Vagal System Research Articles

Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.

Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity. To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery. This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups. The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05). The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

The efficacy of the use of atropine in children with reflex anoxic syncope during pallid breath-holding spells: can cardiac pacemaker implantation be avoided?

Reflex anoxic syncope is the result of an overreaction of the vagal system, resulting in hypotension and bradycardia or brief cardiac arrest. Because of the benign character and the absence of complications in short or long term, treatment is only necessary in case of frequent or severe clinical presentation. Treatment options are anticholinergic drugs or cardiac pacemaker placement. We investigated atropine treatment and aimed to examine if pacemaker placement can be avoided. We retrospectively reviewed patients treated with atropine for severe reflex anoxic syncope in our centre from January 2017 until May 2023, and compared our results to those in the literature. The study population consisted of 10 children, 70% female, with an age ranging from 5 months to 3 years (mean 14.5 months) when atropine treatment was started (dose 17-50 microg/kg/day). All patient's parents reported adequate symptom management during atropine treatment, with complete resolution in 10%. Minor side effects were reported in 60% (dry mucosa in 40%, obstipation in 20%, and nausea or blurry vision in 10%). We consider atropine a safe and effective treatment to manage reflex anoxic syncope with similar success rate to pacemaker implantation. However, pacemaker implantation entails substantial risk for complications (up to 25%) such as infection or technical problems and morbidity such as scar formation. This might be considered redundant for a benign and temporary condition, certainly given the possibility of other efficient treatment options. Consequently, we recommend atropine treatment over implantation of a cardiac pacemaker in children with severe reflex anoxic syncope.

Nodose afferent fibers require PIEZO2 for esophageal mechanosensation

The esophagus receives dual innervation of extrinsic afferent fibers from both the dorsal root ganglia as well as the vagal ganglia. These are polymodal sensory afferents that are able to sense a variety of stimuli that include chemical and mechanical stimuli. Previous research has demonstrated that the esophagus is innervated by low threshold mechanoreceptors arising from the nodose ganglia, which provide critical peripheral feedback that is required for proper swallowing and peristaltic reflexes. We know that in the vagal system, PIEZO2 plays a critical role in lung inflation and baroreceptor function in the aorta and carotid sinus. Hence, we hypothesize that PIEZO2 is the mechanotransducer in these nodose esophageal low threshold mechanoreceptors. We used a two-pronged approach to elucidate PIEZO2’s role in esophageal mechanosensation: first, GCaMP6s imaging and then single fiber electrophysiology to understand the kinetics of nodose esophageal afferent fiber activation. Both of these approaches used our ex-vivo intact vagal esophageal preparation. Our proof-of-principle studies were conducted in PIRT-GCaMP6s mice, obtained through the crossbreeding of Pirt-Cre (Cre expressed in all sensory neurons) mice with Cre-dependent, ROSA26 based, GCaMP6s reporter (B6.129S6-Gt(ROSA)26Sor-tm96(CAG-CGaMP6s)Hze). Our preliminary data in Pirt-GCaMP6s mice showed a profound increase in the Ca2+ influx in a subset of nodose neurons in response to mechanical distention of the esophagus at 5, 10, and 30mmHg pressures. For our knockout group, we obtained nodose-specific knockout of PIEZO2 by crossing P2X2-Cre mice (P2X2 is expressed in all nodose neurons) with PIEZO2fl/fl mice (P2X2/PIEZO2 KO mice). Upon performing our GCaMP6s imaging experiments in this group, we saw that there was a significant reduction in the number of nodose neurons that were responsive to esophageal distention (58% down to 17%). Comparing the fluorescence intensities of all esophageal neurons between the control and KO groups, we observed a significant reduction at all three intraesophageal pressures (p&lt;0.05, n=458 and 395 neurons in control and KO groups, respectively). In our single fiber electrophysiology experiments, our control and KO groups were PIEZO2fl/fl mice and P2X2/PIEZO2 KO respectively. We were able to successfully record APs from A-fiber mechanosensitive esophageal neurons. The number of APs recorded from KO group was reduced at all the three intraesophageal pressures when compared to the control PIEZO2fl/fl mice. Our findings support the hypothesis that PIEZO2 is the mechanotransduction protein involved in vagal nodose afferent fibers innervating the esophagus. NIH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Stimuli factor of muscular receptors, extraocular muscles and oculocardiac reflex (OCR)

Introduction: The oculocardiac reflex (OCR) was first described in 1908 as a reduction in heart rate secondary to direct pressure on the eyeball. OCR has been described during ophthalmologic procedures. This is also a standard test for peripherical autonomic and vagal system with the diving reflex and overtraining. The aim studied the specificities of stimuli of stretch receptors wich can be the traction at the extraocular muscles. Materials: 7 rabbits were included on the study. The anesthesia was done by an Intraperitoneal administration of ethyl carbamate. During all the study the rabbit is immobilized with a gripping frame for the head. Heart rate and RR were measured with EKG was recorded online. Methods: Bilateral pressure is applied using a mechanical pressure compression device, ranging from 100 to 800 mmHg, either instantaneously or in 15 or 30 seconds. For each pression we studied the variations of the RRspace (RRmax and RRt function of time) compared with the RRcontrol. If no variation, RRmax/RRcontrol and RRt/RRcontrol =1 Results: Response to abrupt compression RRmax varied linearly and significantly with pression. Response to progressive compression did not show any significant variation either during rise of pressure or when pressure was reached. Time-based response was studied from 56RR intervals. With abrut compression, the increase was effective from the first or second RR intervals. Depending on the pressure, it increased up to the 20th, presented a peak and decreased even with maintained pressure. The RR interval reverted to the control (RR/tRR = 1) around the 40th interval. With progressive stimulation, the maximum elongation value is lower, with an identical decay. Discussion: Our work showed the characteristics of stimulating factor: we used pressure on eyeballs, as in a sports medicine test (cardiac parasympathetic analysis) and in emergencies for the reduction of arrhythmias. This principal factor is tension in function of time, with an elongation of the periorbital muscles and the neuromuscular spindle. This is a proprioceptive sensory mecano-receptor sensitive to elongation. It is made up of primary neuromuscular fibers known as nuclear sac fibers and secondary neuromuscular fibers known as nuclear chain fibers. The former are 'phasic' (i.e. reacting to a variation in tension) and the latter 'tonic' (i.e. reacting directly to tension). Our work showed that the neuromuscular fibers of the nuclear sac type are stimulated by variations in tension as a function of time. Platen (1961) in ocular surgery introduced the notion of traction on the oculomotor muscles. In ‘OpenAnesthesia 2023’ Dennath Chatterjee did a synthesis work in the traction and anesthesia factors. In sports medicine, the dive reflex has been shown to be responsable of arythmia and paroxysmal supraventricular tachycardia. To trigger this reflex, several tests have beeen proposed. A recommandation during clinical examination is the OCR or Carotid glomus massage, with record of EKG and cardiac frequency. Conclusion: The OCR is defined by a reduction in heart rate from direct pressure on the eyeball. Afferent and efferent pathways are known and studied. But the stimulating factor must be studied. We have demontred that is the elongation of neuro-muscular fibers according to the time that excites the phasic fibers. This notion must be integrated both in eye surgery and in tests to highlight the cardiac parasympathetic balance, especially in sports physiology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hacking the vagal system to treat chronic cough

Hacking the vagal system to treat chronic cough

An in-depth analysis of the polyvagal theory in light of current findings in neuroscience and clinical research.

The polyvagal theory has led to the understanding of the functions of the autonomic nervous system in biological development in humans, since the vagal system, a key structure within the polyvagal theory, plays a significant role in addressing challenges of the mother-child dyad. This article aims to summarize the neurobiological aspects of the polyvagal theory, highlighting some of its strengths and limitations through the lens of new evidence emerging in several research fields-including comparative anatomy, embryology, epigenetics, psychology, and neuroscience-in the 25years since the theory's inception. Rereading and incorporating the polyvagal idea in light of modern scientific findings helps to interpret the role of the vagus nerve through the temporal dimension (beginning with intrauterine life) and spatial dimension (due to the numerous connections of the vagus with various structures and systems) in the achievement and maintenance of biopsychosocial well-being, from the uterus to adulthood.

Molecular mechanisms of postoperative ileus following gastrointestinal surgery

Abstract Postoperative ileus (POI) is characterized by a transient cessation of gastrointestinal (GI) motility and is a common complication following surgery, especially GI surgery. The mechanism of POI is complex and multifactorial and is considered to be mainly related to sympathetic neural reflexes, activation of gut opioid receptors, and inflammatory reactions. Incision of the skin and muscle, as well as the opening of the peritoneal cavity cause a neurological reflex arc involving the spinal loop with afferent splanchnic nerves synapsing in the spinal cord, activating efferent traveling back to the gut, which constitutes the first phase of POI. Once the stimulation by intestinal manipulation, traction of the abdomen for laparotomy, and distension for laparoscopy have been completed, accompanied by abdominal closure, activation of these signal pathways will terminate. As the neurological phase subsides, numerous immune cell infiltration, including mast cells, monocytes, and macrophages, appear in the intestine, which promotes the secretion of pro-inflammatory molecules and the induction of intestinal inflammation. The resolution of inflammation is the last pathological phase of POI, which is mainly mediated by the macrophage polarization and vagal system. This review highlights the current knowledge of molecular mechanisms of POI after elective intestinal surgery, which may offer the possibility and direction for effective management and treatment plans to reduce the burden of POI.

Low heart rate variability is associated with a negativity valence bias in interpreting ambiguous emotional expressions.

Most people tend to overstate positive aspects of their experiences, that is, a positive valence bias. However, some people tend to have attenuated attention for negative aspects of perceived information, that is, negative valence bias. This dispositional tendency in either valence is especially significant for emotion regulation as it influences the intensity of later stages of emotional experiences. Heart rate variability (HRV) is used as an index of emotion regulation and for the effect dispositional valence bias has on social cognition. The aim of the current study was to investigate whether a positivity or negativity bias in processing ambiguous facial expressions would predict high or lower HRV, respectively, in a healthy sample. The Reading the Mind in the Eyes Test was presented to a sample of 128 healthy participants (N = 86 women participants), and resting HRV was acquired. In multiple linear regression analyses, the mean accuracy scores for items with positive, negative, and neutral valences were included as predictors of HRV. As a follow-up analysis, we tested whether a general tendency to interpret negative stimulus as positive, that is, a positivity bias, predicted HRV. Higher accuracy on items with negative emotional valence predicted lower HRV. There was no association between accuracy scores on items of positive or neutral valence and HRV. Higher positivity bias predicted higher HRV. The present findings suggest that a dispositional valence bias relates to levels of HRV and, as such, is influenced by the functioning of the vagal system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Coupling between prefrontal brain activity and respiratory sinus arrhythmia in infants and adults

Self-regulation is an essential aspect of healthy child development. Even though infants depend on their caregivers for co-regulation during the first years, they begin to gain regulatory abilities through social interactions as well as their own developing agency and inhibitory control. These early regulatory abilities continue to increase with the development of both the prefrontal cortex and the vagal system. Importantly, theoretical accounts have suggested that the prefrontal cortex and the vagal system are linked through forward and backward feedback loops via the limbic system. Decreased coupling within this link is suggested to be associated with psychopathology. The primary goal of this study was to examine whether intrapersonal coupling of prefrontal brain activity and respiratory sinus arrhythmia is evident in infancy. Using the simultaneous assessment of functional near-infrared spectroscopy and electrocardiography, we used Cross-Recurrence Quantification Analysis to assess the coupling of prefrontal brain activity and respiratory sinus arrhythmia in 69 4- to 6-month-old infants and their mothers during a passive viewing condition. However, we did not find significant coupling between the PFC and RSA in infants and adult caregivers. Future studies could examine social contexts associated with greater emotional reactivity to deepen our understanding of the pathways involved in self-regulation.

Automatic Detection and Characterization of Autonomic Dysreflexia Using Multi-Modal Non-Invasive Sensing and Neural Networks.

Autonomic dysreflexia (AD) frequently occurs in persons with spinal cord injuries (SCIs) above the T6 level triggered by different stimuli below the level of injury. If improperly managed, AD can have severe clinical consequences, even possibly leading to death. Existing techniques for AD detection are time-consuming, obtrusive, lack automated detection capabilities, and have low temporal resolution. Therefore, a non-invasive, multi-modal wearable diagnostic tool was developed to quantitatively characterize and distinguish unique signatures of AD. Electrocardiography and novel skin nerve activity (skNA) sensors with neural networks were used to detect temporal changes in the sympathetic and vagal systems in rats with SCI. Clinically established metrics of AD were used to verify the onset of AD. Five physiological features reflecting different metrics of sympathetic and vagal activity were used to characterize signatures of AD. An increase in sympathetic activity, followed by a lagged increase in vagal activity during the onset of AD, was observed after inducing AD. This unique signature response was used to train a neural network to detect the onset of AD with an accuracy of 93.4%. The model also had a 79% accuracy in distinguishing between sympathetic hyperactivity reactions attributable to different sympathetic stressors above and below the level of injury. These neural networks have not been used in previous work to detect the onset of AD. The system could serve as a complementary non-invasive tool to the clinically accepted gold standard, allowing an improved management of AD in persons with SCI.

Xylan Prebiotics and the Gut Microbiome Promote Health and Wellbeing: Potential Novel Roles for Pentosan Polysulfate.

This narrative review highlights the complexities of the gut microbiome and health-promoting properties of prebiotic xylans metabolized by the gut microbiome. In animal husbandry, prebiotic xylans aid in the maintenance of a healthy gut microbiome. This prevents the colonization of the gut by pathogenic organisms obviating the need for dietary antibiotic supplementation, a practice which has been used to maintain animal productivity but which has led to the emergence of antibiotic resistant bacteria that are passed up the food chain to humans. Seaweed xylan-based animal foodstuffs have been developed to eliminate ruminant green-house gas emissions by gut methanogens in ruminant animals, contributing to atmospheric pollution. Biotransformation of pentosan polysulfate by the gut microbiome converts this semi-synthetic sulfated disease-modifying anti-osteoarthritic heparinoid drug to a prebiotic metabolite that promotes gut health, further extending the therapeutic profile and utility of this therapeutic molecule. Xylans are prominent dietary cereal components of the human diet which travel through the gastrointestinal tract as non-digested dietary fibre since the human genome does not contain xylanolytic enzymes. The gut microbiota however digest xylans as a food source. Xylo-oligosaccharides generated in this digestive process have prebiotic health-promoting properties. Engineered commensal probiotic bacteria also have been developed which have been engineered to produce growth factors and other bioactive factors. A xylan protein induction system controls the secretion of these compounds by the commensal bacteria which can promote gut health or, if these prebiotic compounds are transported by the vagal nervous system, may also regulate the health of linked organ systems via the gut–brain, gut–lung and gut–stomach axes. Dietary xylans are thus emerging therapeutic compounds warranting further study in novel disease prevention protocols.

Emx1-Cre Is Expressed in Peripheral Autonomic Ganglia That Regulate Central Cardiorespiratory Functions.

The Emx1-IRES-Cre transgenic mouse is commonly used to direct genetic recombination in forebrain excitatory neurons. However, the original study reported that Emx1-Cre is also expressed embryonically in peripheral autonomic ganglia, which could potentially affect the interpretation of targeted circuitry contributing to systemic phenotypes. Here, we report that Emx1-Cre is expressed in the afferent vagus nerve system involved in autonomic cardiorespiratory regulatory pathways. Our imaging studies revealed expression of Emx1-Cre driven tdtomato fluorescence in the afferent vagus nerve innervating the dorsal medulla of brainstem, cell bodies in the nodose ganglion, and their potential target structures at the carotid bifurcation such as the carotid sinus and the superior cervical ganglion (SCG). Photostimulation of the afferent terminals in the nucleus tractus solitarius (NTS) in vitro using Emx1-Cre driven ChR2 reliably evoked EPSCs in the postsynaptic neurons with electrophysiological characteristics consistent with the vagus afferent nerves. In addition, optogenetic stimulation targeting the Emx1-Cre expressing structures identified in this study, such as vagus nerve, carotid bifurcation, and the dorsal medulla surface transiently depressed cardiorespiratory rate in urethane anesthetized mice in vivo. Together, our study demonstrates that Emx1-IRES-Cre is expressed in the key peripheral autonomic nerve system and can modulate cardiorespiratory function independently of forebrain expression. These results raise caution when interpreting systemic phenotypes of Emx1-IRES-Cre conditional recombinant mice, and also suggest the utility of this line to investigate modulators of the afferent vagal system.

Analysis of the distribution of vagal afferent projections from different peripheral organs to the nucleus of the solitary tract in rats.

Anatomical tracing studies examining the vagal system can conflate details of sensory afferent and motor efferent neurons. Here, we used a serotype of adeno-associated virus that transports retrogradely and exhibits selective tropism for vagal afferents, to map their soma location and central termination sites within the nucleus of the solitary tract (NTS). We examined the vagal sensory afferents innervating the trachea, duodenum, stomach, or heart, and in some animals, from two organs concurrently. We observed no obvious somatotopy in the somata distribution within the nodose ganglion. The central termination patterns of afferents from different organs within the NTS overlap substantially. Convergence of vagal afferent inputs from different organs onto single NTS neurons is observed. Abdominal and thoracic afferents terminate throughout the NTS, including in the rostral NTS, where the 7th cranial nerve inputs are known to synapse. To address whether the axonal labeling produced by viral transduction is so widespread because it fills axons traveling to their targets, and not just terminal fields, we labeled pre and postsynaptic elements of vagal afferents in the NTS . Vagal afferents form multiple putative synapses as they course through the NTS, with each vagal afferent neuron distributing sensory signals to multiple second-order NTS neurons. We observe little selectivity between vagal afferents from different visceral targets and NTS neurons with common neurochemical phenotypes, with afferents from different organs making close appositions with the same NTS neuron. We conclude that specific viscerosensory information is distributed widely within the NTS and that the coding of this input is probably determined by the intrinsic properties and projections of the second-order neuron.

Polyvagal Theory and Its Clinical Potential: An Overview

The polyvagal theory, proposed by Stephen Porges, describes the adaptive responses of the mammalian autonomic nervous system. According to this novel theory, the vagus nerve functions through two independent pathways, referred to as the ventral and the dorsal vagal pathways. The ventral vagus is a myelinated nerve that has newly emerged in mammals and in coordination with cranial nerves regulates the muscles of the face and head to form the ventral vagal complex, which enables social engagement via exchange of safety cues and downregulating sympathetic defense reaction. In a safe environment, mammals normally adapt using the social engagement system; however, depending on the degree of risk exposure in the environment, activation of the sympathetic nervous system triggers the fight-or-flight response, and the dorsal vagal system initiates the immobilization shutdown response. The involuntary neural process through which the nervous system evaluates risk is referred to as neuroception. The polyvagal theory explains the pathophysiology of trauma and various physical symptoms associated with ventral vagal complex dysfunction. Moreover, this may potentially be useful as a fundamental theory in psychotherapy, in which the quality of social interaction is critical.

The Indices of Instantaneous Pulse Rate Variability Are Indicators for Daily Life Quality Assessment in Patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory illness. Questionnaires such as modified Medical Research Council (mMRC) dyspnea scale and COPD assessment test (CAT) are useful for COPD condition and life quality assessment. These questionnaires reflect how respiratory disorder affects daily life. Breathing and autonomic nervous system (ANS) usually regulate each other. Few studies discussed the ANS activity and daily life quality in patients with COPD. Therefore, this study aimed to find the relationship between daily life quality assessed by mMRC or CAT and ANS assessed by a novel method, instantaneous pulse rate variability (iPRV), a method indicating not only the ANS activity but also the peripheral response. The result showed that the change in mMRC and the change in low frequency power to high frequency power ratio, which usually represents the sympathetic activity in conventional heart rate variability analysis, had significant correlation (r = 0.63; p < 0.05). The change in CAT and the change in high frequency power (regulated by vagal nervous and respiratory system) or very high frequency power (new frequency band can be indicated in iPRV spectrum) had significant negative correlation (r = −0.64 and −0.55, respectively; p < 0.05 for both). This study showed the change in iPRV indices when the condition of COPD was improvement or exacerbation. This study presents a possible way to show how cardiovascular activity affects daily life quality in patients with COPD. Increase in LF or decrease in HF and VHF would cause poorer quality of daily life in patients with COPD. The result can also be a reference for patients with COPD to choose the breathing type to adjust rehabilitation and therapy program for ANS regulation to indicate or improve their daily life quality.

Coupling between prefrontal brain activity and respiratory sinus arrhythmia in infants and adults

Self-regulation is an essential aspect of healthy child development. Even though infants are dependent on their caregivers for co-regulation during the first years, they begin to gain early regulatory abilities through social interactions as well as their own cognitive development. These early regulatory abilities continue to increase with the maturation of both the prefrontal cortex and the vagal system. Importantly, theoretical accounts have suggested that the prefrontal cortex and the vagal system are linked through forward and backward feedback loops via the limbic system. Decreased coupling within this link is suggested to be associated with psychopathology.The primary goal of this study is to examine whether intrapersonal coupling of prefrontal brain activity and respiratory sinus arrythmia is evident in infancy. Using the simultaneous assessment of functional near-infrared spectroscopy and electrocardiography, we will use Cross-Recurrence Quantification Analysis to assess the coupling of prefrontal brain activity and respiratory sinus arrhythmia in 69 4–6-month-old infants and their mothers during rest.Understanding the developmental emergence of the neurobiological correlates of self- regulation will allow us to help identify neurodevelopmental risk factors.

Decreased risk of liver and intrahepatic cancer in non-H. pylori-infected perforated peptic ulcer patients with truncal vagotomy: a nationwide study

The vagal nervous system is central to the physiological responses and systemic diseases of the liver. We evaluated the subsequent risk of liver and intrahepatic cancer (HCC/ICC) in non-H. pylori (HP)-infected perforated peptic ulcer (PPU) patients with and without vagotomy. Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database from 2000 to 2008 were enrolled. The exclusion criteria included: (1) Multiple surgeries for PPU were received at the same admission; (2) Any cancer history; (3) Previous peptic ulcer-associated surgery; (4) HP infection history; (5) Viral hepatitis infection history; (6) Follow-up duration < 1 year; and (7) Age < 18 years. The risks of developing HCC/ICC in PPU patients with and without vagotomy were assessed at the end of 2013. To balance the baseline condition between groups, we used the propensity score matched method to select study subjects. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence interval (CI) of HCC/ICC. Before propensity score matching, 675 simple suture patients and 54 TVP patients had HCC/ICC, which corresponded to incidences of 2.11 and 0.88 per 1000 person-years, respectively. After propensity score matching, 145 simple suture patients and 54 TVP patients experienced HCC/ICC, which corresponded to incidences of 1.45 and 0.88 per 1000 person-years, respectively. The TVP patients had a 0.71 (95% CI 0.54–0.95)- and 0.69 (95% CI 0.49–0.97)-fold risk of developing HCC/ICC compared to simple suture patients before and after propensity score matching. Our findings reported that, in the Asian population, TVP decreases the risk of HCC/ICC in non-HP-infected PPU patients compared to simple closure patients. However, further studies are warranted.

Acute and Time-Course Effects of Osteopathic Manipulative Treatment on Vascular and Autonomic Function in Patients With Heart Failure: A Randomized Trial

ObjectiveThe purposed of this study was to valuate the effect of osteopathic manipulative treatment (OMT) on flow-mediated dilation and heart rate variability of patients with heart failure. BackgroundOsteopathic manipulative treatment modulates both the vascular and autonomic nervous system (ANS) in healthy volunteers. However, the acute and time-course effects of the OMT on patients with an overactive ANS remain unclear. MethodsThis randomized controlled trial study included 20 patients with heart failure aged 50 to 60 years, allocated to a single session of OMT (base of the skull, retromaxillary region, heart, and thoracic duct) or sham. Flow-mediated dilation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability were assessed in 3 periods (baseline, immediately after the intervention, and after 15 minutes). Multivariate analysis of variance procedure was used to compare intervention and periods. ResultsThe OMT group had a greater FMD modulation compared with the sham (FMD,% = 9.5 vs. –5.6, 95% confidence interval (CI): [6.6, –12.35] vs. [–14.25, 2.8]; p = 0.001) and grater peak diameter (PD, mm = 0.77 vs –0.16 mm, 95% CI: [0.31,-1.24] vs [–0.63, 0.29]; P = 0.001), suggesting an important acute and time-course vascular effect from OMT. We also found some relevant heart rate variability modulation after 15 minutes from OMT: high frequency (HF, ms2 = 295 vs –354, 95% CI: [144.2, -769]; P = .001) and low frequency (LF, ms2) = 670 vs 775, 95% CI: [–98, 3591]; P = .001), suggesting a time-course ANS modulation after OMT. ConclusionsOsteopathic manipulative treatment was effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Moreover, vascular changes seem to precede the autonomic modulation.

다미주이론이 스트레스반응과 호흡건강관리에 미치는 문헌고찰

The current research conducted a literatural review on polyvagal theory, human stress response and health maintenance utilizing breath exercise.Our research followed track of polyvagal thoery to present thorough overview of vagal nervous mechanism, relationship of breathing and vagal nerve, and the role of the vagal nervous system itself. What was especially notable was that the linkage among most recent researches on immune system cardiac system, and human stress responses were suggested to expand on the importance of vagal nerve. Necessity of empirical research on regulation of vagal nerve crucial to stress & health management is also discussed. We argue that, in order to address this need, breathing utilization among fields of exercise & sports coping should be taken into broader consideration.

Psychosomatic disorders: influence of white noise on disease in patients with cervicalgia (Message 1)

Introduction . Psychosomatic disorders (PSR) develop as a result of somatization of psychogenic factors. In osteopathy, PSRs are reflected in the so-called psychoviscerosomatic disorder which is a variant of a global neurodynamic functional disorder characterized by poly-regional disorders of tissue mobility that are associated with psychoemotional overloads. In most cases of PSR, neurotization of patients is obligate due to the involvement of a number of nervous structures in the pathological process and the subsequent general decrease in the body's adaptive reserves. According to the polyvagal theory of S. Porges (1995), the vagus nerve is divided into two functionally different branches: nucl. dorsalis n. vagi and n. ambigius. Third core nucl. tractussolitarii is the endpoint of many afferent pathways through n. vagus from peripheral organs, which forms the central regulator of the vagal system. In the process of phylogenesis, the vagus nerve system became more complex due to the inclusion of the pathways of the trigeminal, facial, accessory and glossopharyngeal nerves. S. Porges distinguishes the autonomic vagus nerve associated with passive regulation of visceral functions and the social or intellectual vagus, which is responsible for the processes of attention, movement and communication. The auditory sensory system provides encoding and evaluation of acoustic stimuli that determine the ability to adapt. We suggested that by affecting the auditory system, it is possible to affect the autonomic nervous system and reduce the severity of individual symptoms of PSR. The goal of research — is to study the effect of white noise (WN) stimulation of the auditory sensory system on the manifestations of the disease in patients with cervicalgia (CA). Materials and methods . In the period from 03.2020 to 07.2020 on the basis of the «Professor Novikov'sFamily Osteopathy Clinics», an analytical one-stage (cross-sectional) study was conducted, which involved 109 patients with an established clinical diagnosis of CA, who were divided into two groups: an experimental group (76 people) exposed to WN, and a control group (33 people), in which there was no such exposure. To irritate the auditory sensory system, a WN with a frequency of 1-22,05 kHz was used. Patients of the experimental group were divided into 3 groups depending on the level of neuroticism: low (13 people), medium (49 people), high (14 people). The examination included an assessment of the level of neuroticism, biomechanical indicators that characterize the volume of movements in the cervical region, and the level of pain. The L. I. Wasserman questionnaire was used to assess the level of personal neuroticism. The volume of movements in the cervical spine in degrees was determined using an original device for determining the mobility of the cervical spine. Subjective assessment of pain was performed using the VAS scale. To obtain a quantitative assessment of the achieved result, a «B-A-analysis» method is proposed, based on the evaluation of the modules of 6-timer (by the number of analyzed indicators) vectors A (after the study) and B (before the study) and pairwise analysis of the corresponding components of these vectors. Results . Patients of the main group in subgroups with high, medium and low levels of neuroticism irritation auditory system has led to increased range of motion in the cervical spine that best identified patients with low levels of neuroticism, and minimally high. No significant changes were registered in the control group. There was no convincing difference in the dynamics of VAS indicators. Conclusion . The study showed the possibility of influencing biomechanical parameters when the auditory sensory system is irritated by WN in patients with CA, and the result differed depending on the level of neuroticism — high, medium, low. The subjective assessment of the pain syndrome in VAS case is significantly influenced by the emotional component. Thus, if the nervous system is exposed, the biomechanical parameters changes take place, and it indirectly confirms the integrity and interdependence of the neurodynamic and biomechanical components of functional disorders. The results suggest further study of the possibilities of using WN in patients with various somatic dysfunctions accompanying PSR.