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Objectives Arthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re‐excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts. Methods A total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re‐excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre‐ and postoperative indexes was performed using Student's t‐test. Results After a mean follow‐up period of 29.3 months (range, 24–34 months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t = 3.833, p = 0.003), and residual pain was reported by three patients (VAS score = 1 for each). Active wrist flexion increased from 73.6° to 78.2° (t = 2.887, p = 0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study. Conclusion Arthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2‐year follow‐up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence.

Dorsal root ganglion (DRG) stimulation emerged as an effective treatment for various forms of refractory chronic pain, although the evidence for thoracic neuropathic pain is scarce. Pain relief can decrease over time and might be underappreciated in clinical studies. Hence, alternative procedures should be kept in mind when DRG stimulation fails to provide lasting pain relief. A 55-year-old man had a 3-year history of severe right-sided refractory intercostal neuralgia after thoracic trauma (visual analogue scale (VAS) 6/10 for average intensity of pain) concerning T10 and T11 with allodynia. He underwent DRG stimulation, providing initial improvement (VAS 4/10). After two years, the relief had diminished (VAS 6/10), and a salvage ganglionectomy was performed (VAS 4/10). Seven months later DRG trial stimulation was performed for new pain at T9. Since no pain relief was achieved, a ganglionectomy at T9 was performed with subsequent removal of the stimulation system. At the last follow-up 3 years after the initial presentation, the patient reported continued pain relief (VAS 4/10) with absence of allodynia. Selective thoracic ganglionectomy is a viable rescue technique in patients with intercostal neuralgia in whom DRG stimulation fails to provide continuous pain relief.

Objectives: Arthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re‐excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts. Methods: A total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re‐excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre‐ and postoperative indexes was performed using Student's t‐test. Results: After a mean follow‐up period of 29.3 months (range, 24–34 months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t = 3.833, p = 0.003), and residual pain was reported by three patients (VAS score = 1 for each). Active wrist flexion increased from 73.6° to 78.2° (t = 2.887, p = 0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study. Conclusion: Arthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2‐year follow‐up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence. [ABSTRACT FROM AUTHOR]

Microglial cells are one of the interstitial elements of the pineal gland (PG). We recently reported the pattern of microglia colonization and activation, and microglia-Pax6+ cell interactions during normal pineal ontogeny. Here, we describe the dynamics of microglia-Pax6+ cell associations and interactions after surgical or pharmacological manipulation. In adult rats, the superior cervical ganglia (SCG) were exposed, and either bilaterally excised (SCGx) or decentralized (SCGd). In the SCGx PGs, the density of Iba1+ microglia increased after surgery and returned to sham baseline levels 13 days later. Pineal microglia also responded to SCGd, a more subtle denervation. The number of clustered Iba1+ /PCNA+ /ED1+ microglia was higher 4 days after both surgeries compared to the sham-operated group. However, the number of Pax6+ /PCNA- cells and the percentage of Pax6+ cells contacted by and/or phagocytosed by microglia increased significantly only after SCGx. Separate groups of rats were treated with either bacterial lipopolysaccharides (LPS) or doxycycline (DOX) to activate or inhibit pineal microglia, respectively. Peripheral LPS administration caused an increase in the number of clustered Iba1+ /PCNA+ /ED1+ microglial cells, and in the percentage of Pax6+ cells associated with and/or engulfed by microglia. In the LPS-treated PGs, we also noted an increase in the number of PCNA+ cells that were Iba1- within the microglial cell clusters. The density of Pax6+ cells did not change after LPS treatment. DOX administration did not influence the parameters analyzed. These data suggest that pineal microglia are highly receptive cells capable of rapidly responding in a differential manner to surgical and pharmacological stimuli.

BackgroundSelective bilateral cervicothoracic sympathectomy has proven to be effective for managing ventricular arrhythmias in the setting of structural heart disease. In the procedure currently used, the caudal portions of both stellate ganglia along with thoracic chain ganglia down to T4 ganglia are removed.ObjectiveThe purpose of this study was to define the relative contributions of the T1-T2 and T3-T4 paravertebral ganglia in modulating ventricular electrical function.MethodsIn anesthetized vagotomized porcine subjects (n = 8), the heart was exposed via sternotomy along with right and left paravertebral sympathetic ganglia to the T4 level. A 56-electrode epicardial sock was placed over both ventricles to assess epicardial activation-recovery intervals (ARIs) in response to individually stimulating right and left stellate vs T3 paravertebral ganglia. Responses to T3 stimuli were repeated after surgical removal of the caudal portions of stellate ganglia and T2 bilaterally.ResultsIn intact preparations, stellate ganglion vs T3 stimuli (4 Hz, 4-ms duration) were titrated to produce equivalent decreases in global ventricular ARIs (right side: 85 ± 6 ms vs 55 ± 10 ms; left side: 24 ± 3 ms vs 17 ± 7 ms). Threshold of stimulus intensity applied to T3 ganglia to achieve threshold was 3 times that of T1 threshold. ARIs in unstimulated states were unaffected by bilateral stellate-T2 ganglion removal. After acute decentralization, T3 stimulation failed to change ARIs.ConclusionPreganglionic sympathetic efferents arising from the T1-T4 spinal cord that project to the heart transit through stellate ganglia via the paravertebral chain. Thus, T1-T2 surgical excision is sufficient to functionally interrupt central control of peripheral sympathetic efferent activity.

OBJECTIVE: The aim of this study was to determine the pertinent anesthetic considerations for patients undergoing surgical sympathectomy for electrical storm (incessant ventricular tachycardia (VT) refractory to traditional therapies). DESIGN: This is a retrospective review of a prospective database. SETTING: This single-center study took place in a university hospital setting. PARTICIPANTS: Twenty-six patients were enrolled. INTERVENTIONS: Fifteen patients underwent left-sided sympathectomy, whereas 11 patients underwent bilateral sympathectomy. MEASUREMENTS AND MAIN RESULTS: Anesthetic management of these patients was quite complex, requiring invasive monitoring, transesophageal echocardiography, one-lung ventilation, programming of cardiac rhythm management devices, and titration of vasoactive medications. Paired t test of hemodynamic data before, during, and after surgery showed no significant difference between preoperative and postoperative blood pressure values, regardless of whether the patient underwent unilateral or bilateral sympathectomy. Eight patients remained free of VT, three patients responded well to titration of oral medications, and one patient required 2 radiofrequency ablations after sympathectomy to control his VT. Three patients continued to have VT episodes, although reduced in frequency compared with before the procedure. Four patients were lost to followup. Overall, five patients within the cohort died within 30 days of the procedure. No patients developed any anesthetic complications or Horners syndrome. The overall perioperative mortality (within the first 7 days of the procedure) was 2 of 26, or 7.7%. CONCLUSIONS: The anesthetic management of patients undergoing surgical sympathectomy for electrical storm can be quite complex, because these patients often present in a moribund and emergent state and cannot be optimized using current ACC/AHA guidelines. Expertise in invasive monitoring, transesophageal echocardiography, one-lung ventilation, cardiac rhythm device management, and pressor management is crucial for optimal anesthetic care.

Ventricular arrhythmias are potentially life-threatening disorders that are commonly treated with medications, catheter ablation and implantable cardioverter defibrillator (ICD). Adult patients who continue to be symptomatic, with frequent ventricular arrhythmia cardiac events or defibrillation from ICD despite medical treatment, are a challenging subgroup to manage. Surgical cardiac sympathetic denervation has emerged as a possible treatment option for people refractory to less invasive medical options. Recent treatment guidelines have recommended cardiac sympathectomy for ventricular tachycardia (VT) or VT/fibrillation storm refractory to antiarrhythmic medications, long QT syndrome, and catecholaminergic polymorphic VT, with much of the data pertaining to pediatric literature. However, for the adult population, the disease indications, complications, and risks of cardiac sympathectomy are less understood, as are the most effective surgical cardiac denervation techniques for this patient demographic. This systematic review navigates available literature evaluating surgical denervation disease state indications, techniques, and sympathectomy risks for medically refractory ventricular arrhythmia in the adult patient population. [ABSTRACT FROM AUTHOR]

Background: Two dominating theories regarding median arcuate ligament syndrome include vascular and neurogenic etiologies from celiac artery and ganglion compression, respectively. Celiac ganglionectomy is not routine during surgery, and specimens are rarely excised; therefore, the extent of nerve involvement and histopathology are unknown. Our study aims to characterize histopathologic findings in median arcuate ligament syndrome, establish a histopathologic grading system, and correlate with clinical outcomes., Methods: Robotic median arcuate ligament release, celiac ganglionectomy, and lymphadenectomy were performed with specimens excised and stained using hematoxylin & eosin, trichrome, and S100. Neurofibrosis, adiposity, and reactive changes were described, a grading scale was developed, and results were analyzed with clinical outcomes., Results: Fifty-four patients were evaluated, of whom 36 met inclusion criteria (81% female, 34.9 [25.9-47.5] years, body mass index 23.5 [19.6-28.1] kg/m 2 ). Histopathologic evaluation revealed fibrosis (hematoxylin & eosin and trichrome median score 1.5 [0-2.5]), reactive lymphadenopathy (89%), intraparenchymal nerves (31%), and lipogranulomas (31%). Greater fibrosis was associated with a lack of preoperative celiac plexus block relief (100% vs. 30%, P = .044) and lower postoperative celiac artery velocities (198 vs 323 cm/s, P = .02). Intraparenchymal nerves were associated with greater decreases in pre to postoperative velocities (161 vs 84 cm/s, P = .037). Symptoms improved in 28 patients (78%)., Conclusion: We developed the first histopathologic grading system and identified unique findings of intraparenchymal nerves and lipogranulomas. Histopathologic abnormalities were associated with objective improvement and symptomatic relief postoperatively. These findings support nerve compression and inflammation as predominant contributors to median arcuate ligament syndrome pain, celiac ganglia resection to treat symptoms, and continued histopathologic analysis to better elucidate median arcuate ligament syndrome etiology., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Ingestion of dietary fat stimulates production of the small-intestinal satiety factors oleoylethanolamide (OEA) and N-palmitoyl-phosphatidylethanolamine (NPPE), which reduce food intake through a combination of local (OEA) and systemic (NPPE) actions. Previous studies have shown that sympathetic innervation of the gut is necessary for duodenal infusions of fat to induce satiety, suggesting that sympathetic activity may engage small-intestinal satiety signals such as OEA and NPPE. In the present study, we show that surgical resection of the sympathetic celiac-superior mesenteric ganglion complex, which sends projections to the upper gut, abolishes feeding-induced OEA production in rat small-intestinal cells. These effects are accounted for by suppression of OEA biosynthesis, and are mimicked by administration of the selective β2-adrenergic receptor antagonist ICI-118,551. We further show that sympathetic ganglionectomy or pharmacological blockade of β2-adrenergic receptors prevents NPPE release into the circulation. In addition, sympathetic ganglionectomy increases meal frequency and lowers satiety ratio, and these effects are corrected by pharmacological administration of OEA. The results suggest that sympathetic activity controls fat-induced satiety by enabling the coordinated production of local (OEA) and systemic (NPPE) satiety signals in the small intestine.

Objective: Our objective was to know the percent mortality of ventricular arrhythmia (VA) storm, its major leading factor and the predictors of inhospital mortality of VA storm in our population. Methodology: In this retrospective observational study conducted at The Aga Khan University Hospital Karachi, all patients with age =16, with VA storm were included. Baseline demographic, clinical characteristics, laboratory parameters and management interventions were recorded in pre prepared questionnaire. The data was analyzed using SPSS version 21. Results: Of the total 74 patients, 86.5% were male, 77% were having monomorphic VT and 60.8% were in pulmonary edema. Hypertension (73%), IHD (63.5%), DM (48.6%) MR (56.8%) TR (50%) and LV dysfunctions were the commonest risk factors of VA storm. The mean hospital stay was 5.64 ± 5.63 and 59.5% patients were discharged home in stable condition. On bivariate analysis female gender, polymorphic VT, pulmonary edema, intubation, baseline hemoglobin levels, and baseline WBC counts were predictors of in-hospital mortality of VA storm with hazard ratios (HR) of 2.22 [0.95-5.18], 2.44 [1.18-5.08], 13.49 [1.82-99.85], 17.54 [2.38-129.44], 1.25 [1.05-1.47], and 1.06 [1.01-1.11] respectively. On multivariate analysis, female gender, intubation, and baseline hemoglobin level were independent predictors of in-hospital mortality of VA storm with adjusted HRs of 3.88 [1.02-14.77], 9.9 [0.95-103.25], and 1.47 [1.2-1.79] respectively. Conclusion: VA storm mortality for conservative management in our region is comparable to the international figures. Also we have similar risk factors for VA storm like low EF, structural heart disease and similar predictors of in-hospital mortality for VA storm. [ABSTRACT FROM AUTHOR]

We present a case of a 34-year-old right-handed Caucasian male with chronic occipital neuralgia refractory to medical therapies and minimally invasive pain procedures who underwent surgical cervical dorsal root ganglionectomy which completely relieved his headaches. The histopathological and immunohistochemical findings of the resected cervical dorsal root ganglia were consistent with active herpes simplex virus type 1 (HSV-1) infection causing ganglionitis. To the best of our knowledge, this case represents the first histopathologically proven HSV-1 cervical dorsal root ganglionitis in humans. This case provides an insight into a possible etiology of occipital neuralgia.

The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable. Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed. The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating. Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique. [ABSTRACT FROM AUTHOR]

Ganglion of the anterolateral elbow is rare and may be associated with compression neuropathy of the radial nerve or its branches. Open ganglionectomy implies extensive soft tissue dissection. We present a case of anterolateral elbow ganglion without any compression neuropathy. This was successfully treated with endoscopic ganglionectomy. [ABSTRACT FROM AUTHOR]

Microglial cells are one of the interstitial elements of the pineal gland (PG). We recently reported the pattern of microglia colonization and activation, and microglia‐Pax6+ cell interactions during normal pineal ontogeny. Here, we describe the dynamics of microglia‐Pax6+ cell associations and interactions after surgical or pharmacological manipulation. In adult rats, the superior cervical ganglia (SCG) were exposed, and either bilaterally excised (SCGx) or decentralized (SCGd). In the SCGx PGs, the density of Iba1+ microglia increased after surgery and returned to sham baseline levels 13 days later. Pineal microglia also responded to SCGd, a more subtle denervation. The number of clustered Iba1+/PCNA+/ED1+ microglia was higher 4 days after both surgeries compared to the sham‐operated group. However, the number of Pax6+/PCNA− cells and the percentage of Pax6+ cells contacted by and/or phagocytosed by microglia increased significantly only after SCGx. Separate groups of rats were treated with either bacterial lipopolysaccharides (LPS) or doxycycline (DOX) to activate or inhibit pineal microglia, respectively. Peripheral LPS administration caused an increase in the number of clustered Iba1+/PCNA+/ED1+ microglial cells, and in the percentage of Pax6+ cells associated with and/or engulfed by microglia. In the LPS‐treated PGs, we also noted an increase in the number of PCNA+ cells that were Iba1− within the microglial cell clusters. The density of Pax6+ cells did not change after LPS treatment. DOX administration did not influence the parameters analyzed. These data suggest that pineal microglia are highly receptive cells capable of rapidly responding in a differential manner to surgical and pharmacological stimuli. Pineal Iba1+/PCNA+/ED1+ microglia are constantly 'activated' cells able to sense and differentially respond to surgical and pharmacological stimuli. Here, we show how bilateral superior cervical ganglionectomy (SCGx) and decentralization (SCGd), and peripheral administration of bacterial lipopolysaccharides (LPS) and doxycycline (DOX) impact in a stimulus‐specific manner on microglia, Pax6+ cells, and associations and interactions between both cell types within the pineal gland. We propose the pineal gland as an attractive model to study phagocyte renewal and the interface between the immune system and the central nervous system. [ABSTRACT FROM AUTHOR]

Background: Although early brain injury (EBI) is recognized as a critical step following subarachnoid hemorrhage (SAH), its pathophysiology and underlying mechanisms remain poorly understood. Herein, we investigated the role of cerebral circulation in the acute phase using patient data and a mouse SAH model and evaluated its regulation via the sympathetic nervous system., Methods: The cerebral circulation time and neurological outcomes in the human body were retrospectively examined in 34 SAH cases with ruptured anterior circulation aneurysms and 85 cases with unruptured anterior circulation cerebral aneurysms at Kanazawa University Hospital from January 2016 to December 2021. In a mouse study, a SAH model was created via endovascular perforation, and India-ink angiography was performed over time. Additionally, bilateral superior cervical ganglionectomy was performed immediately before surgery, and neurological scores and brain water content were evaluated after SAH., Results: Cerebral circulation time was prolonged in the acute phase of SAH compared with that in the unruptured cerebral aneurysm group, especially in those with electrocardiographic changes. Furthermore, it was more prolonged in the poor prognosis group (modified Rankin Scale scores 3-6) than in the good prognosis group (modified Rankin Scale scores 0-2) at discharge. In mice, cerebral perfusion was significantly reduced at 1 and 3 hours after SAH and recovered at 6 hours. superior cervical ganglionectomy improved cerebral perfusion without altering the diameter of the middle cerebral artery at 1 hour and improved neurological outcomes at 48 hours after SAH. Consistently, brain edema, quantified by brain water content, was improved by superior cervical ganglionectomy 24 hours after SAH., Conclusions: Sympathetic hyperactivity may play a critical role in the development of EBI by impairing cerebral microcirculation and edema in the acute phase following SAH., Competing Interests: Disclosures None.

Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruction methods, involving tissue replacement and essential structural augmentation, have been shown to be beneficial. This article discusses the most prevalent reasons and uses for wrist arthroscopy, with an emphasis on Indonesia's most recent and major advances in reconstructive arthroscopic surgery. Joint debridement, synovectomy, ganglionectomy, capsular release, and osteotomies are frequent resection operations. Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Growing evidence suggests that the sympathetic nervous system plays an important role in cancer progression. Adrenergic innervation regulates salivary gland secretion, circadian rhythm, macular degeneration, immune function, and cardiac physiology. Murine surgical sympathectomy is a method for studying the effects of adrenergic innervation by allowing for complete, unilateral adrenergic ablation while avoiding the need for repeated pharmacologic intervention and the associated side effects. However, surgical sympathectomy in mice is technically challenging because of the small size of the superior cervical ganglion. This study describes a surgical technique for reliably identifying and resecting the superior cervical ganglion to ablate the sympathetic nervous system. The successful identification and removal of the ganglion are validated by imaging the fluorescent sympathetic ganglia using a transgenic mouse, identifying post-resection Horner's syndrome, staining for adrenergic markers in the resected ganglia, and observing diminished adrenergic immunofluorescence in the target organs following sympathectomy. This model enables future studies of cancer progression as well as other physiological processes regulated by the sympathetic nervous system.

Stellate ganglionectomy (SGx) was used to assess the contribution of cardiac sympathetic nerves to neurogenic hypertension in deoxycorticosterone (DOCA)–salt treated rats. Experiments were conducted in two substrains of Sprague–Dawley (SD) rats since previous studies reported bradycardia in Charles River-SD (CR-SD) rats and tachycardia in SASCO-SD (SA-SD) rats with DOCA treatment suggesting different underlying neural mechanisms. Uninephrectomized male rats underwent SGx or SHAM surgery and were instrumented for telemetric monitoring of mean arterial pressure (MAP) and heart rate (HR). After recovery, 0.9% saline solution and DOCA (50mg) were administered. Baseline MAP (Days 0–5 average) after SGx in CR-SD rats (96±2mmHg; n=7) was not significantly different (p=0.08) than CR-SD SHAM rats (103±3mmHg; n=9); however, there was a significantly lower HR during the baseline period (377±7 vs. 432±7bpm, p<0.05) in SGx rats. In SA-SD rats baseline MAP was not different between SGx and SHAM rats and HR was lower in SGx rats (428±8 vs. 371±5bpm, p<0.05). After DOCA treatment in both substrains, MAP and HR were elevated similarly in SHAM and SGx groups showing minimal impact in both groups of SGx on hypertension development. However, overall MAP in SA-SD SHAM rats reached a significantly higher level (155±10mmHg vs 135±5mmHg, p<0.05) than that observed in CR-SD SHAM rats demonstrating that the magnitude of hypertensive response to DOCA–salt treatment varies between substrains. In conclusion, removal of cardiac sympathetic nerves did not alter the development or maintenance of DOCA–salt hypertension in SD rats. [ABSTRACT FROM AUTHOR]