Intraoperative sudden arrhythmias in cervical spine surgery adjacent to the stellate ganglion:A case report

BACKGROUND Atrial arrhythmias such as paroxysmal supraventricular tachycardia(PSVT)and atrial flutter(AF)are common in the perioperative setting.They commonly resolve spontaneously.However,occasionally,they may continually progress to fatal arrhythmias or cause complications.Therefore,prompt and appropriate management is important.CASE SUMMARY A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third,fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery.Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction.However,the patient remained stable.Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective.Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve.The surgery was paused,and the patient’s fraction of inspired oxygen was set to 100%.Adenosine was administered for pharmacological management of PSVT.The arrhythmia temporarily resolved.However,it then transformed into AF.Diltiazem was administered,which briefly decreased blood pressure,which immediately recovered.Surgery resumed while the patient was in normal sinus rhythm.She was discharged safely on postoperative day 6 without complications or abnormalities.Currently,she is living a healthy life without arrhythmia recurrence.CONCLUSION Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.

Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke

Diabetes mellitus is an independent risk factor for ischemic stroke.Both diabetes mellitus and stroke are linked to systemic inflammation that aggravates patient outcomes.Stellate ganglion block can effectively regulate the inflammatory response.Therefore,it is hypothesized that stellate ganglion block could be a potential therapy for ischemic stroke in diabetic subjects.In this study,we induced diabetes mellitus in rats by feeding them a high-fat diet for 4 successive weeks.The left middle cerebral artery was occluded to establish models of ischemic stroke in diabetic rats.Subsequently,we performed left stellate ganglion block with 1%lidocaine using the percutaneous posterior approach 15 minutes before reperfusion and again 20 and 44 hours after reperfusion.Our results showed that stellate ganglion block did not decrease the blood glucose level in diabetic rats with diabetes mellitus but did reduce the cerebral infarct volume and the cerebral water content.It also improved the recovery of neurological function,increased 28-day survival rate,inhibited Toll like receptor 4/nuclear factor kappa B signaling pathway and reduced inflammatory response in the plasma of rats.However,injection of Toll like receptor 4 agonist lipopolysaccharide 5 minutes before stellate ganglion block inhibited the effect of stellate ganglion block,whereas injection of Toll like receptor 4 inhibitor TAK242 had no such effect.We also found that stellate ganglion block performed at night had no positive effect on diabetic ischemic stroke.These findings suggest that stellate ganglion block is a potential therapy for diabetic ischemic stroke and that it may be mediated through the Toll like receptor 4/nuclear factor kappa B signaling pathway.We also found that the therapeutic effect of stellate ganglion block is affected by circadian rhythm.

Effect of sinomenine stellate ganglion block on chronic myocardial ischemia in rats

Objective:To investigate the protective effect of sinomenine stellate ganglion block(SGB)on chronic myocardial ischemia and its related mechanism.Methods:SD male and female rats(180~200g)were randomly divided into four groups:blank group,model group,lidocaine group,lidocaine+sinomenine group.The rats in blank group were fed with normal standard diet without modeling,and the other rats were fed with high-fat diet.After 8 weeks of feeding,the rats in high-fat diet group were significantly different from those in blank control group.Then they were randomly divided into 3 groups,10 rats in model group were injected with 0.9%NaCl into right stellate ganglion(RSG)After 2 weeks of continuous injection,pituitrin injection was continuously injected into sublingual vein of rats for 3 days,once every 24 hours;lidocaine group rats were injected with 0.24 mL 1%lidocaine injection in RSG,the rest was the same as model group;lidocaine+sinomenine group rats were injected with 0.24 mL 1%lidocaine injection+0.095 mL sinomenine hydrochloride+2.9 mL 0.8 mL 0.8 mL in RSG,the rest was the same as model group.At the end of the eighth week of the experiment,the rats in the high-fat diet feeding group and the standard ordinary diet feeding group were given the medicine after there was significant difference in blood lipid;before the third injection of pituitrin,the ECG changes of the rats in each group were observed;the general situation of the rats before and after the administration was observed;after the experiment,the blood of the rats in each group was taken from the abdominal aorta,and the serum oxidative stress indexes,such as total superoxide dismutase(SOD)and malondialdehyde,were detected(MDA,IL-6 and cTnI were measured.Results:compared with the blank group,the ECG of the model group changed significantly(P<0.01),the cTnI value increased significantly(P<0.01),indicating that the rat myocardial ischemia model was successfully established;compared with the model group,the SOD level of lidocaine group and lidocaine+sinomenine group increased significantly(P<0.05,P<0.01),the MDA level decreased significantly(P<0.05,P<0.01),IL-6 decreased significantly(P<0.05,P<0.01)05,P<0.01).Conclusion:sinomenine SGB has protective effect on rats with chronic myocardial ischemia,which is related to anti oxidative stress and inhibition of inflammatory reaction.

Effects of Fluvastatin on Characteristics of Stellate Ganglion Neurons in a Rabbit Model of Myocardial Ischemia

Background：Stellate ganglion （SG） plays an important role in cardiovascular diseases.The electrical activity of SG neurons is involved in the regulation of the autonomic nervous system.The aim of this research was to evaluate the effects offluvastatin on the electrophysiological characteristics of SG neurons in a rabbit model of myocardial ischemia （MI）.Methods：The MI model was induced by abdominal subcutaneous injections of isoproterenol in rabbits.Using whole-cell patch clamp technique,we studied the characteristic changes of ion channels and action potentials （APs） in isolated SG neurons in control group （n =20）,MI group （n =20） and fluvastatin pretreated group （fluvastatin group,n =20）,respectively.The protein expression of sodium channel in SG was determined by immunohistochemical analysis.Results：MI and the intervention of fluvastatin did not have significantly influence on the characteristics of delayed rectifier potassium channel currents.The maximal peak current density of sodium channel currents in SG neurons along with the characteristics of activation curves,inactivation curves,and recovery curves after inactivation were changed in the MI group.The peak current densities of control group,MI group,and fluvastatin group （n =10 in each group） were-71.77 ± 23.22 pA/pF,-126.75 ± 18.90 pA/pF,and-86.42 ± 28.30 pA/pF,respectively （F=4.862,P =0.008）.Fluvastatin can decrease the current amplitude which has been increased by MI.Moreover,fluvastatin induced the inactivation curves and post-inactive recovery curves moving to the position of the control group.But the expression of sodium channel-associated protein （Nav 1.7） had no significantly statistical difference among the three groups.The percentages of Nav 1.7 protein in control group,MI group,and fluvastatin group （n =5 in each group） were 21.49 ± 7.33%,28.53 ± 8.26%,and 21.64 ± 2.78%,respectively （F =1.495,P =0.275）.Moreover,MI reduced the electrical activity of AP and increased amplitude of AP,fluvastatin pretreatment could recover amplitude and electrical activity of AP.The probability of neurons induced continuous APs were 44.44%,14.29%,and 28.57% in control group,MI group,and fluvastatin group,respectively.Conclusions：Fluvastatin pretreatment can recover electrophysiology characteristics of ion channel and AP in SG neurons in a rabbit model of MI.It could be considered as potential method for treating coronary heart diseases.

Effects of acupuncture at stellate ganglion on lower limb atherosclerosis of early diabetes mellitus

Objective To compare the efficacy between acupuncture at stellate ganglion combined with intravenous administration of alprostadil and simple intravenous administration of alprostadil on lower limb atherosclerosis of early diabetes mellitus.Methods Sixty patients of lower limb atherosclerosis of early diabetes mellitus were randomly divided into an observation group and a

Effect of stellate block on vasomotor factor, vascular endothelial nitricoxide synthase and pulmonary arterial pressure in rabbits with hypoxic pulmonary artery hypertension

BACKGROUND： At present, inhalation of nitrogen monoxidum （NO） or other angiotenic is widely used to cure hypoxic pulmonary artery hypertension. In addition, recent researches demonstrate that postganglionic fiber of stellate ganglion can regulate contents of blood vessel endothelium-calcitonin gene-related peptide （BVE-CGRP） and nitricoxide synthase （NOS） in lung tissue. Therefore, stellate ganglion which is blocked with the local anesthetic may cause therapeutic effects on hypoxic pulmonary artery hypertension. OBJECTIVE： To observe the effects of stellate block on calcitonin gene-related peptide （CGRP） of vasodilation factors, prostacyclin, endothelin-i of vasoconstriction factors, thromboxan, blood vessel endothelium-nitricoxide synthase （BVE-NOS） and mean arterial pressure of lung tissue in rabbits with hypoxic pulmonary artery hypertension. DESIGN： Randomly controlled animal study. SETTING： Neurological Institute of Taihe Hospital Affiliated to Yunyang Medical College. MATERIALS： A total of 24 adult Japanese rabbits of both genders and weighing 2.3 - 2.6 kg were provided by Animal Experimental Center of Hubei Academy of Medical Science. SP kit was provided by Beijing Zhongshan Biotechnology Co., Ltd.; moreover, kits of endothelin-1, CGRP, prostacyclin and thromboxan were provided by Radioimmunity Institute, Scientific and Technological Developing Center, General Hospital of Chinese PLA, and color image analytical system （Leica-Q500IW） was made in Germany. METHODS：The experiment was carried out in the Neurological Institute of Taihe Hospital affiliated to Yunyang Medical College from February to December 2002. ① Rabbits were performed with aseptic manipulation to exposure left stellate ganglion and then it was put in epidural catheter for 1 week. In addition, one end of epidural catheter was fixed near by stellate ganglion and the other end was fixed through dorsal neck. All rabbits were randomly divided into 4 groups, including normal control group, stellate block group, hypoxia group and hypoxia ＋ stellate block group, with 6 in each group. Rabbits in the normal control group were perfused with saline through epidural catheter with 0.5 mL once for three times per day and 3 successive days in total; in addition, rabbits in the stellate block group were perfused with 2.5 g/L bupivacaine through epidural catheter with 0.5 mL once for three times per day and 3 successive days in total. Rabbits in the hypoxia group were used to establish hypoxic pulmonary artery hypertension models. That was to say, the experimental rabbits were put in hypoxic box （containing sodalime and calcium chloride to absorb CO2 and water） and given various flows of oxygen and nitrogen through the two lateral wells simultaneously. And then, oxygen was monitored with oxygen-concentration monitoring device to control the concentration in （10±2）% for 8 hours per day and 2 successive weeks in total. Rabbits in the hypoxia ＋ stellate block group were used to establish hypoxia models as the same as those in the hypoxia group. Two weeks later, 2.5 g,/L bupivacaine was pushed into epidural catheter with 0.5 mL once for three times per day and 3 successive days in total. Breast was directly opened to measure mean pulmonary artery pressure.② 6 mL blood was collected through pulmonary arterial duct to measure levels of plasma CGRP, prostacyclin, endothelin-I and thromboxane with radio-immunity technique; meanwhile, immunohistochemical staining was used to observe the changes of BVE-NOS content of the experimental rabbits in all groups. MAIN OUTCOME MEASURES： Changes of CGRP, prostacyclin, endothelin-1 and thromboxane and BVE-NOS. RESULTS： A total of 24 experimental rabbits were involved in the final analysis. ①As compared with those in the normal control group, hypoxic pulmonary artery hypertension of the experimental rabbits was higher in the hypoxia group and hypoxia ＋ stellate block group after hypoxia [（3.8±0.30）, （3.16±0.45）, （2.60± 0.27） kPa, P 〈 0.05, 0.01]; CGRP was lower [（68.20 ±8.78）, （108.24 ±14.35）, （130.25 ±22.70） ng/L, P 〈 0.05, 0.01]; prostacyclin was lower [（94.45± 10.68）, （98.77± 12.31）, （155.27±20.67） ng/L, P 〈 0.01]; endothelin-1 was higher [（184.7±29.66）, （115.27± 13.62）, （98.20±11.52）, ng/L, P 〈 0.05, 0.01]; thromboxan was higher [（226.27 ±30.46）, （207.67 ±27.32）, （124.25 ± 16.89） ng/L, P 〈 0.01 ]. As compared with that in hypoxia group, hypoxic pulmonary artery hypertension was decreased in hypoxia ＋ stellate block group （P 〈 0.05）, CGRP was increased （P 〈 0.01）, and endothelin-1 was decreased remarkably （P 〈 0.05）. ② Level of BVE-NOS of the experimental rabbits was higher in stellate block group, hypoxia group and hypoxia ＋ stellate block group than that in the normal control group [（0.25±0.06）, （0.27±0.07）, （0.46± 0.12）, （0.14±0.03）, P 〈 0.05], and NOS level was higher in the hypoxia ＋ stellate block group than that in hypoxia group （P 〈 0.05）. CONCLUSION： Mean arterial pressure is decreased in rabbits with hypoxic pulmonary artery hypertension after stellate block and level of endothelin-1 is also decreased; however, levels of CGRP and NOS are increased respectively.

Identification of Differentially Expressed Proteins and Validation of the Changes of N-Ethylmaleimide-sensitive Factor in Rats with Focal Cerebral Ischemia after Transection of the Cervical Sympathetic Trunk

Stellate ganglion blockade （SGB） protects patients from focal cerebral ischemic injury, and transection of the cervical sympathetic trunk （TCST） in a rat model can mimic SGB in humans. The purpose of this study was to investigate the mechanisms underlying the neuroprotective effects of TCST on neuronal damage in the hippocampus in a rat model of middle cerebral artery occlusion （MCAO） in an attempt to elucidate the neuroprotective effects of SGB. The modified method of Zea Longa was used to establish the permanent MCAO model. Male Wistar rats were randomly divided into three groups： sham-operated group, MCAO group, and TCST group. The animals in TCST group were sacri- ficed 48 h after TCST which was performed after the establishment of the MCAO model. Proteins were extracted from the ipsilateral hippocampus and analyzed by two-dimensional difference gel electropho- resis （2D-DIGE） and peptide mass fingerprinting （PMF）. The levels of N-ethylmaleimide-sensitive fac- tor （NSF） were measured as well. The results showed that 11 types of proteins were identified by 2D- DIGE. The expressions of eight proteins were changed both in the sham-operated and TCST groups, and the expressions of the other three proteins were changed in all three groups. Moreover, the expres- sion of NSF was higher in the TCST group than in the MCAO group but lower in the MCAO group than in sham-operated group. The ratio of NSF expression between the MCAO group and sham- operated group was -1.37 （P〈0.05）, whereas that between the TCST group and MCAO group was 1.35 （P〈0.05）. Our results imply that TCST increases the expression of NSF in the hippocampus of adult rats with focal cerebral ischemia, which may contribute to the protection of the injured brain. Our study pro- vides a theoretical basis for the therapeutic application of SGB to patients with permanent cerebral ischemia.

A three-dimensional digital visualization model of cervical nerves in a healthy person

Three-dimensional reconstruction nerve models are classically obtained from two-dimensional images of ＂visible human＂ frozen sections. However, because of the flexibility of nerve tissues and small color differences compared with surrounding tissues, the integrity and validity of nerve tissues can be impaired during milling. Thus, in the present study, we obtained two-dimensional data from a healthy volunteer based on continuous CT angiography and magnetic resonance myelography. Semi-automatic segmentation and reconstruction were then conducted at different thresholds in different tissues using Mimics software. Small anatomical structures such as muscles and cervical nerves were reconstructed using the medical computer aided design module. Three-dimensional digital models of the cervical nerves and their surrounding structures were successfully developed, which allowed visualization of the spatial relation of anatomical structures with a strong three-dimensional effect, distinct appearance, clear distribution, and good continuity, precision, and integrality. These results indicate the validity of a three-dimensional digital visualization model of healthy human cervical nerves, which overcomes the disadvantages of milling, avoids data loss, and exhibits a realistic appearance and three-dimensional image.

Multidisciplinary Treatment for Severe Secondary Raynaud’s Phenomenon:A Case Report

Raynaud’s phenomenon is a symptom complex manifested as intermittent fingertip ischemia caused by cold or other sympathetic drivers.Secondary Raynaud’s phenomenon is often more severe and could even lead to finger ulceration,making it particularly complicated to treat.We describe a case of severe Raynaud’s phenomenon secondary to subclinical hypothyroidism lasting for more than 6 hours in a 65-year-old woman.The patient was also diagnosed with hypothyroidism,epilepsy,and secondary soft tissue infection of the right middle and ring fingers.After careful multidisciplinary consultation and discussion,the patient received vasodilation,anticoagulation,thyroxine supplementation,stellate ganglion block,hyperbaric oxygen therapy and debridement.The patient responded well to the medication,avoiding amputation or obviously dysfunction.Multidisciplinary team gathering the doctors from different departments proposes appropriate strategies for patients with severe Raynaud’s phenomenon and could improve the prognosis and satisfaction of patient effectively.

Diagnosis and management of ophthalmic zoster sine herpete accompanied by cervical spine disc protrusion:A case report

BACKGROUND Zoster sine herpete(ZSH)can be misdiagnosed because there are no typical vesicular eruptions characterized by a dermatomal distribution.However,incorrect treatment due to a misdiagnosis can lead to severe pain and fatal complications.CASE SUMMARY A 75-year-old woman complained of sudden onset right shoulder pain and atypical headache.After 18 d,sudden hearing loss occurred in the left ear.In serology tests conducted after the onset of hearing loss,varicella-zoster virus IgM was positive.She had no history of a rash or trauma.Under the suspicion of ZSH,antiviral treatment and stellate ganglion block were administered four times,and the pain was effectively controlled.CONCLUSION Early diagnosis and treatment of ZSH can help not only by reducing pain but also by preventing fatal complications.