Distribution of proteinase K-resistant anti-α-synuclein immunoreactive axons in the cardiac plexus is unbiased to the left ventricular anterior wall.

Lewy body disease (LBD) is characterized by the appearance of Lewy neurites and Lewy bodies, which are predominantly composed of α-synuclein. Notably, the cardiac plexus (CP) is one of the main targets of LBD research. Although previous studies have reported obvious differences in the frequency of Lewy body pathology (LBP) in the CP, none of them have confirmed whether LBP preferably appears in any part of the CP. Thus, we aimed to clarify the emergence and/or propagation of LBP in the CP. In this study, 263 consecutive autopsy cases of patients aged ≥50 years were included, with one region per case selected from three myocardial perfusion areas (MPAs) and subjected to proteinase K and then immunohistochemically stained with anti-α-synuclein antibodies to assess LBP. We stained all three MPAs in 17 cases with low-density LBP and observed the actual distribution of LBP. LBP were identified in the CP in 20.2% (53/263) of patients. Moreover, we found that LBP may appear in only one region of MPAs, mainly in the young-old group (35.3% (6/17) of patients). These findings suggest that it is possible to underestimate LBP in the CP, especially in the young-old group, by restricting the search to only one of the three MPAs.

Human apoCIII transgenic mice with epicardial adipose tissue inflammation and PRESERVATION of the cardiac plexus.

Hypertriglyceridemia is a result of the increase in the serum levels of lipoproteins, which are responsible for the transport of triglycerides and can be caused by genetic and/or metabolic factors. Animal models which either express or lack genes related to changes in the lipoproteins profile are useful to understand lipid metabolism. Apolipoprotein CIII (apoCIII) is an important modulator of hepatic production and peripheral removal of triglycerides. Mice that overexpress the apoCIII gene become hypertriglyceridemic, showing high concentrations of free fatty acids in the blood. Since hypertriglyceridemia is related to atherosclerosis, and the latter refers to cardiac alterations, this study aimed at evaluating the morphological, morphometric and quantitative profiles of the cardiac plexus, as well as the morphometric and histopathological aspects of the epicardial adipose tissue in human apoCIII transgenic mice. Therefore, 8-12-month-old male C57BL/6 mice that overexpressed human apoCIII (CIII) and their respective controls were used. Our results showed that overexpression of human apoCIII did not modify morphological or quantitative parameters of cardiac plexus neurons; however, age increased both, the area and the number of such cells. Furthermore, there was a direct correlation of this dyslipidemia to the thickening of periganglionar type 1 collagens. On the other hand, this overexpression caused epicardial adipose tissue inflammation and an increase in the area of the adipocytes, thus, favoring the recruitment of inflammatory cells in this tissue. In conclusion, this overexpression is harmful since it is related to an increase in cardiac adiposity, as well as to a predisposition to an inflammatory environment in the epicardial fat and to the incidence of cardiovascular diseases.

Anatomical consideration of the cardiac plexus to prevent grave bradycardiac arrhythmias associated with lung cancer surgery: a case report.

BACKGROUND: Arrhythmias are known as one of the complications of lung cancer surgery, and most of them are not lethal. Life-threatening arrhythmias have been reported in the literature but in reality very rare. CASE PRESENTATION: A 67-year-old Japanese man with a history of hypertension was diagnosed with squamous cell carcinoma in left lower lobe underwent a left lower lobectomy and bilateral mediastinal lymph node dissection through a median sternotomy. During lymph node dissection along the right vagus nerve, the patient's heart rate and blood pressure dropped suddenly and an electrocardiogram monitor showed ST elevation. These abnormalities returned to normal soon after cardiac massage was performed and a coronary vasodilator was given. A temporary pacing wire was inserted at the end of the surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 11 without a need for permanent pacemaker. CONCLUSIONS: We present a patient who was complicated with lethal arrhythmias during lung cancer surgery for the purpose of elucidating, from anatomical viewpoint, the relationship between arrhythmias and the involvement of cardiac plexus during lymph node dissection. The result showed that arrhythmia was inadvertently elicited by cardiac plexus stimulation during lymph nodes dissection around the vagus nerve. It is important to be familiar not only with the course of phrenic, vagus, and recurrent laryngeal nerve but also the anatomy of cardiac plexus to prevent arrhythmic complications in lung cancer surgery.

Excitatory effect of bradykinin on intrinsic neurons of the rat heart.

The heart receives sympathetic and parasympathetic innervation through the intrinsic cardiac nervous system. Although bradykinin (BK) has negative inotropic and chronotropic properties of cardiac contraction, the direct effect of BK on the intrinsic neural network of the heart is still unclear. In the present study, the effect of BK on the intracardiac ganglion neurons isolated from rats was investigated using the perforated patch-clamp technique. Under current-clamp conditions, application of 0.1 µM BK depolarized the membrane, accompanied by repetitive firing of action potentials. When BK was applied repeatedly, the second responses were considerably less intense than the first application. The BK action was fully inhibited by the B2 receptor antagonist Hoe-140, but not by the B1 receptor antagonist des-Arg9-[Leu8]-BK. The BK response was mimicked by the B2 agonist [Hyp3]-BK. The BK-induced depolarization was inhibited by the phospholipase C inhibitor U-73122. BK evoked inward currents under voltage-clamp conditions at a holding potential of -60 mV. Removal of extracellular Ca2+ markedly increased the BK-induced currents, suggesting an involvement of Ca2+-permeable non-selective cation channels. The muscarinic agonist oxotremorine-M (OxoM) also elicited the extracellular Ca2+-sensitive cationic currents. The OxoM response did not exhibit rundown with repeated agonist application. The amplitude of current evoked by 1 µM OxoM was comparable to that induced by 0.1 µM BK. Co-application of 0.1 µM BK and 1 µM OxoM elicited the current whose peak amplitude was almost the same as that elicited by OxoM alone, suggesting that BK and OxoM activate same cation channels. BK also reduced the amplitude of M-current, while the M-current inhibitor XE-991 affected neither resting membrane potential nor the BK-induced depolarization. From these results, we suggest that BK regulates excitability of intrinsic cardiac neurons by both an activation of non-selective cation channels and an inhibition of M-type K+ channels through B2 receptors.

Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation.

BACKGROUND: Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. OBJECTIVE: The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. METHODS: In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. RESULTS: Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dTmax (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. CONCLUSION: Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.

The recurrent laryngeal cardiac nerve in fetuses / El nervio laríngeo recurrente cardiaco en fetos

The recurrent laryngeal nerve has been reported to supply cardiac branches to the cardiac plexus. A review of anatomical literature on the existing term used to describe these branches revealed that varying interpretations and descriptions exist among various authors. Therefore, this study aimed to investigate the origin and incidence of branches from the recurrent laryngeal nerves to the cardiac plexus and their connections with sympathetic cardiac nerves. The sample comprised 40 cadaveric fetuses (n=80) (gestational ages: 16-30 weeks). The recurrent laryngeal cardiac nerve was described as the cardiac branch that originated directly from the recurrent laryngeal nerve and reached the superficial or deep parts of the cardiac plexus. This study found the recurrent laryngeal cardiac nerve in 76% of the cases contributing direct and indirect branches in 75% and 25% of the cases, respectively. This study recorded only two (2%) of these branches contributing to the superficial cardiac plexus while the rest (74%) of these branches contributed to the deep cardiac plexuses. The remaining 24% had no contributions from the recurrent laryngeal nerve to either the superficial or deep part of the cardiac plexus. The most common point of origin for the recurrent laryngeal cardiac nerve was at the lower distal part in 59% of the specimens. In the remaining 41% of branches, this nerve originated from the point of curvature, upper proximal part and both the point of curvature and lower distal part in 26%, 10% and 5% of the specimens.

El nervio laríngeo recurrente suministra las ramas cardiacas para el plexo cardíaco. Una revisión de la literatura anatómica nos muestra que existen diferentes interpretaciones y descripciones de estas ramas por parte de los distintos autores consultados. En consecuencia este estudio tuvo como objetivo investigar el origen, además de la incidencia de las ramas de los nervios laríngeos recurrentes al plexo cardíaco y sus conexiones con los nervios cardiacos simpáticos. La muestra incluyó 40 fetos (n=80) (edades gestacionales: 16-30 semanas). El nervio laríngeo recurrente cardiaco fue descrito como la rama cardíaca que se originó directamente del nervio laríngeo recurrente, que llega a las partes superficiales o profundas del plexo cardíaco. En este estudio observamos que el nervio laríngeo recurrente cardiaco en el 76% de los casos contribuye a las ramas directas e indirectas, en el 75% y el 25% de los casos, respectivamente. Se observó en este estudio que solamente dos (2%) de estas ramas contribuían en la formación del plexo cardíaco superficial, mientras que el resto (74%) de estas ramas contribuía a los plexos cardíacos profundos. El 24% restante no tenía contribuciones del nervio laríngeo recurrente ya sea para la parte superficial o profunda del plexo cardíaco. El punto de origen más común del nervio laríngeo recurrente cardiaco se observó en la parte distal inferior en un 59% de las muestras. En el 41% restante de las ramas este nervio se originó desde el punto de curvatura, la parte proximal superior y tanto en el punto de curvatura inferior como la parte distal en 26%, 10% y 5% de los especímenes.

The Sympathetic and Parasympathetic Contributions to the Cardiac Plexus: a Fetal Study / Contribuciones Simpáticas y Parasimpáticas al Plexo Cardíaco: Estudio Fetal

The cardiac plexus is formed by sympathetic nerves originating from the superior, middle, inferior cervical or cervicothoracic ganglia as well as from the first to the fifth thoracic ganglia. Furthermore, the vagus nerve and its counterpart, the recurrent laryngeal nerve supply the cardiac plexus with parasympathetic cardiac nerves. This investigation aimed to review and record the medial contributions of the cervical ganglia, first to fifth thoracic ganglia and medial contributions of the vagus and recurrent laryngeal nerves to the cardiac plexus. The study involved bilateral micro-dissection of forty cadaveric fetal specimens (n=80). The origins of sympathetic contributions to the cardiac plexus were described as either ganglionic, inter-ganglionic or from both the ganglion and the inter-ganglionic sympathetic chain. The number of cervical sympathetic ganglia varied from two to five in this study; the superior cervical ganglion was constant while the middle cervical, vertebral, inferior cervical or cervicothoracic ganglia were variable. The prevalence of cardiac nerves were as follows: superior cervical cardiac nerve (95%); middle cervical cardiac nerve (73%); vertebral cardiac nerve (41%); inferior cervical cardiac nerve (21%) and cervicothoracic cardiac nerve (24%). This investigation records the thoracic caudal limit of the thoracic sympathetic contributions to the cardiac plexus as the T5 ganglion. The findings of this study highlight the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal access surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Raynaud's Phenomenon and angina pectoris.

El plexo cardíaco está formado por los nervios simpáticos procedentes de los ganglios cervicales superior, medio e inferior o cervicotorácico, así como los ganglios torácicos desde el primero al quinto. Por otra parte, el nervio vago y su contraparte, el nervio laríngeo recurrente suministra al plexo cardíaco nervios cardíacos parasimpático. Esta investigación tuvo como objetivo revisar y registrar las contribuciones mediales de los ganglios cervicales, ganglios torácicos del primero al quinto ganglios y contribuciones mediales de los nervios laríngeos recurrentes y vagos en el plexo cardíaco. Se realizó la micro-disección bilateral de cuarenta especímenes cadavéricos fetales (n = 80). Los orígenes de las contribuciones simpáticas hacia el plexo cardíaco se describen de forma independiente como ganglionar o inter-ganglionar, o desde ambos ganglios y la cadena simpática interganglionar. El número de ganglios simpáticos cervicales varió de dos a cinco; el ganglio cervical superior fue constante, mientras que los ganglios medio-cervical, vertebral, cervical inferior o cervicotorácico fueron variables. La prevalencia de los nervios cardíacos fueron: nervio cardíaco cervical superior (95%); nervio cardíaco cervical medio (73%); nervio cardiaco vertebral (41%); nervio cardíaco cervical inferior (21%) y nervio cardíaco cervicotorácico (24% ). La investigación registró el límite torácico caudal de las contribuciones torácicas simpáticos al plexo cardíaco como el ganglio T5. Los resultados de este estudio muestran la importancia de comprender las contribuciones simpáticas mediales y sus variaciones en el plexo cardíaco, ya que podrían ayudar a los cirujanos durante los procedimientos quirúrgicos mínimanente invasivos, simpatectomías, pericardiectomías y en el manejo de enfermedades como el fenómeno de Raynaud y la angina de pecho.

IMMUNOHISTOCHEMICAL RESEARCH ON CGRP AND SP IN THECANINE MAIN SUPERFICIAL CARDIAC PLEXUS / 解剖学报

Objective To investigate the chemical properties of superficial cardiac neurons. Methods By means of immunohistochemical ABC technique,the study was performed concerning the distribution of calcitonin gene-related peptide(CGRP) and substance P(SP) in the canine main cardiac superficial plexus. Results CGRP-immunoreactive(IR) neurons were found in every plexus,but SP-IR neurons could be observed only in dorsal atria plexus(DAP),inter atria plexus(IAP) and aorta-pulmonary plexus(A-PP).The shape and size of CGRP-IR and SP-IR neurons were similar.The comparative study on atria and ventricles indicated that CGRP-IR and SP-IR neurons in atria were more than those in ventricles.Numerous CGRP-IR,SP-IR nerve fibers could be observed in each fat pats and intermyocardiocytes.These nerve fibers were usually situated near blood vessels,or were attached to vessel wall.Somewhat CGRP-IR and SP-IR nerve fibers were connected with myocardiocytes in some regions.Conclusion The results indicated that actually existed two peptides in canine cardiac superficial plexus.These implied that the regulations of the two kinds of peptidergic neurons to atria and ventricle were different.The two kinds of neurons mentioned above were likely to perform different or similar functions in canine heart.CGRP and SP could possibly modulate the activities of myocardiocytes and vessels of heart directly.