Autonomic Neuroscience-Basic & Clinical最新文献

We provide an account of enteric neuron types and their roles throughout the digestive tract. It is notable that CNS control is essential in the esophagus and has greater importance in the stomach and distal colon than in the small intestine. CNS control is not essential for the small intestine. Enteric neuron phenotypes and ENS circuits have been determined in detail in the small intestine and colon, but for only two functions, muscle movement and fluid secretion. We discuss neurons controlling other ENS functions, in particular control of neuro-immune interactions and control of nutrient transport. In the small intestine, key neurons include intrinsic primary afferent neurons (IPANs), muscle motor neurons and secretomotor neurons. Neurons for control of acid, enzyme and hormone secretion occur in the stomach, but, except for the muscle motor neurons, gastric neuron types are poorly understood, and information on equivalences of structural and functional types with types defined by expression analysis is lacking. There are substantial gaps in knowledge of esophageal circuitries. IPANS occur in the colon, but whether they occur in the stomach and esophagus is uncertain. We also discuss species differences in organisation of the enteric plexuses and chemical coding of functionally identified neurons. We conclude that there are at least 26 definable enteric neuron types, and several subtypes. There is a need for more in-depth correlated functional and gene expression studies in order to reach a fuller understanding of the physiological roles of the ENS, its constituent neurons and its central connections.

Purpose: To characterize autonomic nervous system alterations in patients with delirium, focusing on cardiovascular, respiratory, ocular, exocrine, and gastrointestinal functions, as well as neurotransmitter levels. This review aims to synthesize current evidence and explore potential clinical implications for monitoring delirium.

Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines and the Joanna Briggs Institute framework. Searches were performed on the Web of Science, PubMed, Scopus, and EBSCOhost. Eligible studies included experimental, quasi-experimental, observational, or descriptive designs involving hospitalized adults with delirium, diagnosed using standardized tools and accompanied by documented evaluation of the autonomic nervous system.

Results: Twenty-seven studies were included. Four domains were identified: cardiovascular activity (18 studies), which addressed heart rate variability, blood pressure variability, and blood flow. Several studies have reported changes in heart rate variability, increased blood pressure variability, and a reduction in mean arterial pressure associated with delirium. Four studies examined ocular changes, reporting reduced pupillary reflex responses in delirium. Gastrointestinal function was assessed in three studies through gut microbiota analysis, showing reduced microbial diversity and increased pathogenic taxa. Two studies examined neurotransmitter levels, reporting elevated norepinephrine in blood and urine associated with delirium.

Conclusions: This scoping review reveals that autonomic alterations are commonly reported in delirium across various domains, including cardiovascular, ocular, gastrointestinal, and neurochemical systems. The evidence is heterogeneous in terms of measures, timing, and study designs, which limits the integration of findings. Autonomic measures may reflect physiological vulnerability, highlighting the need for standardized and longitudinal research.