Introduction: Cranial nerve palsies have been reported in patients with uncontrolled hypothyroidism. We describe a case of overt hypothyroidism due to treatment disruption following radioiodine therapy, presented with a unilateral lower motor neuron seventh cranial nerve palsy. Case: A 32-year-old female presented with hypertension, dyslipidemia, class III obesity, and Graves’ disease post radioiodine therapy. She had stable thyroid function test with levothyroxine replacement post radioiodine. She presented with a 3-day history of right-sided facial droop associated with lethargy, weight gain, and constipation. She reported inadequate levothyroxine supply due to 2-month lapses in follow-up. On examination, there was a right-sided lower motor neuron 7th cranial nerve palsy with delayed ankle reflexes. No additional neurological deficits, goiter, cutaneous rashes, or vesicular lesions were noted. There was no preceding viral illness or otologic symptoms. Thyroid function tests showed overt hypothyroidism with thyroid-stimulating hormone 38 mIU/L, free thyroxine <5.4 pmol/L with a deranged lipid profile (total cholesterol: 8.8 mmol/L, low-density lipoprotein: 5.72 mmol/L, triglyceride: 1.77 mmol/L). Renal and liver function tests were within normal limits, with no leukocytosis. Neuroimaging of the brain was unremarkable. She was commenced on a short course of high-dose prednisolone, with no improvement in symptoms. Levothyroxine replacement therapy initiated led to progressive restoration of thyroid function, accompanied by symptom recovery. Conclusion Isolated lower motor 7th nerve palsy has been reported as a manifestation of hypothyroidism. This case underscores the importance of early recognition to enable timely and appropriate management, as patients with hypothyroidisminduced isolated seventh nerve palsy demonstrate marked recovery with adequate levothyroxine replacement.
Facial Nerve ; Hypothyroidism ; Motor Neurons ; Paralysis

OBJECTIVE

To describe the clinical presentation, management and outcome of a rare case of isolated oculomotor nerve palsy in an immunocompromised adult secondary to a central nervous system (CNS) tuberculoma.

This is a case report.

A Filipino male in his 30s developed severe throbbing headache followed by binocular diplopia and drooping of the right upper eyelid. Findings were compatible with a neurologically-isolated pupil-involving, complete oculomotor nerve palsy on the right. Brain magnetic resonance imaging demonstrated enlargement and contrast enhancement of the cisternal portion of the right oculomotor nerve. Serologic testing was positive for the human immunodeficiency virus (HIV) and syphilis. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and elevated protein. CSF polymerase chain reaction was positive for Mycobacterium tuberculosis (TB). The patient was treated with penicillin, quadruple anti-Koch’s, and anti-retrovirals. Eyelid position and ocular motility improved after treatment. Aberrant regeneration of the right oculomotor nerve was observed with elevation of the right eyelid on downgaze (pseudo-Graefe sign).

CNS tuberculoma may present as a neurologically-isolated oculomotor nerve palsy, particularly in immunocompromised individuals. In TB-endemic countries, like the Philippines, it should be considered in the differential diagnosis. Early recognition and appropriate antimicrobial therapy can lead to neurologic improvement.

The paper reports acupuncture treatment for one case of oculomotor nerve palsy after cranial-orbital communicating tumor surgery. The acupoint prescription was composed of the local acupoints of the eyes (Yansanzhen, Tijian, Cuanzhu [BL2], Yuyao [EX-HN4] and Sizhukong [TE23]), the acupoints on the head, face and neck (Yangbai [GB14], Sibai [ST2] and Fengchi [GB20]), Guanyuan (CV4) on the abdomen, and those on the four limbs (Hegu [LI4], Zusanli [ST36], Shenmai [BL62] and Zhaohai [KI6]). The point-to-point needling technique with the eyelid lifted was operated at Tijian, Cuanzhu (BL2), Yuyao (EX-HN4), and Sizhukong (TE23). Warm needling with moxa cone placed on the needle handle was operated at Guanyuan (CV4) and Zusanli (ST36), and the usual needling technique was delivered at the rest acupoints. The treatment was given once daily, discontinued for 1 day after every 6 treatments. One course of treatment was composed of 7 days, and 6 courses were required. After treatment completion, the upper eyelids were basically symmetrical and the bilateral eye cracks were equal, the double vision appeared occasionally. No recurrence and no aggravation were reported in 1 month of follow up visit.
Humans ; Acupuncture Points ; Acupuncture Therapy ; Oculomotor Nerve Diseases/etiology* ; Orbital Neoplasms/surgery* ; Postoperative Complications/etiology*

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It has a high prevalence and poor prognosis. The application of antiarrhythmic drugs and even surgery cannot completely treat the disease, and there are many sequelae. AF can be classified into the category of "palpitation" in Chinese medicine according to its symptoms. Acupuncture has a significant effect on AF. The authors find that an important mechanism of acupuncture in AF treatment is to regulate the cardiac vagus nerve. Therefore, this article intends to review the distribution and function of vagus nerve in the heart, the application and the regulatroy effect for the treatment of AF.
Atrial Fibrillation/physiopathology* ; Humans ; Acupuncture Therapy ; Vagus Nerve/physiology* ; Animals

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

BACKGROUND: Hepatic inflammatory cell accumulation and the subsequent systematic inflammation drive acute-on-chronic liver failure (ACLF) development. Previous studies showed that the vagus nerve exerts anti-inflammatory activity in many inflammatory diseases. Here, we aimed to identify the key molecule mediating the inflammatory process in ACLF and reveal the neuroimmune communication arising from the vagus nerve and immunological disorders of ACLF. METHODS: Proteomic analysis was performed and validated in ACLF model mice or patients, and intervention animal experiments were conducted using neutralizing antibodies. PNU-282987 (acetylcholine receptor agonist) and vagotomy were applied for perturbing vagus nerve activity. Single-cell RNA sequencing (scRNA-seq), flow cytometry, immunohistochemical and immunofluorescence staining, and clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) technology were used for in vivo or in vitro mechanistic studies. RESULTS: The unbiased proteomics identified C-X-C motif chemokine ligand 9 (CXCL9) as the greatest differential protein in the livers of mice with ACLF and its relation to the systematic inflammation and mortality were confirmed in patients with ACLF. Interventions on CXCL9 and its receptor C-X-C chemokine receptor 3 (CXCR3) improved liver injury and decreased mortality of ACLF mice, which were related to the suppressing of hepatic immune cells' accumulation and activation. Vagus nerve stimulation attenuated while vagotomy aggravated the expression of CXCL9 and the severity of ACLF. Blocking CXCL9 and CXCR3 ameliorated liver inflammation and increased ACLF-associated mortality in ACLF mice with vagotomy. scRNA-seq revealed that hepatic macrophages served as the major source of CXCL9 in ACLF and were validated by immunofluorescence staining and flow cytometry analysis. Notably, the expression of CXCL9 in macrophages was modulated by vagus nerve-mediated cholinergic signaling. CONCLUSIONS Our novel findings highlighted that the neuroimmune communication of the vagus nerve-macrophage-CXCL9 axis contributed to ACLF development. These results provided evidence for neuromodulation as a promising approach for preventing and treating ACLF.
Animals ; Mice ; Chemokine CXCL9/metabolism* ; Vagus Nerve/physiology* ; Acute-On-Chronic Liver Failure/metabolism* ; Humans ; Male ; Mice, Inbred C57BL ; Proteomics ; Flow Cytometry ; Receptors, CXCR3/metabolism*

This study examined the regulatory effects of autonomic nervous system on aerobic endurance exercise performance in cold exposure, focusing on heart rate recovery (HRR) and heart rate variability (HRV) across genders. Thirty participants (17 males and 13 females) from a university track endurance program, classified as exercise grade II or above, underwent monitoring of HRV in time domain, frequency domain, nonlinear correlation indices and 1 min HRR. Measurements were taken before, during, and after aerobic endurance exercise in cold and normal environments, respectively. The results were as follows. (1) The duration of aerobic endurance exercise completed by all the subjects in cold environment was significantly increased compared with that in normal environment. The 1 min HRR after aerobic endurance exercise in cold environment was significantly lower than that in normal environment, and the decrease in the males was significantly higher than that in the females. (2) The time domain analysis results showed that, prior to the aerobic endurance exercise, there were no significant difference of standard deviation from the mean value of normal to normal intervals (SDNN), root mean square of successive differences (RMSSD), and percentage of adjacent normal-to-normal intervals differing by more than 50 ms (pNN50) between cold and normal environments. During aerobic endurance exercise in cold environment, SDNN, RMSSD and pNN50 were significantly higher than those in normal environment, with the females showing significantly greater increases compared with those of the males. The levels of SDNN, RMSSD and pNN50 in the males at different time points under different environments were significantly lower than those in the quiet state; The levels of SDNN and RMSSD of the females at different time points under different environments were significantly lower than those in the quiet state, while the pNN50 at different time points under cold environments was significantly lower than that in the quiet state. (3) Frequency domain analysis results showed that, prior to the aerobic endurance exercise, there was no significant difference of high frequency normalized units [HF (n.u.)], low frequency normalized units [LF (n.u.)] and LF/HF ratio between cold and normal environments. During aerobic endurance exercise in cold environment, the levels of HF (n.u.) significantly increased compared to normal environment in the females, while LF (n.u.) and LF/HF ratio levels significantly decreased compared to normal environments. The levels of HF (n.u.), LF (n.u.) and LF/HF ratio of different genders at different time points in the different environments showed no significant changes, compared to those in the quiet state. (4) Non-linear analysis results showed a significant increase in SD1 (standard deviation perpendicular to the line-of-identity)/SD2 (standard deviation along the line-of-identity) ratio during aerobic endurance exercise in cold environment in the females, while no significant changes were observed in the males. SD1/SD2 ratios in the males at different time points and in the females at 1 min under cold environments were significantly higher than those in the quiet state. These findings suggest that aerobic endurance performance increases during cold exposure, accompanied by gender-specific differences in the regulation of autonomic nervous system. Females exhibit higher vagal activity and faster autonomic nervous system recovery compared to males.
Humans ; Male ; Female ; Heart Rate/physiology* ; Cold Temperature ; Exercise/physiology* ; Physical Endurance/physiology* ; Autonomic Nervous System/physiology* ; Young Adult ; Adult ; Sex Factors

The nucleus tractus solitarius (NTS) is the primary brain region for receiving and integrating cardiovascular afferent signals. It plays a crucial role in maintaining balance of autonomic nervous system and regulating blood pressure through cardiovascular reflexes. Neurons within the NTS form complex synaptic connections and interact reciprocally with other brain regions. The NTS regulates autonomic nervous system activity and arterial blood pressure through modulating baroreflex, sympathetic nerve activity, renin-angiotensin-aldosterone system, and oxidative stress. Dysfunctions in NTS activity may contribute to hypertension. Understanding the NTS' role in centrally regulating blood pressure and alterations of neurotransmission or signaling pathways in the NTS may provide rationale for new therapeutic strategies of prevention and treatment. This review summarizes the research findings on autonomic nervous system regulation and arterial blood pressure control by NTS, as well as unresolved questions, in order to provide reference for future investigation.
Solitary Nucleus/physiopathology* ; Hypertension/physiopathology* ; Humans ; Animals ; Autonomic Nervous System/physiopathology* ; Blood Pressure/physiology* ; Baroreflex/physiology* ; Renin-Angiotensin System/physiology* ; Sympathetic Nervous System/physiology*

Heart rate variability time and frequency indices are widely used in functional assessment for autonomic nervous system (ANS). However, this method merely analyzes the effect of cardiac dynamics, overlooking the effect of cardio-pulmonary interplays. Given this, the present study proposes a novel cardiopulmonary coupling (CPC) algorithm based on cross-wavelet transform to quantify cardio-pulmonary interactions, and establish an assessment system for ANS aging effects using wearable electrocardiogram (ECG) and respiratory monitoring devices. To validate the superiority of the proposed method under nonstationary and low signal-to-noise ratio conditions, simulations were first conducted to demonstrate the performance strength of the proposed method to the traditional one. Next, the proposed CPC algorithm was applied to analyze cardiac and respiratory data from both elderly and young populations, revealing that young populations exhibited significantly stronger couplings in the high-frequency band compared with their elderly counterparts. Finally, a CPC assessment system was constructed by integrating wearable devices, and additional recordings from both elderly and young populations were collected by using the system, completing the validation and application of the aging effect assessment algorithm and the wearable system. In conclusion, this study may offers methodological and system support for assessing the aging effects on the ANS.
Humans ; Autonomic Nervous System/physiology* ; Algorithms ; Aging/physiology* ; Electrocardiography/methods* ; Heart Rate/physiology* ; Wavelet Analysis ; Aged ; Signal Processing, Computer-Assisted ; Wearable Electronic Devices

Objective:To exploring the value of MR neuroimaging for quantitative assessment of the facial nerve and peripheral lymph nodes in patients with acute peripheral facial paralysis. Methods:Based on a prospective experimental design, 32 patients with idiopathic peripheral facial palsy were enrolled in the experiment. Based on MR neuroimaging technology, MR high-resolution thin-layer images of bilateral facial nerves were acquired. The diameters of different segments of the bilateral facial nerve were measured, including the labyrinthine segment, the geniculate ganglion, the horizontal segment, the vertical segment, the stem-mammary foramen segment, the trunk of the parotid segment, the temporal trunk, and the cervical trunk, as well as the quantitative indicators of peri-auricular and parotid lymph nodes（number, length and diameter of the largest lymph nodes）. Differences in quantitative indices of nerve diameter and peripheral lymph nodes between the paraplegic and healthy sides were compared using the paired t-test and Wilcoxon signed rank test. Results:The diameter of geniculate ganglion, mastoid foramen stem, parotid main trunk, temporal facial trunk, and cervical facial trunk were notably increased on the facial paralysis side compared to the contralateral side（P<0.05）. However, no significant differences were observed in the diameter of labyrinthine segment, horizontal segment, or vertical segment compared to the contralateral side. There were significantly more periauricular lymph nodes on the facial paralysis side than the contralateral side（P=0.001）. Conclusion:MR neuroimaging enables the quantitative assessment of structural changes in the facial nerve of patients with acute peripheral facial paralysis, demonstrating nerve enlargement in the geniculate ganglion, stylomastoid foramen segment, main trunk of the parotid segment, temporal facial trunk, and cervical facial trunk. Additionally, an increased number of periauricular lymph nodes is observed on the affected side. These findings may aid clinicians in assessing the efficacy of treatments and predict the prognosis of these patients.
Humans ; Facial Nerve/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Prospective Studies ; Female ; Male ; Neuroimaging/methods* ; Lymph Nodes/diagnostic imaging* ; Facial Paralysis/diagnostic imaging* ; Adult ; Middle Aged