Using the GI Tract as a Window to the Autonomic Nervous System in the Thorax and in the Abdomen

项目摘要/摘要 使用自主神经调节作为治疗的主要绊脚石之一是无法 进入支配腹部和胸部终末器官的自主神经周围支 龋齿。通过在周围自主神经上放置电极，将有可能记录和调节这些 神经和再生或抑制各种自主神经的生理功能。与迷走神经干形成对比 刺激时，外周迷走神经刺激的效果会针对特定的器官，并可 对特定的生理效应有特殊作用的。此外，我们假设这些影响或多或少是可以产生的 通过在一定范围内改变神经信号的频率、强度和/或持续时间而变得强烈 会产生系统性副作用。 透壁内窥镜使用Z轨道隧道穿过食道和/或胃进入 胸部和腹部的神经和器官，以微创的方式。在最低限度上使用这个- 侵入性技术，安全可靠地进入胸腔和腹腔很容易获得，并且 患者可以在手术后的同一天回家。 当前研究的主要目标是：1)开发一种猪模型、方法、技术、工具 和设备进行透壁内窥镜检查，以便识别、定位电极并将电极放置在 迷走神经的外周分支，以记录和刺激靠近末梢器官的神经 2)将这项技术转化为在诗歌过程中用于人类。神经靶点和末梢器官 可以通过食道到达的是肺、心脏、食道、胸腔的大小血管 还有胃。可以通过胃到达的器官有胃、肝脏、胰腺、肾脏、 小肠、腹部、脾和结肠的大小血管。 这些技术有可能治疗许多疾病，这些疾病对刺激 植物性神经系统。我们对慢性阻塞性肺疾病的治疗前景尤为乐观。 高血压、糖尿病、GERD、胃瘫、终末期心力衰竭、终末期肺部疾病 举几个明显的例子，肺高压、肥胖和外周自主神经 神经修饰可能会对寿命和生活质量产生重大影响。我们很高兴能做出贡献 下一代神经调节设备的开发和三叉神经核的测绘 SPARC程序。

Project Summary/Abstract One of the main stumbling blocks to using autonomic nerve modulation, as a therapy, is the inability to access peripheral branches of autonomic nerves innervating end organs in the abdominal and thoracic cavities. By placing electrodes on peripheral autonomic nerves, it will be possible to record and modulate these nerves and reproduce or inhibit various autonomic physiologic functions. In contrast to truncal vagal nerve stimulation, the effects of peripheral vagal nerve stimulation will be targeted at specific organs, and can be specific for particular physiologic effects. In addition, we hypothesize that the effects can be made more or less intense by varying the frequency, strength and/or duration of the nerve signal within a range that will not engender systemic side effects. Transmural endoscopy uses Z track tunneling through the esophagus and/or stomach to access the nerves and organs of the thoracic and abdominal cavity in a minimally-invasive manner. Using this minimally- invasive technique, safe and reliable access to the thoracic and abdominal cavity is easily obtained, and patients can go home on the same day after the procedure. The main objectives of the current study are to 1) develop a swine model, methods, technology, tools and devices to perform transmural endoscopy in order to identify, localize and place electrodes on the peripheral branches of the Vagus nerve, in order to record and stimulate the nerve near to the end organ and 2) to transition this technology for use in humans during POEM procedures. Nerve targets and end organs that can be reached through the esophagus are the lungs, heart, esophagus, small and great vessels of the thorax and stomach. Organs that can be reached through the stomach are the stomach, liver, pancreas, kidneys, small intestine, large and small vessels of the abdomen, spleen and colon. These techniques have the potential to treat many diseases that respond to stimulation of the autonomic nervous system. We are particularly optimistic about the future prospects of treating chronic hypertension, diabetes, GERD, gastroparesis, end stage CHF, end stage pulmonary disease such as pulmonary hypertension, and obesity to name a few of the obvious examples where peripheral autonomic nerve modification could have a significant impact on longevity and quality of life. We are excited to contribute to the development of next generation of neuromodulation devices and mapping of the PNS as a part of the SPARC program.