炎性反应反射-胆碱能抗炎通路

机体对外源性侵袭或创伤所产生的炎性反应是局部的、保护性的反应。反应不足和过度都会导致疾病的发生,因此必须有精确的调控机制。抑制急性炎性反应的“胆碱能抗炎通路”的发现,大大的拓展了我们对神经系统如何调节免疫反应的理解：就象对心率及其它重要功能的调节一样,神经系统对炎性反应进行实时的反射性调节。借助这种理解,我们可以通过选择性的、可逆的、神经连接通路治疗炎性反应性疾病。     

Enhanced stretch reflex excitability of the soleus muscle in experienced swimmers

The purpose of this study was to investigate effects of long-term participation to swimming on adaptations of spinal reflex excitability. To this end, mechanically induced stretch reflex (SR) and electrically induced Hoffmann (H-) reflex of the soleus muscle were investigated between swimmers with experience of more than 10 years and non-trained individuals while sitting at rest. The amplitude and the gain (stretch velocity vs. amplitude of the reflex response) of the SR were significantly greater in the swimming group than in the non-trained control group. Similarly, the responses of the H-reflex were also significantly greater in the swimming group than in the non-trained control group. Results of this study demonstrated that the spinal reflex excitability in experienced swimmers was far more enhanced than in non-trained individuals.     

Vagal reflex provoked by radiofrequency catheter ablation in the right aortic sinus cusp: a Bezold–Jarisch-like phenomenon

A 66-year-old woman with idiopathic premature ventricular contractions with a left bundle branch block QRS morphology and left inferior axis underwent electrophysiologic testing. Successful radiofrequency ablation was achieved in the right coronary cusp (RCC). However, radiofrequency ablation at sites adjacent to the successful ablation site provoked sinus bradycardia followed by atrioventricular conduction block. That phenomenon might be explained by a vagal reflex through stimulation of vagal pathways or receptors in the anterior epicardial fat pads neighboring to the RCC. A vagal reflex should be kept in mind as a complication during catheter ablation of ventricular arrhythmias originating from the RCC.     

Delayed‐onset muscle soreness in human masticatory muscles increases inhibitory jaw reflex responses

The effects of masticatory muscles’ overloading on jaw‐motor control are not yet fully clarified. Therefore, it was tested whether eccentric and concentric exercises of the human masticatory muscles would influence inhibitory jaw reflex responses. Eleven participants (6 males, 5 females) performed 6, 5‐minutes bouts of eccentric‐concentric contractions. Before, immediately after, 24 hours, 48 hours and 1 week afterwards, visual analogue scale (VAS) scores for jaw muscle fatigue and pain, maximum voluntary bite force (MVBF) and inhibitory jaw reflexes were recorded. Reflex data were analysed with the cumulative sum control chart error box method. Immediate and delayed masticatory muscle fatigue and pain were provoked. Further, 24 hours after the exercises, MVBF tended to decrease (P = .056), suggesting that delayed‐onset muscle soreness (DOMS) was provoked in the masticatory muscles. In addition, the inhibitory jaw reflex showed a delayed increase in size 24 hours after the exercise (P < .05). In conclusion, DOMS provoked in the masticatory muscles alters jaw motor control by inducing a delayed increase in the size of the inhibitory jaw reflex.     

Neurological and humoral control of blood pressure

There is a relationship between arterial blood pressure, cardiac output and vascular resistance described mathematically, that helps us to understand short-term control of blood pressure in terms of a hydraulic system. Arterial baroreceptors are specialized sensors which mediate a rapid response to sudden changes in pressure through interaction with the autonomic nervous system. This in turn influences heart rate, inotropic state and vascular tone, altering distribution of blood between arterial and venous systems, thus compensating for acute changes in total blood volume. Total blood volume is controlled predominantly by the kidney, with the renin–angiotensin–aldosterone system acting as both the ‘sensor’ of blood pressure/volume (via renin release in the juxtaglomerular apparatus) and the ‘effector’ of blood pressure/volume (via aldosterone secretion by the adrenal cortex). Overall control is shared; the baroreceptors being responsible for mediating short-term changes, and renal mechanisms determining the long-term control of blood pressure. These systems have to be adaptable in order to deal with physiological variation in the delivery of blood to tissues from rest to exercise, and with the large shifts in blood volume seen in acute haemorrhage. Pathophysiological changes in these systems lead to maladaptive responses, with systemic hypertension the most commonly seen.     

General anaesthesia for ophthalmic surgery

The majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surgery. Therefore adequate preoperative evaluation and preparation will minimize perioperative complications. The goals of general anaesthesia are smooth induction and emergence, with stable intra-ocular pressure (IOP) and akinesia of the globe. These can be achieved with a combination of intravenous and inhalational agents with or without muscle relaxants and opiates. Use of the laryngeal mask airway has the advantage of causing a smaller rise in IOP on insertion and less coughing on emergence. Total intravenous anaesthesia with propofol and remifentanil has the advantages of causing less postoperative nausea and vomiting (PONV), reduced stress response to airway intervention, rapid recovery and smooth emergence. Some eye procedures require special consideration, for example, strabismus and vitreoretinal surgery involves traction of the rectus muscles producing a higher incidence of oculocardiac reflex and PONV. Most ophthalmic surgery produces mild to moderate pain amenable to non-opioid analgesics. Intraoperative topical and regional anaesthesia reduce postoperative pain and opiate requirement. Open globe injury and a full stomach present unique challenges to prevent increase in IOP as well as protecting the airway.     

Central noradrenergic involvement in yohimbine excitation of acoustic startle: Effects of DSP4 and 6-OHDA

It was previously shown that i.p. administration of the alpha 2-adrenergic antagonist yohimbine increased the magnitude of the acoustic startle response in rats. The purpose of the present study was to determine possible central noradrenergic involvement in yohimbine's effect on startle. Pretreatment with N-(2-chloroethyl)-N-ethyl-2-bromo-benzylamine (DSP4; 50 mg/kg, i.p.; 1-2 days before testing) completely blocked the excitatory effect of yohimbine on startle. DSP4 reduced forebrain and spinal cord NE levels by 47% and 56%, respectively, without affecting forebrain or spinal serotonin (5-HT), or forebrain dopamine (DA). Pretreatment with the NE reuptake blocker desmethylimipramine (DMI; 20 mg/kg, i.p.; 30 min before DSP4) prevented the ability of DSP4 to block the yohimbine effect. DMI partially reversed the NE-depleting effects of DSP4. Neither bilateral adrenalectomy nor intravenously administered 6-hydroxydopamine (6-OHDA; 20 mg/kg; 1-2 days before testing) altered the excitatory effect of yohimbine, indicating that peripheral NE is not involved. 6-OHDA (2 X 200 micrograms) injected into the lateral ventricles blocked yohimbine's effect, and depleted NE by 95% (spinal cord) and 86% (forebrain), without affecting 5-HT in either region. 6-OHDA also depleted forebrain DA levels by 49%. Finally, intrathecal administration of 6-OHDA (20 micrograms; 14 days before testing) into the subarachnoid space of the lumbar spinal cord blocked the excitatory effect of yohimbine, and produced an extensive (94%) depletion of spinal cord NE. Intrathecal 6-OHDA did not alter spinal levels of 5-HT or forebrain levels of NE, 5-HT or DA. In summary, these data indicate that central descending NE neurons are necessary for yohimbine's excitatory effect on startle.     

The effects of a distant noxious stimulation on A and C fibre-evoked flexion reflexes and neuronal activity in the dorsal horn of the rat

In the halothane-anaesthetized rat, the responses of 49 neurons in the lumbo-sacral cord and the reflex discharge in the common peroneal nerve following electrical stimulation of the sural nerve were recorded in order to study possible relations between neuronal events and reflex nerve discharges. A distant noxious stimulus (to activate Diffuse Noxious Inhibitory Controls (DNIC) of Le Bars et al.¹⁹) was used as a conditioning stimulus. Only the responses of neurons receiving an input from both A and C fibres were studied. The neurons were classified as class 1 (low threshold mechanoreceptive input only, n = 2), class 2 (nonnoxious and noxious inputs, n =34) or class 3 (responding to noxious stimuli only, n = 13). During conditioning stimulation the C fibre evoked discharge was inhibited in 32 out of 34 class 2 neurons. The A fibre-evoked discharge was simultaneously inhibited in 29 of these neurons. The main effect of the distant noxious stimulation on the C fibre evoked neuronal discharge was to decrease the discharge by a constant number of spikes, independent of the level of evoked activity. Only one class 3 neuron was inhibited during conditioning stimulation and none of the class 1 cells were influenced by DNIC. During conditioning stimulation the late and prolonged C fibre evoked reflex nerve discharge (latency 160–200 ms, duration up to several hundred ms) was strongly depressed. Concomitantly, a short-lasting reflex nerve discharge appeared over the interval 115–160 ms. This released reflex nerve discharge (RR) had a constant latency. There was no simultaneous change of the Aβ evoked reflex nerve discharge. After the end of the distant noxious stimulation the late C fibre evoked reflex nerve discharge (latency 160–200 ms) recovered. Concomitantly, the RR disappeared. The possibility that the class 2 neurons and the class 3 neurons are intercalated in different reflex pathways is discussed.     

The ventrolateral medulla of the cat mediates vestibulosympathetic reflexes

Extracellular recordings were made from 94 neurons located in the ventrolateral medulla (VLM) whose firing rate was affected by vestibular nerve (VN) stimulation; 50 of these units were in the subretrofacial (SRF) nucleus, which contains cells that make direct excitatory connections with sympathetic preganglionic neurons. The sample included 12 SRF cells which were antidromically driven from the upper thoracic spinal cord and had conduction velocities of 10 m/s or less; the effect of VN stimulation on all but one of these units was inhibition. The onset latency of the response to VN stimulation was long [20.3 +/- 3.7 (S.E.M.) ms, n = 9, for the antidromically activated neurons and 12.1 +/- 1.2 ms, n = 73, for the others], suggesting that the effects were predominantly polysynaptic. In addition, most of the spontaneously active units tested (33/36) received convergent inputs from the carotid sinus nerve (CSN), as would be expected for neurons which influence sympathetic outflow. Vestibular-elicited inhibition of SRF neurons with projections to the intermediolateral cell column could account for late, long duration inhibition of sympathetic discharges produced by labyrinth stimulation.