Sympathetic Ganglia Research Articles

Biodistribution and Tolerability of AAV-PHP.B-CBh-SMN1 in Wistar Han Rats and Cynomolgus Macaques Reveal Different Toxicologic Profiles.

Recombinant adeno-associated viruses (AAVs) have emerged as promising vectors for human gene therapy, but some variants have induced severe toxicity in Rhesus monkeys and piglets following high-dose intravenous (IV) administration. To characterize biodistribution, transduction, and toxicity among common preclinical species, an AAV9 neurotropic variant expressing the survival motor neuron 1 (SMN1) transgene (AAV-PHP.B-CBh-SMN1) was administered by IV bolus injection to Wistar Han rats and cynomolgus monkeys at doses of 2 × 1013, 5 × 1013, or 1 × 1014 vg/kg. A dose-dependent degeneration/necrosis of neurons without clinical manifestations occurred in dorsal root ganglia (DRGs) and sympathetic thoracic ganglia in rats, while liver injury was not observed in rats. In monkeys, one male at 5 × 1013 vg/kg was found dead on day 4. Clinical pathology data on days 3 and/or 4 at all doses suggested liver dysfunction and coagulation disorders, which led to study termination. Histologic evaluation of the liver in monkeys showed hepatocyte degeneration and necrosis without inflammatory cell infiltrates or intravascular thrombi, suggesting that hepatocyte injury is a direct effect of the vector following hepatocyte transduction. In situ hybridization demonstrated a dose-dependent expression of SMN1 transgene mRNA in the cytoplasm and DNA in the nucleus of periportal to panlobular hepatocytes, while quantitative polymerase chain reaction confirmed the dose-dependent presence of SMN1 transgene mRNA and DNA in monkeys. Monkeys produced a much greater amount of transgene mRNA compared with rats. In DRGs, neuronal degeneration/necrosis and accompanying findings were observed in monkeys as early as 4 days after test article administration. The present results show sensory neuron toxicity following IV delivery of AAV vectors at high doses with an early onset in Macaca fascicularis and after 1 month in rats, and suggest adding the autonomic system in the watch list for preclinical and clinical studies. Our data also suggest that the rat may be useful for evaluating the potential DRG toxicity of AAV vectors, while acute hepatic toxicity associated with coagulation disorders appears to be highly species-dependent.

Endoscopic confocal laser-microscopy for the intraoperative nerve recognition: is it feasible?

Surgeons lose most of their tactile tissue information during minimal invasive surgery and need an additional tool of intraoperative tissue recognition. Confocal laser microscopy (CLM) is a well-established method of tissue investigation. The objective of this study was to analyze the feasibility and diagnostic accuracy of CLM nervous tissue recognition. Images taken with an endoscopic CLM system of sympathetic ganglions, nerve fibers and pleural tissue were characterized in terms of specific signal-patterns ex-vivo. No fluorescent dye was used. Diagnostic accuracy of tissue classification was evaluated by newly trained observers (sensitivity, specificity, PPV, NPV and interobserver variability). Although CLM images showed low CLM image contrast, assessment of nerve tissue was feasible without any fluorescent dye. Sensitivity and specificity ranged between 0.73 and 0.9 and 0.55-1.0, respectively. PPVs were 0.71-1.0 and the NPV range was between 0.58 and 0.86. The overall interobserver variability was 0.36. The eCLM enables to evaluate nervous tissue and to distinguish between nerve fibers, ganglions and pleural tissue based on backscattered light. However, the low image contrast and the heterogeneity in correct tissue diagnosis and a fair interobserver variability indicate the limit of CLM imaging without any fluorescent dye.

Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial.

The present study was designed to test the hypothesis that botulinum toxin would prolong the duration of a lumbar sympathetic block measured through a sustained increase in skin temperature. The authors performed a randomized, double-blind, controlled trial to investigate the clinical outcome of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome. Lumbar sympathetic ganglion block was conducted in patients with lower-extremity complex regional pain syndrome using 75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic (control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as the pain intensity changes. A total of 48 participants (N = 24/group) were randomly assigned. The change in relative temperature increase was higher in the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ± 0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), which was maintained at 3 months (1.1°C ± 0.8 vs. -0.2°C ± 1.2, respectively; P = 0.009). Moreover, pain intensity was greatly reduced in the botulinum toxin group compared with the control group at 1 month (-2.2 ± 1.0 vs. -1.0 ± 1.6, respectively; P = 0.003) and 3 months (-2.0 ± 1.0 vs. -0.6 ± 1.6, respectively; P = 0.003). There were no severe adverse events pertinent to botulinum toxin injection. In patients with complex regional pain syndrome, lumbar sympathetic ganglion block using botulinum toxin type A increased the temperature of the affected foot for 3 months and also reduced the pain.

Features of the physiological distribution of <sup>68</sup>Ga-PSMA and its importance in the differential diagnosis of metastatic lesions of lymph nodes in patients with prostate cancer

Introduction. The appearance of new radiopharmaceuticals based on prostate-specific membrane antigen has significantly increased the accuracy of prostate cancer diagnosis. The physiological accumulation of 68Ga-PSMA in the sympathetic ganglia is important in the diagnosis of metastatic lesions of the lymph nodes. Erroneous interpretation of images can lead to an incorrect choice of tactics for the treatment of prostate cancer.Purpose: improving the diagnosis of prostate cancer with the help of updated data on the physiological accumulation of 68GaPSMA. Identify the sources of potential errors in the interpretation of PET/CT with 68Ga-PSMA.Materials and methods. In order to stage the verified prostate cancer, PET was performed in our center/CT with 68Ga-PSMA in 109 men. All patients were divided into groups by the level of prostate-specific antigen, Gleason sum, and d’Amico.Results. In all patients, we observed the accumulation of RFP in the cervical, abdominal and presacral ganglia. The capture level of the radiotracer was in the range of SUV=1,6–2,3 (median SUV=1,9). In the control PET/CT study after treatment, the accumulation of RFP in the cervical, abdominal and presacral ganglia remained at the same values, which made it possible to identify the detected changes as a variant of the physiological norm.Conclusions. It is necessary to take into account the peculiarities of the physiological distribution and accumulation of radiotracer in organs and tissues, in particular, the capture of 68Ga-PSMA by sympathetic ganglia. This will avoid false-positive cases when describing PET-CT images and will make it possible to increase the informative value of the method.

A Primer for Assessing the Pathology in Mouse Models of Neuroblastoma.

Neuroblastoma, the most common extracranial solid tumor in young children, arises from the sympathetic nervous system. Our understanding of neuroblastoma has been improved by the development of both genetically engineered and xenograft mouse models of the disease. Anatomical pathology is an essential component of the phenotyping of mouse models of cancer, characterizing the morphologic effects of genetic manipulation and drug treatment. The Th-MYCN model, the most widely used of several genetically engineered mouse models of neuroblastoma, was established by targeted expression of the human MYCN gene to murine neural crest cells under the control of the rat tyrosine hydroxylase promoter. Neuroblastoma development in Th-MYCN mice is preceded by neuroblast hyperplasia-the persistence and proliferation of neural crest-derived neuroblasts within the sympathetic autonomic ganglia. The neuroblastomas that subsequently develop morphologically resemble human neuroblastoma and carry chromosomal gains and losses in regions syntenic with those observed in human tumors. In this overview, we describe the essential pathologic features for investigators when assessing mouse models of neuroblastoma. We outline human neuroblastoma as the foundation for understanding the murine disease, followed by details of the murine sympathetic ganglia from which neuroblastoma arises. Sympathetic ganglia, both with and without neuroblast hyperplasia, are described. The macroscopic and microscopic features of murine neuroblastoma are explained, including assessment of xenografts and tumors following drug treatment. An approach to experimental design is also detailed. Increased understanding of the pathology of murine neuroblastoma should improve reproducibility and comparability of research findings and assist investigators working with mouse models of neuroblastoma. © 2021 Wiley Periodicals LLC.

Caroli disease: an update on pathogenesis.

Caroli disease: an update on pathogenesis.

Detailed gross anatomy and topography of the sympathetic cardiac nerves and related ganglia in Syrian hamsters (Mesocricetus auratus)

BackgroundThe detailed morphology and topography of the sympathetic cardiac nerves (SCNs) and ganglia with their surrounding structures in Syrian hamsters were examined to document the general topography and morphology and variations and to discuss the comparative anatomy between the SCNs and ganglia in Syrian hamsters and other rodents, as well as their comparative morphology and macroscopic evolutionary changes among rodents, rabbits, domestic animals (cats, dogs, sheep, goats, oxen, pigs and horses), primates, and humans. MethodsThe composition of the cervical and thoracic parts of the sympathetic trunks and ganglia was bilaterally microdissected in twenty-eight sides of 14 adult male and female Syrian hamsters under a stereomicroscope. ResultsThe general morphology of the SCNs and related ganglia in Syrian hamsters was obtained and noted as follows: (1) the absence of the vago-sympathetic trunk, (2) the absence of the middle cervical ganglion (MG), (3) constant presence of the cervicothoracic ganglion (CT) comprising generally from the caudal cervical ganglion and 1–2 thoracic ganglia and locating over the lateral surface of the longus colli muscle ventral to the heads of the first two ribs and communicating to the eight cervical and first two thoracic spinal nerves (C8-T2) in addition to the vertebral nerve, (4) extensive coverage of the lateral surface of the CT by branches of the subclavian artery, (5) the cranial and caudal limbs of the ansa subclavia (AS) joining the CT to the caudal end of the cervical sympathetic trunk, (6) the presence of an independent thoracic ganglion from the 2nd or 3rd to the 13th and connecting by single interganglionic branches, and communicating to each thoracic spinal nerve, (7) close relationship between the caudal portion of the thoracic sympathetic trunk and the psoas minor muscle, (8) the primary cardiac nerves (CNs) arising from the CT, and (9) the absence of CNs originating generally from the cervical sympathetic trunk, AS, MG, or independent thoracic ganglia or their interganglionic branches. Individual variations of the SCNs and ganglia in Syrian hamsters were noted, including the absence of the ansa subclavia on 5/28 sides (17.86%), the presence of the intermediate ganglia (IG) placed on the C7 on 3/28 sides (10.71%) or the C8 on 3/28 sides (10.71%), and no CNs arising from the IG as well as the presence of the double thoracic sympathetic trunk on 5/28 sides (17.86%). The anatomical characteristics of the SCNs and related ganglia were also exhibited sex and laterality differences. ConclusionsFrom a comparative anatomy viewpoint, the general morphology of the SCNs and related ganglia in Syrian hamsters was very similar to that in rats but was considerably different from that in guinea pigs, especially concerning the MG, cranial position and composition of the CT. The general morphology of the SCNs and related ganglia in Syrian hamsters and other laboratory rodents resembled that of rabbits but was essentially different from that in rabbits with respect to the cranial position and composition of the CT. The general morphology of the SCNs and ganglia exhibited significant morphological differences and similarities among laboratory rodents, rabbits, domestic animals, primates, and humans. The main differences include the relationship between the cervical parts of the vagus nerve and sympathetic trunk, the presence of the MG, the position and composition of the CT, the origins and frequencies of the cardiac nerves, and the primary sympathetic contributor. From macroscopic evolutionary change, the expansion of the range of the SCNs origin has occurred from laboratory rodents, rabbits, domestic animals, and primates to humans.

Facial Ganglia - Anatomy, Symptomatology of Lesions and Biological Relevance

The article summarizes information about the head ganglia (the sympathetic ganglia and in the sensory cranial nerves). Gives а brief historical background on the history issue and relevance of the topic. Characterized by each node with its topography and lesion clinic. The described process of treatment, and prospects for new therapies. Raised the issue of the significance of the defeat ganglia, namely, the suffering of the sick and forced treatment costs (due to the complex differential diagnosis). In a biological sense, pain first appears in chordates and during evolution, as well as transformations of the brain and spinal cord, it acquires new types, localization and significance for the performance of a living organism. And facial pain, being a nosology with a multidisciplinary approach in diagnosis and treatment, demonstrates both its complexity and importance in human life.

Aorticorenal ganglion as a novel target for renal neuromodulation.

Clinical trials for renal artery (RA) ablation have shown limited efficacy. The purpose of this study was to investigate whether the aorticorenal ganglion (ARG) can be targeted for renal denervation. Twenty-eight pigs were studied under isoflurane or alpha-chloralose to examine hemodynamic responses and catecholamine release in response to RA or ARG stimulation. To assess the efficacy of ARG ablation, we randomized 16 pigs to either sham, RA, or ARG ablation, followed by occlusion of the left anterior descending coronary artery (LAD). Hemodynamic responses, cardiac electrophysiological parameters, and arrhythmias/sudden cardiac death were assessed following LAD occlusion. Absent hemodynamic responses to stimulation confirmed ARG or RA ablation. Invivo stellate ganglion neural activity was recorded to assess cardiac sympathetic signaling. Cadaveric dissections were performed to localize the ARG in humans for comparison to swine. The ARG is a purely sympathetic ganglion with cholinergic inputs and pass-through sensory afferent fibers. Compared to RA stimulation, ARG stimulation yielded greater hemodynamic responses during alpha-chloralose anesthesia. However, neither site yielded significant responses under isoflurane. Radiofrequency ablation of the ARG eliminated responses to both RA and ARG stimulation, whereas RA ablation did not eliminate responses to ARG stimulation. Ablation of the ARG did not impact the kidneys or adrenal glands. Compared to control and RA ablation, ARG ablation was protective against ventricular arrhythmias and sudden death. Human and swine ARG are similarly located in the aorticorenal region. Our findings indicate that the ARG may be a novel target for renal neuromodulation. Further studies are warranted to validate these findings.

Посттравматическая кокцигодиния: актуальные вопросы. Обзор зарубежной литературы

There are no clear clinical recommendations for the diagnosis and treatment of patients with coccygodynia, and there are still debates about the choice of the best method of diagnosis, the effectiveness of blockades, the indications for surgical treatment and the most appropriate method of surgical treatment, and the need for antibiotics. The aim of the study is to evaluate the current state of the problem of diagnosis, conservative and surgical treatment of patients with post-traumatic coccygodynia based on the analysis of scientific publications. Materials and methods. A review of the literature data published on the problem of diagnosis and treatment of patients with post-traumatic coccigodenia is presented. The features of the anatomical structure of the coccyx are considered. Radiation methods for the diagnosis of coccygodynia, publication materials on the evaluation of the effectiveness of conservative and surgical treatment, and methods of surgical treatment of patients with coccygodynia are presented. The indications for surgical treatment and the results of surgical treatment of patients with coccygodenia are considered. Results. In coccygodynia, surgical treatment is indicated only in patients in whom comprehensive conservative treatment, the combined repeated blockades or radiofrequency ablation of the unpaired sympathetic ganglion are ineffective. Surgical treatment should only be carried out after the diagnosis has been precisely established, including the use of modern radiological diagnostic methods such as CT, MRI. The best method of coccyx resection is subperiosteal total proximal coccygectomy according to Key, with antibiotic therapy. The effectiveness of surgical treatment in patients with idiopathic coccygodynia is lower than in post-traumatic coccygodynia. Conclusion. Complex conservative treatment of patients with coccygodynia in most cases leads to recovery. Steroid blockades or radiofrequency ablation of the impair ganglion prove to be effective. Surgical treatment of post-traumatic coccygodynia is indicated only in cases of resistance to complex conservative treatment and ineffectiveness of blockades. The most optimal method of surgical treatment is subperiosteal proximal complete resection of the coccyx against the background of antibiotics.

Transplantation for ultra high-risk neuroblastoma patients: effect of tandem autologous stem cell transplantation

Aim: Neuroblastoma is a tumor with a high mortality rate originating from primitive sympathetic ganglion cells. In recent years, the definition of "ultra high-risk" has been used, in which the response to treatment is added in addition to the disease characteristics. In this study, the results of tandem high-dose Iodine 131 (131I) metaiodobenzylguanidine (MIBG) and tandem autologous hematopoietic stem cell transplantation (HSCT) in patients who were diagnosed as refractory after first-line treatments and considered with ultra-high risk nöroblastom (NBL) in Erciyes University Medical Faculty Pediatric Bone Marrow Transplant Center were shared.
 Material and Method: Eleven patients who underwent tandem MIBG and autologous HSCT with the diagnosis of refractory/ultra high-risk NBL between 2011 and 2021 were included in the study. Patient's data were obtained retrospectively using an electronic or manuscript medical record.
 Results: Tandem autologous HSCT and MIBG treatment were applied to 11 patients with a median age of 40.5 months who were diagnosed with refractory/ultra high-risk neuroblastoma. In our study, the overall survival rate was 54.5% and event-free survival (EFS) was 39% at a median follow-up of 20.7 (7.8-105.6) months. Of the 6 surviving patients, 4 are followed in complete remission and 2 in partial remission.
 Conclusion: Our study is the only study that includes a group of patients who received tandem high-dose MIBG and tandem autologous HSCT transplantation in refractory NBL patients without cytokine and immunotherapy. Tandem transplantation and MIBG therapy in ultra-high-risk NBL cases remain promising with acceptable toxicity. Adding immunotherapy to this treatment protocol and combining it with new treatment modalities such as anaplastic lymphoma kinase (ALK), which also takes into account genetic characteristics, may increase survival and event-free survival rates.

Effects of thoracic sympathetic stimulation on palmar perfusion: a preliminary study in pigs.

Ablation of the upper thoracic sympathetic ganglia that innervates the hands is the most effective and permanent cure of palmar hyperhidrosis. However, this type of sympathectomy causes irreversible neural damage and may result in severe compensatory hyperhidrosis. This experiment is designed to confirm the hypothesis, in which the stimulation of T2 sympathetic chain leads to increased palmar microcirculation, and thus results in treating hyperhidrosis. In this study, we used electric stimulation to induce reversible blockade of the sympathetic ganglion in pigs and investigated its effect on palmar perfusion. An electrode was inserted to the T2 sympathetic ganglion of the pig through three different approaches: open dorsal, thoracoscopic, and fluoroscopy-guided approaches. Electric stimulation was delivered through the electrode using clinically available pulse generators. Palmar microcirculation was evaluated by laser speckle contrast imaging. The T2 sympathetic ganglion of the pig was successfully accessed by all the three approaches, as confirmed by changes in palmar microcirculation during electric stimulation. Similar effects were not observed when the electrode was placed on the T4 sympathetic ganglion or off the sympathetic trunk. We established a large animal model to verify the effect of thoracic sympathetic stimulation. Electric stimulation can be used for sympathetic blockade, as confirmed by increased blood perfusion of the palm. Our work suggests that sympathetic stimulation is a potential solution for palmar hyperhidrosis.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Thoracic ganglioneuroma with extension into the epidural space

A patient in their 30s presented with chronic right upper quadrant abdominal pain, nausea, bloating, and constipation. Her clinical exam was unremarkable, and computed tomography (CT) of the chest and abdomen which showed a large right-sided thoracic mass with extension into the thoracic spinal canal. A needle biopsy revealed a diagnosis of ganglioneuroma, the patient then underwent a combined approach for excision the tumor. Ganglioneuroma is a neuroblastic tumor of a neural crest origin, it originates from paravertebral sympathetic chain ganglia of the posterior mediastinum or retroperitoneum. They usually extend through neuroforamina to involve the epidural space and surgical excision can be curative.

Changes of sympathetic ganglia in infections. Mogilnitsky (Journal of Psychol., Neurol. and Psychiatry, 1922, 1)

On the basis of studies of sympathetic ganglia in croupic pneumonia, Spanish flu and catarrhal bronchopneumonia, the author concludes that in croupic pneumonia vascular changes are more significant than in other pulmonary inflammations, while in Spanish flu and bronchopneumonia the nerve apparatus is particularly affected.

Rational Design of Live-Attenuated Vaccines against Herpes Simplex Viruses.

Diseases caused by human herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) affect millions of people worldwide and range from fatal encephalitis in neonates and herpes keratitis to orofacial and genital herpes, among other manifestations. The viruses can be shed efficiently by asymptomatic carriers, causing increased rates of infection. Viral transmission occurs through direct contact of mucosal surfaces followed by initial replication of the incoming virus in skin tissues. Subsequently, the viruses infect sensory neurons in the trigeminal and lumbosacral dorsal root ganglia, where they are primarily maintained in a transcriptionally repressed state termed “latency”, which persists for the lifetime of the host. HSV DNA has also been detected in other sympathetic ganglia. Periodically, latent viruses can reactivate, causing ulcerative and often painful lesions primarily at the site of primary infection and proximal sites. In the United States, recurrent genital herpes alone accounts for more than a billion dollars in direct medical costs per year, while there are much higher costs associated with the socio-economic aspects of diseased patients, such as loss of productivity due to mental anguish. Currently, there are no effective FDA-approved vaccines for either prophylactic or therapeutic treatment of human herpes simplex infections, while several recent clinical trials have failed to achieve their endpoint goals. Historically, live-attenuated vaccines have successfully combated viral diseases, including polio, influenza, measles, and smallpox. Vaccines aimed to protect against the devastation of smallpox led to the most significant achievement in medical history: the eradication of human disease by vaccination. Recently, novel approaches toward developing safe and effective live-attenuated vaccines have demonstrated high efficacy in various preclinical models of herpetic disease. This next generation of live-attenuated vaccines has been tailored to minimize vaccine-associated side effects and promote effective and long-lasting immune responses. The ultimate goal is to prevent or reduce primary infections (prophylactic vaccines) or reduce the frequency and severity of disease associated with reactivation events (therapeutic vaccines). These vaccines’ “rational” design is based on our current understanding of the immunopathogenesis of herpesviral infections that guide the development of vaccines that generate robust and protective immune responses. This review covers recent advances in the development of herpes simplex vaccines and the current state of ongoing clinical trials in pursuit of an effective vaccine against herpes simplex virus infections and associated diseases.

Generation, Characterization, and Application of Inducible Proliferative Adult Human Epicardium-Derived Cells.

Rationale: In recent decades, the great potential of human epicardium-derived cells (EPDCs) as an endogenous cell source for cardiac regeneration has been recognized. The limited availability and low proliferation capacity of primary human EPDCs and phenotypic differences between EPDCs obtained from different individuals hampers their reproducible use for experimental studies. Aim: To generate and characterize inducible proliferative adult human EPDCs for use in fundamental and applied research. Methods and results: Inducible proliferation of human EPDCs was achieved by doxycycline-controlled expression of simian virus 40 large T antigen (LT) with a repressor-based lentiviral Tet-On system. In the presence of doxycycline, these inducible EPDCs (iEPDCs) displayed high and long-term proliferation capacity. After doxycycline removal, LT expression ceased and the iEPDCs regained their cuboidal epithelial morphology. Similar to primary EPDCs, iEPDCs underwent an epithelial-to-mesenchymal transition (EMT) after stimulation with transforming growth factor β3. This was confirmed by reverse transcription-quantitative polymerase chain reaction analysis of epithelial and mesenchymal marker gene expression and (immuno) cytochemical staining. Collagen gel-based cell invasion assays demonstrated that mesenchymal iEPDCs, like primary EPDCs, possess increased invasion and migration capacities as compared to their epithelial counterparts. Mesenchymal iEPDCs co-cultured with sympathetic ganglia stimulated neurite outgrowth similarly to primary EPDCs. Conclusion: Using an inducible LT expression system, inducible proliferative adult human EPDCs were generated displaying high proliferative capacity in the presence of doxycycline. These iEPDCs maintain essential epicardial characteristics with respect to morphology, EMT ability, and paracrine signaling following doxycycline removal. This renders iEPDCs a highly useful new in vitro model for studying human epicardial properties.

Association Between 2-Hz Electroacupuncture Stimulation Near the Cervical Sympathetic Trunk and Nasal Skin Temperature: A Randomized Crossover Study.

Objective: Human nasal vessels are innervated by sympathetic vasoconstrictors. This study examined the effect of electroacupuncture (EA) stimulation near the cervical sympathetic ganglion on human nasal skin temperature. Materials and Methods: This prospective, single center study was conducted at Teikyo Heisei University, in Tokyo, Japan, with 20 healthy adults (17 men and 3 women). The subjects were assigned randomly to an untreated group or an EA group in a crossover trial. The washout period was 2 weeks. In both groups, after 5 minutes of rest, a 5-minute additional rest or an EA stimulus was delivered, followed by 5 minutes more of rest. The EA was delivered near the cervical ganglia at the level of the sixth cervical vertebra on the left side. The EA stimulus was set to 2 Hz, and the stimulation intensity was set to a level at which no pain was felt by the subjects. Results: The EA group had significant decreases in nasal skin temperature during the intervention, compared with that temperature before the intervention. Additionally, the EA group had significant decreases in nasal skin temperature, compared with those in the untreated group. Conclusions: Stimulation with 2-Hz EA in the vicinity of the cervical sympathetic trunk decreases nasal skin temperature and activates sympathetic nerves. Future studies should assess EA's effectiveness for conditions such as allergic rhinitis.

Could Interscalene Block Possibly be Protective Against Cerebral Ischemia During Shoulder Surgery in a Beach Chair Position?

IntroductionArthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position.Material and methodsAfter the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOSTM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period.ResultsData of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values ​​after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values ​​in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow.ConclusionOur study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.

Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial.

BackgroundThe study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic.MethodsIn this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed.ResultsProcedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study.ConclusionsVR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.