Normal heart function depends on complex regulation by the brain, and abnormalities in the brain‒heart axis affect various diseases, such as myocardial infarction and anxiety disorders. However, systematic tracking of the brain regions associated with the input and output of the heart is lacking. In this study, we injected retrograde transsynaptic pseudorabies virus (PRV) and anterograde transsynaptic herpes simplex virus (HSV) into the left ventricular wall of mice to identify the whole-brain regions associated with the input to and output from the heart. We successfully detected PRV and HSV expression in at least 170 brain subregions in both male and female mice. Sex differences were discovered mainly in the hypothalamus and medulla, with male mice exhibiting greater correlation and hierarchical clustering than female mice, indicating reduced similarity and increased modularity of virus expression patterns in male mice. Further graph theory and multiple linear regression analysis of different injection timelines revealed that hub regions of PRV had highly similar clusters, with different brain levels, suggesting a top-down, hierarchically transmitted neural control pattern of the heart. Hub regions of HSV had scattered clusters, with brain regions gathered in the cortex and brainstem, suggesting a bottom-up, leapfrog, multipoint neural sensing pattern of the heart. Both patterns contain many hub brain regions that have been previously overlooked in brain‒heart axis studies. These results provide brain targets for future research and will lead to deeper insight into the brain mechanisms involved in specific heart conditions.
Animals ; Male ; Female ; Heart/physiology* ; Mice ; Herpesvirus 1, Suid ; Brain/physiology* ; Mice, Inbred C57BL ; Brain Mapping ; Efferent Pathways/physiology* ; Afferent Pathways/physiology* ; Simplexvirus ; Sex Characteristics

Objective To observe the clinical effectiveness of percutaneous catheter drainage ( PCD ) and PCD + negative pressure irrigation ( PCD + NPI ) for treatment of severe acute pancreatitis ( SAP ) patients with infective pancreatic necrosis (IPN).Methods Data of 71 IPN patients admitted from January 2010 to December 2011 were included and retrospectively analyzed.They were divided into two groups by the different treatment choices:PCD group (52 patients) and PCD + NPI group (19 patients).In PCD group,percutaneous pig-tail drainage catheter was inserted for intermittent IPN drainage,and in PCD + NPI group,negative pressure irrigation catheter was inserted for continuous IPN drainage.The indication for laparotomy surgery was no improvement after PCD or PCD + NPI for 3 days,or septic shock,abdominal cavity bleeding,digestive tract fistula occurred,the area of IPN decreased less than 1/2.Results The surgery rate of PCD +NPI group was 15.8％,which were significantly lower than that in PCD group (48.1％,P ＜0.05).7(36.8％ ) patients in PCD + NPI group received endoscopic drainage,which were significantly higher than that in PCD (0,P ＜0.05).The time interval between initial tube placement and operation in the PCD + NPI group was (22 ± 11 ) d,which were significantly longer than that in PCD group [ ( 10 ± 6 ) d,P ＜ 0.05 ].The difference of mean session and number of tube placement,number of laparotomy surgery,complications of laparotomy surgery in the two groups was not statistically significant.The mortality rate in the PCD + NPI group was 15.8％,which was not significantly higher than that in PCD group ( 13.5％ ).The ICU days,length of hospital stay and hospital costs in PCD + NPI group were lower than those in the PCD group,but the difference between the two groups was not statistically significant.Conclusions PCD + NPI can effectively reduce operation rate for patients with infective pancreatic necrosis.

Infected pancreatic necrosis is a fatal complication of severe acute pancreatitis ( SAP),while traditional laparotomy has many disadvantages,such as great trauma and many complications,in recent years,minimally invasive treatment has got great progress in clearing the necrotic tissue of pancreas,but its drainage effect is not optimal.From January 2010 to December 2011,19 patients with infected pancreatic necrosis complicated by SAP who were admitted to the Nanjing General Hospital of Nanjing Military Area were implemented computed tomography or ultrasound-guided Seldinger puncture.Along the puncture needle,a guide wire was inserted into the necrotic tissue,and then the sinus was expanded,in which a tube was placed for negative pressure irrigation and drainage.By continuous postoperative negative pressure irrigation and drainage,the necrotic tissue gradually dropped off and disappeared in 12 patients,and the other 7 patients were performed endoscopic necrotic tissue removal and drainage along the sinus.Systemic symptons of infection obviously improved in all of the 19 patients,and no organ dysfunction or complications occurred.Finally,16 patients were cured and 3 patients died.Continuous percutaneous negative pressure irrigation and drainage combined with the endoscopic necrotic tissue removal could become an important choice to treat the infected pancreatic necrosis.

Objective To investigate the management of retroperitoneal infected necrotic tissues in pelvic cavity in patients with severe acute pancreatitis (SAP).Methods The clinical data of 5 patients with SAP complicated with retroperitoneal infected necrotic tissue in the pelvic carvity who were admitted to the General Hospital of Nanjing Military Area from December 2009 to February 2012 were retrospectively analyzed.Systemic comprehensive treatement combined with local management were applied to all the patients.Results Systemic comprehensive treatment:all the 5 patients were treated by enteral nutrition,3 by mechanical ventilation and 3 by continuous blood purification.All the retroperitoneal infected necrotic tissues in the pelvic carvity were treated by computed tomography (CT)-guided percutaneous catheter drainage,and then the patients were converted to open surgery for further drainage.Four patients had complication of infected pancreatic necrosis bleeding,and they were treated by arterial embolism and (or) sandwich therapy.Local management:5 patients with retroperitoneal infected necrotic tissues received CT-guided percutaneous catheter drainage via buttocks.The average time of puncturation after illness was 38.4 days,and the average CT density of infected necrotic tissue was 24.4 Hu (20-28 Hu).Catheterization was successfully done in the open surgery for all the 5 patients,and the average time of abdominal drainage was 21 days.The body temperature and white blood cell count were decreased after puncturation.The average duration of intensive care unite stay,the average time of hospital stay and the average cost of hospitalization were (47 ± 20 )days,(88 ±34 )days and (186 342 ± 15 467 )yuan.All the patients were followed up till May 2012,no recurrece of the retroperitoneal infected necrotic tissue was detected.Conclusion CT-guided percutaneous catheter drainage via buttocks is effective for the treatment of retroperitoneal infected necrotic tissue in the pelvic cavity in SAP patients.