heart rate (p=0.12 and p=0.19). Conclusions: The present study demonstrates for the first time that the application of VNS during early reperfusion limits infarct size and no-reflow, independent of bradycardia, in a large animal model of ischemia-reperfusion. Thus, VNS may offer a novel, safe and feasible adjunctive therapy of AMI.

The heat is on: does direct application of capsaicin to autonomic nerves produce a specific deafferentation?

The discovery that capsaicin could excite and block transmission in small-diameter afferent nerve fibres provided an important tool for many researchers to investigate the role of this class of neuron in the regulation of physiological and pathophysiological processes. Systemic administration of capsaicin to neonatal animals produces a life-long deafferentation of all capsaicin-sensitive neurons and, in adults, produces a temporary ‘defunctionalization’ (Holzer, 1991). However, for those interested in reflex regulation of gastrointestinal (GI) function, these useful techniques were limited because the gut receives a dual afferent innervation from both the craniosacral and the thoracolumbar outflow from the central nervous system. The use of perineural application of capsaicin to nerve bundles provided an extremely important tool to determine the specific role of an afferent pathway in homeostatic reflexes. For example, total cervical or subdiaphragmatic vagal transection had been used experimentally to demonstrate a vago-vagal reflex pathway in the regulation of gastric motility and secretion, but delineation of the vagal afferent pathway was confounded by concomitant removal of the vagal efferent pathway. Application of capsaicin to the cervical vagal trunks clearly showed a role for the vagal afferent pathway in mediating inhibition of gastric emptying in response to gut peptides and intestinal nutrients (Raybould & Tache, 1988; Raybould & Holzer, 1992). Taken together with morphological studies (in particular those of Powley and his group; see Powley & Philips, 2002) and electrophysiological recordings (for example, Blackshaw & Grundy, 1990), the importance of vagal afferent neurons in the regulation of postprandial gastrointestinal function became evident. Observations using perineural application of capsaicin were also key in uncovering the ability of the gut peptide cholecystokinin to act via the vagal afferent pathway to inhibit food intake (South & Ritter, 1988). Fast forwarding to today, these initial observations led to profound changes in the way we think about the role of the gut and the gut–brain axis in control of body weight and glucose homeostasis. Decades later, however, it is not necessarily surprising to find that direct application of capsaicin to nerve bundles does not produce a specific ‘defunctionalization’ of afferent neurons, as previously supposed (or hoped). In this issue of The Journal of Physiology, Browning et al. (2013) convincingly show that perivagal application of capsaicin induces a degeneration of vagal efferent neurons and a decrease in vagal efferent responses. Researchers using perineural application of capsaicin attempted to control for the specificity of the treatment, but Browning et al. (2013) perform a number of well-designed morphological and electrophysiological experiments that clearly show the lesion produced by perivagal application of capsaicin is not restricted to vagal afferent fibres. One can quibble with the technique of capsaicin application – the use of DMSO and ethanol as the vehicle rather than oil as used by most previous investigators – oil allows for a much more controlled, local application with reduced risk of systemic absorption. The important message from the data in this study is to call into question some previous conclusions that the vagal afferent pathway is the sole mediator of changes in GI function in response to peripheral stimuli. The receptor for capsaicin has been identified and mapped, and capsaicin (particularly at high concentrations) has been shown to have non-TRPV1 receptor-mediated effects. Earlier publications showing altered functional response to vagal ‘efferent’ stimulation by perineural application of capsaicin ascribed these unexpected effects to retrograde activation of vagal afferent neurons or the lack of input to second-order neurons in the nucleus tractus solitarii as being important in the function of the overall reflex pathway (Raybould et al. 1990; Thiefin et al. 1990). The data of Browning et al. (2013) suggest a different interpretation to explain these findings, and the authors urge caution in the use of this technique. Happily, since the heyday of the use of this technique in the 1980s and 1990s, the advent of different technologies, including transgenic mice with specific receptor deletions, have, to a large extent, reinforced initial observations from the early work using perineural application of capsaicin. While past studies may have been overinterpreted, the central tenet that the vagal afferent pathway plays a crucial role in the control of GI function and food intake remains vindicated.

Thyrocervical Trunk Pseudoaneurysm Following Central Venous Catheterization

A 71-year-old female developed a painless neck mass three months following an aortic valve replacement, mitral commissurotomy, and coronary artery bypass. A cervical trunk angio revealed a pseudoaneurysm supplied from a branch of the thyrocervical trunk, which was successfully excised.

Abstract 4655: Retrograde Ethanol Infusion in the Vein of Marshall for Ablation of Atrial Fibrillation: Tissue Ablation, Effects on Regional Vagal Innervation and First Human Experience

The vein of Marshall (VOM) is an attractive target during ablation of atrial fibrillation due to its autonomic innervation and its location anterior to the left pulmonary veins and drainage in the coronary sinus. We studied 14 dogs. A coronary sinus venogram showed a VOM in 10, which was successfully cannulated with an angioplasty wire and a 2 mm balloon. In 5 dogs, electroanatomical (Carto) maps of the left atrium were performed at baseline and after ethanol (100%, 4 – 8 cc) was infused in the VOM, which demonstrated the creation of a new crescent-shaped scar in the left atrium, extending from the annular left atrium towards the posterior wall and left pulmonary veins. In 4 dogs, both cervical vagal trunks were isolated in the carotid sheath and cuff stimulation electrodes were attached to them. Effective refractory periods (ERP) were measured in 3 sites of the left atrium, before and after high-frequency bilateral vagal stimulation. The baseline ERP was 113.6±35.0 ms, and decreased to 82.2±25.4 ms (p&lt;0.05) after vagal stimulation. After alcohol infusion in VOM, vagally-mediated ERP decrease was eliminated (from 108±27.2 ms to 95.6 ±16.7ms, p=NS). This elimination of vagal effects was not uniform and was limited in sites in proximity with the VOM (baseline ERP 105±18.7ms vs post vagal 98.±37.6ms, p=NS, as opposed to 106.7±27.1ms vs post vagal 73.3±19.7ms, p&lt;0.05, in sites remote to VOM). We also tested feasibility of VOM alcohol infusion in humans: 2 patients undergoing pulmonary vein antral isolation had successful VOM cannulation: left atrial voltage maps demonstrated new scar involving the infero-posterior left atrial wall extending towards the left pulmonary veins. Retrograde alcohol infusion in the VOM achieves significant left atrial tissue ablation, abolishes local vagal responses and is feasible in humans.

Right-sided vagus nerve stimulation in humans: An effective therapy?

Vagus nerve stimulation (VNS) is an additive treatment option for refractory epilepsy. The electrode is placed on the cervical trunk of the left vagus nerve. In patients who are not suitable for left-sided vagus nerve stimulation (L-VNS) right-sided vagus nerve stimulation (R-VNS) may be as effective. In animal models epilepsy is sufficiently suppressed by R-VNS. In a 16 years old boy suffering from medically refractory psychomotoric seizures with secondary generalisation, L-VNS reduced the frequency of generalized seizures. A deep wound infection required the removal of the system eight weeks later. Cicatrisation did not allow preparation of the left vagus nerve, therefore we implanted R-VNS with sufficient seizure suppression. However, compared to L-VNS, the effect occurred months later and cardiac symptoms were induced by stimulation of the right vagus nerve. R-VNS seems to be an effective and alternative therapy in selected patients responding to L-VNS where a left-sided reimplantation is not possible. Placement and adjustment of the device should be performed under ECG control. Further studies are necessary to compare the efficacy of L-VNS and R-VNS.

Autonomic Ganglionated Plexi: Characterization and Effect of Epicardial Microwave Ablation in a Canine Model of Vagally Induced Acute Atrial Fibrillation

: Autonomic ganglionated plexi (GP) in fat pads near the pulmonary veins may contribute to initiation and maintenance atrial fibrillation (AF). We attempted to localize these plexi in a canine model, and evaluate the efficacy of microwave ablation in eliminating their vagal reflexes. : 8 Mongrel dogs (25-31 kg), underwent cervical vagal trunk stimulation to produce AV nodal block and sustained AF. Sternotomy was performed and the epicardial fat on the posterior left atrium and pulmonary veins was locally stimulated at high-frequency (20 Hz, 3-5 mA). Locations that produced a vagal response were identified and in 7 dogs ablated using the Flex 4 epicardial microwave ablation probe (Guidant Corp) at 65 watts/90 sec. One animal was a control and not ablated. Vagal responses were retested with local stimulation as well as stimulation of the cervical vagal trunks. The presence of AV block and duration of sustained AF was recorded. : Baseline cervical vagal stimulation produced AV block and AF in all the animals. Local high-frequency stimulation (HFS) elicited vagal responses at the junction of the inferior vena cava and the middle pulmonary vein (IVC-MPV) in 8 animals, the base of the left pulmonary veins/ligament of Marshall (LoM) in 5 animals, and between the upper and lower right pulmonary veins (RPV) in 2 animals. Microwave ablation at the IVC-MPV eliminated the vagal response upon local fat pad HFS. Cervical vagal trunk stimulation yielded less AV block (n = 2) or no AV block (n = 5) after microwave ablation of the IVC-MPV alone (n = 4) or in conjunction with LoM area ablation (n = 3). The average duration of AF during cervical vagal stimulation decreased significantly from baseline (52.7 ± 27.0 sec) versus after fat pad ablation (13.8 ± 20.3 sec, p = 0.004). : In a canine model we found the primary epicardial autonomic ganglionated plexi to be at the junction of the IVC-MPV. Epicardial microwave ablation of this GP eliminated the vagal response during local fat pad stimulation; and attenuated or eliminated AV block and induction of sustained AF during cervical vagal trunk stimulation. Epicardial microwave ablation of the ganglionated plexi in epicardial fat pads is feasible and can eliminate vagal reflexes that maybe important in atrial fibrillation.

Transfecting rat heart with human pacemaker gene in vivo to create a biological pacemaker

To test the ability and safety of injecting the hHCN gene into the ventricle of intact rats to create a novel biological pacemaker and to explore the duration of the hHCN over-expression in vivo. Adenoviral constructs incorporating hHCN4 and green fluorescent protein (GFP) were subepicardially injected into the rats' left ventricular wall in situ (n = 10). Control group was injected with adenoviral constructs of GFP alone (n = 10). ECGs were recorded every day within the initial three days after operation. Up to seven days after injection, all rats were anesthetized and subjected to cervical vagal trunks stimulation to permit the emergence of escape rhythm. Then pace-mapping was performed by the hand-hold electrode. Finally, hearts were removed for histology and immunofluorescence study. Ventricular arrhythmic events were not found during the first three days. During vagal stimulation, the rate of spontaneous rhythm in the hHCN4-injected group was significantly more rapid than that in the control group (69 bpm +/- 6 bpm vs 41 bpm +/- 10 bpm, P < 0.001). Pace-mapping confirmed the escape rhythm in the hHCN4-injected group was originated near the injection site. Immunofluorescence study showed the overexpression of hHCN4 on the site of injection. However, the duration of hHCN overexpression was no more than one month after injection. The overexpression of hHCN4 provides ventricular escape rhythm with the physiologically acceptable rate. Long-term feasibility of this approach needs to be tested.

Lipopolysaccharide-induced elevation and secretion of interleukin-1beta in the submandibular gland of male mice.

The intraperitoneal injection of lipopolysaccharide (LPS) (400 microg/kg body weight) induced the expression of mRNAs of inflammatory cytokines such as interleukin (IL)-1beta, IL-6 and tumour necrosis factor (TNF)-alpha in the submandibular gland (SMG) of C3H/HeN mice but not that of C3H/HeJ mice, a mutant strain for Toll-like receptor-4 (TLR-4(-) mutant). The mRNA levels of these cytokines in the SMG of the wild-type mice increased as early as 3 hr after injection, peaked at 3-6 hr, and had decreased again by 24 hr. In this study, we particularly focused on IL-1beta, and induction by this endotoxin was investigated in detail. Denervation of the superior cervical trunk and chorda tympani nerve did not diminish the LPS-induced elevation of IL-1beta mRNA in the SMG, indicating the irrelevance of the central nervous system in this induction. TLR-4 mRNA and protein were shown to be strongly expressed in the SMG, suggesting the direct action of LPS on this gland. IL-1beta proteins were localized in the secretory granules of granular convoluted tubular (GCT) cells, and their molecular weights in the gland were 17.5 and 20 kDa. IL-1beta of the same size appeared in the saliva 6 hr after LPS injection in C3H/HeN but not in C3H/HeJ mice. The present study thus suggests that IL-1beta, an inflammation cytokine, is induced and secreted into the saliva in response to endotoxin injected intraperitoneally.