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Makwana R, Crawley E, Straface M, Palmer A, Gharibans A, Devalia K, Loy J, O'Grady G, Andrews PLR, Sanger GJ. Synergistic augmentation of rhythmic myogenic contractions of human stomach by arginine vasopressin and adrenaline: Implications for the induction of nausea. Br J Pharmacol 2022; 179:5305-5322. [PMID: 36068676 PMCID: PMC9826163 DOI: 10.1111/bph.15943] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Nausea is associated with the hormonal secretion of vasopressin and adrenaline, although their actions in inducing nausea is poorly understood. Here, we have investigated their actions on human stomach muscle. EXPERIMENTAL APPROACH Muscle strips were suspended in tissue baths and neuronal-/non-neuronally-mediated contractions were measured. Custom software analysed eight motility parameters defining spontaneous phasic non-neuronally mediated contractions. Receptor distributions were assessed by qPCR and immunofluorescence. KEY RESULTS V1A receptors and α1 -adrenoceptors were located on muscle as well as interstitial cells of Cajal (ICCs). Myogenic contractions of human proximal and distal stomach (respectively, 2.6 ± 0.1 and 2.7 ± 0.0 per minute; n = 44) were larger in the distal area (1.1 ± 0.1 and 5.0 ± 0.1 mN), developing relatively slowly (proximal) or rapidly (distal). Vasopressin caused tonic (proximal) or short-lived (distal) increases in muscle tone and increased myogenic contraction amplitude, frequency and rate (acting at V1A receptors; thresholds 10-11 -10-10 M); by contrast, cholinergically mediated contractions were unaffected. Oxytocin acted similarly to vasopressin but less potently, at OT receptors). Adrenaline increased (10-10 -10-5 M; α1 -adrenoceptors) and decreased (≥10-6 M; β-adrenoceptors) muscle tone and enhanced/reduced myogenic contractions. Cholinergically mediated contractions were reduced (α2 -adrenoceptors). Combined, vasopressin (10-9 M) and adrenaline (10-8 M) increased muscle tone and phasic myogenic activity in a synergistic manner. CONCLUSIONS AND IMPLICATIONS Vasopressin and adrenaline increased human gastric tone and myogenic contraction amplitude, rate of contraction and frequency. In combination, their actions were further increased in a synergistic manner. Such activity may promote nausea.
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Affiliation(s)
- Raj Makwana
- Blizard Institute, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Ellie Crawley
- Blizard Institute, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Marilisa Straface
- Blizard Institute, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Alexandra Palmer
- Blizard Institute, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Armen Gharibans
- Department of Surgery and Auckland Bioengineering InstituteUniversity of AucklandAucklandNew Zealand
| | - Kalpana Devalia
- Bariatric Surgery DepartmentHomerton University HospitalLondonUK
| | - John Loy
- Bariatric Surgery DepartmentHomerton University HospitalLondonUK
| | - Greg O'Grady
- Department of Surgery and Auckland Bioengineering InstituteUniversity of AucklandAucklandNew Zealand
| | | | - Gareth J. Sanger
- Blizard Institute, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
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Kim H, Kim DJ, Kim S, Chung WH, Park KA, Kim JDK, Kim D, Kim MJ, Kim K, Jeon HJ. Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial. Front Psychiatry 2021; 12:614539. [PMID: 34447320 PMCID: PMC8384255 DOI: 10.3389/fpsyt.2021.614539] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback. Methods: Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the State-Trait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases. Results: A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback. Conclusion: VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, South Korea
| | - Dong Jun Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Won Ho Chung
- Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - James D K Kim
- AR Lab, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Dowan Kim
- Advanced Solution Team, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Min Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kiwon Kim
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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Berman CF, Lobetti RG, Lindquist E. Comparison of clinical findings in 293 dogs with suspect acute pancreatitis: Different clinical presentation with left lobe, right lobe or diffuse involvement of the pancreas. J S Afr Vet Assoc 2020; 91:e1-e10. [PMID: 32370532 PMCID: PMC7203193 DOI: 10.4102/jsava.v91i0.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Pancreatitis is a common clinical condition seen in companion animals. The correlation of the region of the pancreas affected to the presentation of clinical signs has not been previously described. A retrospective study on the clinical findings in 293 client-owned dogs diagnosed with suspect pancreatitis based on history, clinical signs, laboratory testing and abdominal ultrasonography was performed. Based on ultrasonography, dogs were divided into three groups: group 1: 41 dogs with ultrasonographic changes consistent with pancreatitis within the left lobe of the pancreas; group 2: 105 dogs with ultrasonographic changes compatible with pancreatitis within the right lobe of the pancreas; and group 3: 147 dogs with ultrasonographic evidence of diffuse pancreatitis. No significant differences regarding age, breed and sex were evident. Furthermore, statistical significance was demonstrated with the presence of pain in group 3; poor appetite in groups 2 and 3; and vomiting and diarrhoea in group 3. Pain is expected to occur with a higher frequency in diffuse pancreatitis, but it is not a common clinical sign. This may represent a more severe form of the disease when the pancreas is diffusely affected. Vomiting was more common than diarrhoea with both clinical signs more prevalent in dogs with diffuse pancreatitis, and this could be ascribed to gastric and intestinal tract involvement. Poor appetite occurred more frequently in dogs with diffuse and right lobe pancreatitis. A possible explanation can be attributed to the fact that the duodenum has many receptors and is referred to as the 'organ of nausea'.
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Affiliation(s)
- Chad F Berman
- Bryanston Veterinary Hospital, Johannesburg, South Africa; and, Department of Companion Animal and Clinical Studies, Onderstepoort.
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Wagoner AL, Tarbell SE, Shaltout HA, Diz DI, Weese-Mayer DE, Fortunato JE. Chronic nausea and orthostatic intolerance: Diagnostic utility of orthostatic challenge duration, Nausea Profile Questionnaire, and neurohumoral measures. Neurogastroenterol Motil 2018; 30:e13433. [PMID: 30101470 PMCID: PMC8045406 DOI: 10.1111/nmo.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic nausea in pediatrics is a debilitating condition with unclear etiology. We aimed to define hemodynamic and neurohumoral characteristics of chronic nausea associated with orthostatic intolerance in order to improve identification and elucidate mechanism. METHODS Children (10-18 years) meeting Rome III criteria for functional dyspepsia with nausea and symptoms of orthostatic intolerance (OI) completed a Nausea Profile Questionnaire followed by prolonged (45 minutes rather than the traditional 10 minutes) head-upright tilt (HUT) (70° tilt up) test. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured supine and after 15 minutes into HUT. Beat-to-beat heart rate and blood pressure were continuously recorded to calculate their variability and baroreflex sensitivity. KEY RESULTS Within 10 and 45 minutes of HUT, 46% and 85% of subjects, respectively, had an abnormal tilt test (orthostatic hypotension, postural orthostatic tachycardia, or syncope). At 15 and 45 minutes of HUT, nausea was elicited in 42% and 65% of subjects respectively. Higher Nausea Profile Questionnaire scores correlated with positive HUT testing at 10 minutes (P = 0.004) and baroreflex sensitivity at 15 minutes (P ≤ 0.01). Plasma vasopressin rose 33-fold in subjects with HUT-induced nausea compared to twofold in those who did not experience HUT-induced nausea (P < 0.01). CONCLUSIONS AND INFERENCES In children with chronic nausea and OI, longer duration HUT elicited higher frequency of abnormal tilt testing and orthostatic-induced nausea. The Nausea Profile Questionnaire predicted the orthostatic response to tilt testing. Exaggerated vasopressin release differentiated patients with HUT-induced nausea (vs those without nausea), suggesting a possible mechanism for chronic nausea in childhood.
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Affiliation(s)
- Ashley L. Wagoner
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sally E. Tarbell
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hossam A. Shaltout
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
- Obstetrics and Gynecology and School of Medicine, Winston-Salem, NC
- SurgeryWake Forest School of Medicine, Winston-Salem, NC
| | - Debra I. Diz
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
- SurgeryWake Forest School of Medicine, Winston-Salem, NC
| | - Debra E. Weese-Mayer
- Center for Autonomic Medicine in Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Stanley Manne Children’s Research Institute, Chicago, IL
| | - John E. Fortunato
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Center for Autonomic Medicine in Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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5
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Bošnjak SM, Gralla RJ, Schwartzberg L. Prevention of chemotherapy-induced nausea: the role of neurokinin-1 (NK 1) receptor antagonists. Support Care Cancer 2017; 25:1661-1671. [PMID: 28108820 PMCID: PMC5378744 DOI: 10.1007/s00520-017-3585-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
Chemotherapy-induced nausea (CIN) has a significant negative impact on the quality of life of cancer patients. The use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists (RAs) has reduced the risk of vomiting, but (except for palonosetron) their effect on nausea, especially delayed nausea, is limited. This article reviews the role of NK1RAs when combined with 5-HT3RA–dexamethasone in CIN prophylaxis. Aprepitant has not shown consistent superiority over a two-drug (ondansetron–dexamethasone) combination in nausea control after cisplatin– or anthracycline–cyclophosphamide (AC)-based highly emetogenic chemotherapy (HEC). Recently, dexamethasone and dexamethasone–metoclopramide were demonstrated to be non-inferior to aprepitant and aprepitant–dexamethasone, respectively, for the control of delayed nausea after HEC (AC/cisplatin), and are now recognized in the guidelines. The potential impact of the new NK1RAs rolapitant and netupitant (oral fixed combination with palonosetron, as NEPA) in CIN prophylaxis is discussed. While the clinical significance of the effect on nausea of the rolapitant–granisetron–dexamethasone combination after cisplatin is not conclusive, rolapitant addition showed no improvement in nausea prophylaxis after AC or moderately emetogenic chemotherapy (MEC). NEPA was superior to palonosetron in the control of nausea after HEC (AC/cisplatin). Moreover, the efficacy of NEPA in nausea control was maintained over multiple cycles of HEC/MEC. Recently, NK1RAs have been challenged by olanzapine, with olanzapine showing superior efficacy in nausea prevention after HEC. Fixed antiemetic combinations (such as NEPA) or new antiemetics with a long half-life that may be given once per chemotherapy cycle (rolapitant or NEPA) may improve patient compliance with antiemetic treatment.
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Affiliation(s)
- Snežana M Bošnjak
- Department of Supportive Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
| | - Richard J Gralla
- Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
The sensation of nausea is a common occurrence with diverse causes and a significant disease burden. Nausea is considered to function as a protective mechanism, warning the organism to avoid potential toxic ingestion. Less adaptive circumstances are also associated with nausea, including post-operative nausea, chemotherapy-induced nausea, and motion sickness. A common definition of nausea identifies the symptom as a precursor to the act of vomiting. The interaction, though present, does not appear to be a simple relationship. Nausea is unfortunately the 'neglected symptom', with current accepted therapy generally directed at improving gastrointestinal motility or acting to relieve emesis. Improved understanding of the pathophysiological basis of nausea has important implications for exploiting novel mechanisms or developing novel therapies for nausea relief.
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Affiliation(s)
- Prashant Singh
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonia S. Yoon
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
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7
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Farmer AD, Ban VF, Coen SJ, Sanger GJ, Barker GJ, Gresty MA, Giampietro VP, Williams SC, Webb DL, Hellström PM, Andrews PLR, Aziz Q. Visually induced nausea causes characteristic changes in cerebral, autonomic and endocrine function in humans. J Physiol 2015; 593:1183-96. [PMID: 25557265 DOI: 10.1113/jphysiol.2014.284240] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/28/2014] [Indexed: 01/09/2023] Open
Abstract
An integrated understanding of the physiological mechanisms involved in the genesis of nausea remains lacking. We aimed to describe the psychophysiological changes accompanying visually induced motion sickness, using a motion video, hypothesizing that differences would be evident between subjects who developed nausea in comparison to those who did not. A motion, or a control, stimulus was presented to 98 healthy subjects in a randomized crossover design. Validated questionnaires and a visual analogue scale (VAS) were used for the assessment of anxiety and nausea. Autonomic and electrogastrographic activity were measured at baseline and continuously thereafter. Plasma vasopressin and ghrelin were measured in response to the motion video. Subjects were stratified into quartiles based on VAS nausea scores, with the upper and lower quartiles considered to be nausea sensitive and resistant, respectively. Twenty-eight subjects were exposed to the motion video during functional neuroimaging. During the motion video, nausea-sensitive subjects had lower normogastria/tachygastria ratio and cardiac vagal tone but higher cardiac sympathetic index in comparison to the control video. Furthermore, nausea-sensitive subjects had decreased plasma ghrelin and demonstrated increased activity of the left anterior cingulate cortex. Nausea VAS scores correlated positively with plasma vasopressin and left inferior frontal and middle occipital gyri activity and correlated negatively with plasma ghrelin and brain activity in the right cerebellar tonsil, declive, culmen, lingual gyrus and cuneus. This study demonstrates that the subjective sensation of nausea is associated with objective changes in autonomic, endocrine and brain networks, and thus identifies potential objective biomarkers and targets for therapeutic interventions.
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Affiliation(s)
- Adam D Farmer
- Centre for Digestive Diseases, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, E1 2AJ, UK; University Hospitals of North Midlands, Stoke on Trent, Staffordshire, ST4 6QG, UK
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8
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Farmer AD, Al Omran Y, Aziz Q, Andrews PL. The role of the parasympathetic nervous system in visually induced motion sickness: systematic review and meta-analysis. Exp Brain Res 2014; 232:2665-73. [PMID: 24792503 DOI: 10.1007/s00221-014-3964-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/11/2014] [Indexed: 12/22/2022]
Abstract
The parasympathetic nervous system (PNS) has been implicated in the development of visually induced motion sickness. The objective of this study was to perform a systematic review and meta-analysis of the effect of visually induced motion sickness on validated parameters of PNS tone. Methods followed PRISMA recommendations. Controlled trials reporting validated measures of PNS tone in visually induced motion sickness in healthy adults were included. One reviewer performed the screening of articles and data extraction, and two reviewers independently performed methodological evaluation. Data were synthesised using standardised mean differences (SMDs) for all relevant outcomes using a random-effects model. Publication bias was assessed via funnel plots and Egger's test. The search strategy identified seven citations comprising 237 healthy individuals. The mean quality score was 4/10 (range 3-7). There was no difference between baseline PNS tone between individuals who developed visually induced motion sickness and those that did not. Visually induced motion sickness (VIMS)-sensitive individuals had a reduction in PNS tone, following exposure to the stimulus (mean weighted SMD = -0.45, 95% confidence interval -0.64 to -0.27, Z = -4.8, p < 0.0001). There was no evidence of heterogeneity or publication bias. These data suggest that baseline PNS parameters do not provide a useful measure of predicting the probability of developing visually induced motion sickness. However, a fall in PNS tone, as indicated by cardiac activity, is characteristic in sensitive individuals. Further work is needed to characterise these responses in clinical populations, in conjunction with improvements and standardisation in study design.
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Affiliation(s)
- Adam D Farmer
- Neurogastroenterology Group, Blizard Institute of Cell and Molecular Science, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK,
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9
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Babic T, Browning KN. The role of vagal neurocircuits in the regulation of nausea and vomiting. Eur J Pharmacol 2013; 722:38-47. [PMID: 24184670 DOI: 10.1016/j.ejphar.2013.08.047] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/20/2013] [Accepted: 08/28/2013] [Indexed: 02/07/2023]
Abstract
Nausea and vomiting are among the most frequently occurring symptoms observed by clinicians. While advances have been made in understanding both the physiological as well as the neurophysiological pathways involved in nausea and vomiting, the final common pathway(s) for emesis have yet to be defined. Regardless of the difficulties in elucidating the precise neurocircuitry involved in nausea and vomiting, it has been accepted for over a century that the locus for these neurocircuits encompasses several structures within the medullary reticular formation of the hindbrain and that the role of vagal neurocircuits in particular are of critical importance. The afferent vagus nerve is responsible for relaying a vast amount of sensory information from thoracic and abdominal organs to the central nervous system. Neurons within the nucleus of the tractus solitarius not only receive these peripheral sensory inputs but have direct or indirect connections with several other hindbrain, midbrain and forebrain structures responsible for the co-ordination of the multiple organ systems. The efferent vagus nerve relays the integrated and co-ordinated output response to several peripheral organs responsible for emesis. The important role of both sensory and motor vagus nerves, and the available nature of peripheral vagal afferent and efferent nerve terminals, provides extensive and readily accessible targets for the development of drugs to combat nausea and vomiting.
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Affiliation(s)
- Tanja Babic
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Kirsteen N Browning
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA 17033, USA.
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10
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Molassiotis A, Stamataki Z, Kontopantelis E. Development and preliminary validation of a risk prediction model for chemotherapy-related nausea and vomiting. Support Care Cancer 2013; 21:2759-67. [PMID: 23715816 DOI: 10.1007/s00520-013-1843-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/07/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND A number of risk factors have been implicated in the development of chemotherapy-induced nausea/vomiting (CINV). Our aim was to develop a risk prediction model and identify patients at high risk for developing CINV before their chemotherapy treatment. PATIENTS AND METHODS A multisite, observational, prospective longitudinal design was used. Participants were 336 chemotherapy-naïve cancer patients providing 791 assessments. They completed measures to assess potential risk factors for CINV, including socio-demographic and clinical/treatment-related characteristics, symptom distress, expectations for CINV and state-trait anxiety. CINV was measured with the MASCC Antiemesis Tool. Participants were divided randomly to a training set (=286) and a test set (=50). Random-effects models were run to ascertain the contribution of risk factors in the development of CINV using the training sample. Specificity and sensitivity of the model were assessed in both sets of samples. RESULTS Younger age, history of nausea/vomiting, trait anxiety and fatigue were linked with higher levels of CINV, and use of moderately and low emetogenic chemotherapy were linked with lower CINV. The model's specificity were 55.4 and 50.0 % and sensitivity were 80.3 and 79.0 % in the training and test sample, respectively. A dynamic web-based tool is freely available for use by clinicians. CONCLUSION This model of risk prediction for CINV can be an aid to clinical decision-making and assist clinicians to rationalise antiemetic use with their patients.
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Affiliation(s)
- A Molassiotis
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK,
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11
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Herbert BM, Muth ER, Pollatos O, Herbert C. Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions. PLoS One 2012; 7:e36646. [PMID: 22606278 PMCID: PMC3350494 DOI: 10.1371/journal.pone.0036646] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 04/10/2012] [Indexed: 12/24/2022] Open
Abstract
The individual sensitivity for ones internal bodily signals ("interoceptive awareness") has been shown to be of relevance for a broad range of cognitive and affective functions. Interoceptive awareness has been primarily assessed via measuring the sensitivity for ones cardiac signals ("cardiac awareness") which can be non-invasively measured by heartbeat perception tasks. It is an open question whether cardiac awareness is related to the sensitivity for other bodily, visceral functions. This study investigated the relationship between cardiac awareness and the sensitivity for gastric functions in healthy female persons by using non-invasive methods. Heartbeat perception as a measure for cardiac awareness was assessed by a heartbeat tracking task and gastric sensitivity was assessed by a water load test. Gastric myoelectrical activity was measured by electrogastrography (EGG) and subjective feelings of fullness, valence, arousal and nausea were assessed. The results show that cardiac awareness was inversely correlated with ingested water volume and with normogastric activity after water load. However, persons with good and poor cardiac awareness did not differ in their subjective ratings of fullness, nausea and affective feelings after drinking. This suggests that good heartbeat perceivers ingested less water because they subjectively felt more intense signals of fullness during this lower amount of water intake compared to poor heartbeat perceivers who ingested more water until feeling the same signs of fullness. These findings demonstrate that cardiac awareness is related to greater sensitivity for gastric functions, suggesting that there is a general sensitivity for interoceptive processes across the gastric and cardiac modality.
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Affiliation(s)
- Beate M Herbert
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
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12
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Percie du Sert N, Chu KM, Wai MK, Rudd JA, Andrews PLR. Telemetry in a motion-sickness model implicates the abdominal vagus in motion-induced gastric dysrhythmia. Exp Physiol 2010; 95:768-73. [PMID: 20360423 DOI: 10.1113/expphysiol.2009.052001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In humans, motion sickness is associated with disruption of normal gastric myoelectric activity, and it has been proposed that this results from an imbalance of autonomic nervous system activity. We used the established Suncus murinus (house musk shrew) model of motion-induced emesis to investigate the effect of horizontal motion on gastric myoelectric activity (recorded using telemetry) and the involvement of the abdominal vagi. Surgical vagotomy increased baseline dysrhythmia and reduced the dominant power of the gastric myoelectric signals. In response to motion, normal gastric myoelectric activity was reduced in sham-operated animals but not in vagotomized animals. Vagotomy, however, failed to affect motion-induced emesis. In conclusion, motion had a differential effect in sham-operated and vagotomized animals, which is consistent with the hypothesis that motion-induced dysrhythmia arises from an autonomic nervous system imbalance.
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13
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Yamamoto K, Chan SW, Rudd JA, Lin G, Asano K, Yamatodani A. Involvement of hypothalamic glutamate in cisplatin-induced emesis in Suncus murinus (house musk shrew). J Pharmacol Sci 2009; 109:631-4. [PMID: 19352072 DOI: 10.1254/jphs.08333sc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We investigated the effect of cisplatin on glutamate release in the hypothalamus of Suncus murinus measured by brain microdialysis. Dialysis samples were collected every 20 min for 1 h before and 3 h after the cisplatin (30 mg/kg, i.p.) administration with the animals also being observed for the development of emesis. Cisplatin increased glutamate levels within 1 h and this was closely associated with the occurrence of emesis. Pretreatment with the 5-HT(3)-receptor antagonist ondansetron (2 mg/kg, i.p.) inhibited both the emesis and the increased glutamate levels. These results suggest that hypothalamic glutamate is involved in cisplatin-induced emesis in Suncus murinus.
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Affiliation(s)
- Kouichi Yamamoto
- Department of Medical Physics and Engineering, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
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Xing J, Qian L, Chen J. Experimental gastric dysrhythmias and its correlation with in vivo gastric muscle contractions. World J Gastroenterol 2006; 12:3994-8. [PMID: 16810746 PMCID: PMC4087708 DOI: 10.3748/wjg.v12.i25.3994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the direct correlation between gastric dysrhythmias and in vivo gastric muscle tone.
METHODS: Five healthy dogs were implanted with 4 pairs of electrodes along the greater curvature, with a strain gauge (SG) being sutured parallel to the distal electrodes (2 cm above the pylorus). Intravenous vasopressin was given to induce gastric dysrhythmia. The percentage of regular slow waves and SG energy were calculated.
RESULTS: (1) the regularity of gastric myoelectric activity (GMA) was reduced during and after infusion of vasopressin; (2) SG energy was significantly decreased during the infusion of vasopressin; (3) the decrease in SG energy was well correlated with the reduction in GMA regularity; (4) SG energy was negatively correlated with bradygastria and tachygastria.
CONCLUSION: Vasopressin inhibits gastric contractions and impairs gastric slow waves; gastric dysrhythmias are associated with the reduced antral muscle contractions, and are indicative of antral hypomotility.
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Affiliation(s)
- Jinhong Xing
- Veterans Research Foundation, Oklahoma City, Oklahoma, United States
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Andrews PLR, Horn CC. Signals for nausea and emesis: Implications for models of upper gastrointestinal diseases. Auton Neurosci 2006; 125:100-15. [PMID: 16556512 PMCID: PMC2658708 DOI: 10.1016/j.autneu.2006.01.008] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 01/14/2006] [Accepted: 01/14/2006] [Indexed: 12/12/2022]
Abstract
Nausea and vomiting are amongst the most common symptoms encountered in medicine as either symptoms of diseases or side effects of treatments. In a more biological setting they are also important components of an organism's defences against ingested toxins. Identification of treatments for nausea and vomiting and reduction of emetic liability of new therapies has largely relied on the use of animal models, and although such models have proven invaluable in identification of the anti-emetic effects of both 5-hydroxytryptamine(3) and neurokinin(1) receptor antagonists selection of appropriate models is still a matter of debate. The present paper focuses on a number of controversial issues and gaps in our knowledge in the study of the physiology of nausea and vomiting including: The choice of species for the study of emesis and the underlying behavioural (e.g. neophobia), anatomical (e.g. elongated, narrow abdominal oesophagus with reduced ability to shorten) and physiological (e.g. brainstem circuitry) mechanisms that explain the lack of a vomiting reflex in certain species (e.g. rats); The choice of response to measure (emesis[retching and vomiting], conditioned flavour avoidance or aversion, ingestion of clay[pica], plasma hormone levels[e.g. vasopressin], gastric dysrhythmias) and the relationship of these responses to those observed in humans and especially to the sensation of nausea; The stimulus coding of nausea and emesis by abdominal visceral afferents and especially the vagus-how do the afferents encode information for normal postprandial sensations, nausea and finally vomiting?; Understanding the central processing of signals for nausea and vomiting is particularly problematic in the light of observations that vomiting is more readily amenable to pharmacological treatment than is nausea, despite the assumption that nausea represents "low" intensity activation of pathways that can evoke vomiting when stimulated more intensely.
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Affiliation(s)
- Paul L R Andrews
- Division of Basic Medical Sciences, St George's University of London, Cranmer Terrace, London, SW 17 0RE, UK.
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16
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Scurr JH, Gulati OP. Zinopin--the rationale for its use as a food supplement in Traveller's thrombosis and motion sickness. Phytother Res 2004; 18:687-95. [PMID: 15478211 DOI: 10.1002/ptr.1575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Venous thrombo-embolism (VTE) has been associated with periods of prolonged immobility during air, sea and road travel. Motion sickness (MS) has also been reported during both long and short journeys. Current prophylactic therapies for both these indications are generally associated with side effects. Physiological profiles of Pycnogenol and Standardized Ginger Root Extract (SGRE) representing active constituents of Zinopin have been described and reviewed in relation to their activities involved in the patho-physiology of VTE (Traveller's Sickness) and MS and their safe use as food supplement, in traveller's thrombosis and motion sickness. The pathophysiology of VTE and MS is discussed in light of epidemiological data and risk factors associated with these conditions. Rationale of development of Zinopin and its mechanism of action are discussed based on physiological synergy of Pycnogenol and SGRE. Conclusions are made in light of preliminary clinical findings obtained in an open controlled clinical trial. Further clinical study on Zinopin on these lines is suggested.
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Affiliation(s)
- J H Scurr
- The Lister Hospital, Chelsea Bridge Road, London, UK
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17
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Xing J, Brody F, Rosen M, Chen JDZ, Soffer E. The effect of gastric electrical stimulation on canine gastric slow waves. Am J Physiol Gastrointest Liver Physiol 2003; 284:G956-62. [PMID: 12584109 DOI: 10.1152/ajpgi.00477.2002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study determined the most efficient parameters of low-frequency/long-pulse gastric electrical stimulation (GES) required to entrain gastric slow waves and also evaluated the effect of entrainment and high-frequency, short-pulse GES on gastric electrical activity (GEA). Nine dogs were fitted with stimulation wires along the greater curvature. Entrainment was observed in six or seven animals, with long-pulse GES at six cycles per minute (cpm), at various combinations of current and pulse width and was directly related to the energy delivered. Entrainment was observed in four to seven animals, with GES at 12 cpm, and the maximal driven frequency was 6 cpm. Entrainment did not significantly increase the dominant power of GEA. High-frequency, short-pulse GES, using pulse trains of 14 Hz, 5 mA, and 330 micros, with 0.1 s on and 5 s off, and pulse trains of 40 Hz, 10 mA, and 330 micros, with 2 s on 3 s off, did not affect variables of GEA. We conclude that acute low-frequency GES but not high-frequency, short-pulse GES can entrain slow waves; the power of slow waves is not affected by either type of stimulation.
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Affiliation(s)
- Jinhong Xing
- Gastroenterology, General Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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18
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Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 2003; 284:G481-9. [PMID: 12576305 DOI: 10.1152/ajpgi.00164.2002] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ginger has long been used as an alternative medication to prevent motion sickness. The mechanism of its action, however, is unknown. We hypothesize that ginger ameliorates the nausea associated with motion sickness by preventing the development of gastric dysrhythmias and the elevation of plasma vasopressin. Thirteen volunteers with a history of motion sickness underwent circular vection, during which nausea (scored 0-3, i.e., none to severe), electrogastrographic recordings, and plasma vasopressin levels were assessed with or without ginger pretreatment in a crossover-design, double-blind, randomized placebo-controlled study. Circular vection induced a maximal nausea score of 2.5 +/- 0.2 and increased tachygastric activity and plasma vasopressin. Pretreatment with ginger (1,000 and 2,000 mg) reduced the nausea, tachygastria, and plasma vasopressin. Ginger also prolonged the latency before nausea onset and shortened the recovery time after vection cessation. Intravenous vasopressin infusion at 0.1 and 0.2 U/min induced nausea and increased bradygastric activity; ginger pretreatment (2,000 mg) affected neither. Ginger effectively reduces nausea, tachygastric activity, and vasopressin release induced by circular vection. In this manner, ginger may act as a novel agent in the prevention and treatment of motion sickness.
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Affiliation(s)
- Han-Chung Lien
- Department of Internal Medicine, Division of Gastroenterology Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Owyang C, Hasler WL. Physiology and pathophysiology of the interstitial cells of Cajal: from bench to bedside. VI. Pathogenesis and therapeutic approaches to human gastric dysrhythmias. Am J Physiol Gastrointest Liver Physiol 2002; 283:G8-15. [PMID: 12065286 DOI: 10.1152/ajpgi.00095.2002] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This review describes recent advances in our knowledge about the pathogenesis and therapeutic approaches to human gastric dysrhythmias. A number of clinical conditions has been found to be associated with gastric slow-wave rhythm disturbances that may relate to the induction of nausea and vomiting. Human and animal studies indicate that multiple neurohumoral factors are involved in the generation of gastric dysrhythmias. Antral distension and increased intestinal delivery of lipids may cause slow-wave disruption and development of nausea. This may be mediated by cholinergic and serotonergic pathways. Similarly, progesterone and estrogen may also disrupt gastric slow-wave rhythm in susceptible individuals. Prostaglandin overproduction in gastric smooth muscle appears to mediate slow-wave disruption in diabetes and with tobacco smoking. On the other hand, central cholinergic pathways play an important role in the genesis of gastric dysrhythmias associated with motion sickness. This may be mediated by vasopressin released from the pituitary. Although it is difficult to ascribe with certainty a causative role of slow-wave rhythm disturbances in the genesis of nausea and vomiting, the search has begun for novel antiemetic therapies based on their abilities to ablate or prevent gastric dysrhythmia formation. This includes the use of prostaglandin synthesis inhibitors, central muscarinic receptor antagonists, and dopamine receptor antagonists. Finally direct gastric electrical stimulation using a surgically implanted neurostimulator has shown promise in reducing emesis in patients with gastroparesis and gastric dysrhythmias.
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Affiliation(s)
- Chung Owyang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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