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Objective To investigate the effect of ultrasound-guided right stellate ganglion block (SBG) on postoperative visceral pain and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (LC). Methods A total of 120 patients scheduled for elective LC were divided into the SGB group (n=60) and the control group (n=60) using a random number table. Ultrasound-guided right SGB was conducted with 1% lidocaine 6 mL before surgery in the SGB group, and the equal volume of normal saline was given at the same site in the control group. Local infiltration anesthesia at incision site was performed with 1% ropivacaine 10 mL at the end of surgery in both groups. The mean arterial pressure (MAP) and heart rate (HR) were recorded at different time points, including before anesthesia induction (T0), after endotracheal intubation (T1), skin incision (T2), pneumoperitoneum establishment (T3), 10 min after pneumoperitoneum establishment (T4) and at the end of surgery (T5). Postoperative visceral pain scores evaluated by the Numerical Rating Scale (NRS) at four times (0.5 h, 4 h, 12 h, 24 h after surgery), incidence of PONV and rate of using antiemetics during the first 24 h after surgery were recorded. The operation time, total dose of propofol and remifentanil, extubation time, first anal exhaust time, Athens Insomnia Scale (AIS) scores on the first night after surgery and satisfaction scores were recorded as well. Results The MAP and HR were significantly lower at T1 and T4 in the SGB group than those in the control group (P＜0.05). Compared with the control group, the SGB group showed lower NRS scores of visceral pain at 4 h and 12 h after surgery, lower incidence of PONV and lower rate of using antiemetics (P＜0.05). Meanwhile, earlier first anal exhaust, lower AIS scores on the first night after surgery and higher satisfaction scores were observed in the SGB group (P＜0.05). Conclusion Ultrasound-guided right SGB can alleviate postoperative visceral pain in patients after LC, reduce the incidence of PONV and improve the quality of sleep after surgery. [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of acupuncture at stellate ganglion on orthostatic hypotension (OH) in Parkinson's disease (PD), and explore its action mechanism., Methods: A total of 68 patients with OH in PD were randomly divided into a combination group (34 cases, 2 cases dropped out, 1 case was eliminated) and a western medication group (34 cases, 1 case was eliminated). Both groups received stable dose anti-PD western medication, the western medication group received oral midodrine hydrochloride tablets, 2.5 mg each time, 2 times a day. The combination group was treated with acupuncture at bilateral stellate ganglion on the basis of the western medication group, without retaining needles, once a day, 5 times a week. Both groups were treated for 2 weeks. Supine and orthostatic blood pressure, orthostatic hypotension questionnaire (OHQ) score, TCM syndrome score, unified Parkinson's disease rating scale (UPDRS) score before and after treatment in the two groups were observed, the level of serum norepinephrine (NE) was detected, and the clinical effect was evaluated., Results: After treatment, orthostatic systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the combination group were increased compared with those before treatment ( P <0.01), OHQ score, TCM syndrome score, UPDRS score were decreased compared with those before treatment ( P <0.01); supine SBP in the western medication group was increased compared with that before treatment ( P <0.05), OHQ score was decreased compared with that before treatment ( P <0.05); the levels of serum NE in both groups were increased compared with those before treatment ( P <0.01). After treatment, orthostatic SBP, orthostatic DBP and the level of serum NE in the combination group were higher than those in the western medication group ( P <0.01, P <0.05), the OHQ score, TCM syndrome score, UPDRS score were lower than those in the western medication group ( P <0.05, P <0.01). The total effective rate was 87.1% (27/31) in the combination group, which was higher than 63.6% (21/32) in the western medication group ( P <0.05)., Conclusion: Acupuncture at stellate ganglion can increase the orthostatic blood pressure in patients with OH in PD , improve clinical symptoms, and the mechanism may be related to the up-regulation of NE.

Objective: To analyze the effect and mechanism of stellate ganglion block on cardiomyocyte apoptosis in rats with heart failure. Methods: The rat model of heart failure was established by abdominal artery stenosis. Eighteen SD rats were randomly divided into normal control group (NC group), sham operation group (SO group) and stellate ganglion block group (SGB group), with 6 rats in each group. The rats in the control group were not treated. After the establishment of the model, the skin of SGB group was exposed to stellate ganglion, and then epidural puncture needle was implanted to stellate ganglion distribution for stellate ganglion block; In SO group, the skin was exposed to stellate ganglion and sutured directly. After 12 weeks, the body weight, heart weight, heart weight index, swimming time, swimming index, myocardial histology, positive apoptosis number of myocardial cells, the expression of tumor necrosis factor - α (TNF-α) and interleukin-1 β (IL-1 β), mRNA and protein expression of phosphatidylinositol-3 kinase (PI3K), Akt and caspase-3 were evaluated. Results: Compared with NC group, body weight, heart weight, swimming time, swimming index, mRNA and protein expression of PI3K and Akt were significantly decreased in SO group, while cardiac weight index, average number of myocardial cell apoptosis, TNF-α expression, IL-1 β expression, caspase-3 mRNA and protein expression were significantly increased in so group (all P<0.05). Compared with SO group, body weight, heart weight, swimming time, swimming index, mRNA and protein expression of PI3K and Akt were significantly increased in SGB group, while cardiac weight index, average number of apoptosis of myocardial cells, expression of TNF-α, expression of IL-1 β, mRNA and protein expression of Caspase-3 were significantly decreased in SGB group (all P<0.05). After stellate ganglion block, the arrangement of myocardial cells in SGB group became regular, and the vacuolation, intercellular space, inflammatory reaction and cytolysis of myocardial cells in SGB group were significantly improved. Conclusion: Stellate ganglion block can significantly inhibit cardiomyocyte apoptosis in rats with heart failure. This inhibition can significantly protect cardiac function, which is closely related to the upregulation of PI3K / Akt signaling pathway. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stellate ganglion block is feasible for the patients in sub-health status, but it is invasive and the patient compliance is poor. OBJECTIVE: To investigate the clinical effectiveness of ultrasound-induced transdermal drug delivery for reducing the hyperactivity of the cervical sympathetic ganglia in the sub-health status. METHODS: Sixty-nine participants in sub-health state from different age levels and professions were recruited and were randomly divided into treatment (n=31) and control (n=38) groups. The treatment group underwent ultrasound-induced transdermal drug delivery to the cervical sympathetic ganglia, while the control group received psychological counseling on sub-health education and behavior intervention. All patients were assessed with Sub-Health Measurement Scale Version1.0, and the Medical Outcomes Study 36-Item Short-Form Health Survey prior to and post treatment, along with clinical curative effect assessment. RESULTS AND CONCLUSION: After treatment, 29 participants in the treatment group were improved or recovered from sub-health, with an effective rate of 93.5%. Compared with the control group, the scores were significantly improved in the treatment group. To conclude, ultrasound-induced transdermal drug delivery to the stellate ganglion has a significant effect on sub-health state. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy of ultrasound-stellate ganglion block (US-SGB) with that of blind SGB (B-SGB) in the management of breast cancer patients with postoperative neuropathic pain (NP). Methods Forty-eight breast cancer patients with postoperative neuropathic pain were randomly assigned to either US-SGB group (N = 24) or B-SGB group (N = 24). The mean age of US-SGB and B-SGB groups were (51.35 ± 5.63) and (49.54 ± 4.77) years, respectively. Two blockade procedures with 8-day interval were performed on the affected side. Visual Analogue Scale (VAS) was assessed before treatment, and in the 4th and 8th week after treatment. Results In both groups, VAS scores were significantly decreased after 4 and 8 weeks. The VAS score in US-SGB group was decreased from 5.44 ± 1.52 before treatment to 2.68 ± 1.33 at 4th week and to 1.32 ± 0.85 at 8th week after treatment, while in B-SGB group decreased from 5.36 ± 1.21 before treatment to 3.31 ± 1.27 at 4th week and to 2.09 ± 1.02 at 8th week after treatment. The alleviation of pain in US-SGB group was more significant than that in B-SGB group (4th week: t = 2.251, P = 0.038; 8th week: t = 1.971, P = 0.029). Conclusion Both US-SGB and B-SGB techniques were effective in relieving pain in breast cancer patients with neuropathic pain. However, with postoperative favorable clinical efficacy, US-SGB was better in pain relief in comparison with B-SGB.

Objective To compare the efficacy of ultrasound-stellate ganglion block (US-SGB) with that of blind SGB (B - SGB) in the management of breast cancer patients with postoperative neuropathic pain (NP). Methods Forty-eight breast cancer patients with postoperative neuropathic pain were randomly assigned to either US-SGB group (N = 24) or B-SGB group (N = 24). The mean age of US-SGB and B-SGB groups were (51.35 ± 5.63) and (49.54 ± 4.77) years, respectively. Two blockade procedures with 8 - day interval were performed on the affected side. Visual Analogue Scale (VAS) was assessed before treatment, and in the 4th and 8th week after treatment. Results In both groups, VAS scores were significantly decreased after 4 and 8 weeks. The VAS score in US-SGB group was decreased from 5.44 ± 1.52 before treatment to 2.68 ± 1.33 at 4th week and to 1.32 ± 0.85 at 8th week after treatment, while in B-SGB group decreased from 5.36 ± 1.21 before treatment to 3.31 ± 1.27 at 4th week and to 2.09 ± 1.02 at 8th week after treatment. The alleviation of pain in US-SGB group was more significant than that in B-SGB group (4th week: t = 2.251, P = 0.038; 8th week: t = 1.971, P = 0.029). Conclusion Both US - SGB and B - SGB techniques were effective in relieving pain in breast cancer patients with neuropathic pain. However, with postoperative favorable clinical efficacy, US-SGB was better in pain relief in comparison with B-SGB. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer., Methods: This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m 2 ) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n =30) and control group (NS group, n =30). In S group, SGB at the C 6 level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups., Results: There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels ( P < 0.05) and higher MOT level ( P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group ( P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher ( P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group ( P < 0.05)., Conclusion: In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.

Objective: To observe the impact and difference of resection of left stellate ganglion (LSG) or right stellate ganglion (RSG) on rats with heart failure. Methods: Thirty male SD rats were divided into 3 groups ( n =10 each) by random number table method: control group, LSG group, RSG group. All three groups underwent TAC surgery to establish a pressure-overloaded heart failure model. Then, LSG and RSG were bluntly separated and removed in rats assigned to the LSG group or RSG group by surgery, while rats in the control group underwent sham operation. The changes in blood pressure and heart rate before operation, 30 minutes and 10 weeks after operation were recorded; echocardiography was performed before operation and 10 weeks after operation to detect the thickness of the ventricular septum, left ventricle posterior wall diameter, left ventricular end diastolic diameter, left ventricular end diastolic volume, and calculate the left ventricular fractional shortening and left ventricular ejection fraction. HE staining and Masson staining were performed to observe the degree of myocardial hypertrophy and myocardial fibrosis, and to judge the ventricular remodeling. Results: The heart rates of the three groups of rats were (352.4±4.3), (320.3±4.0) and (297.9±5.9) beats/min, and the blood pressure was (142.8±2.3), (123.4±2.7) and (129.6±2.9) mmHg(1 mmHg=0.133 kPa) at thirty minutes after surgery; the heart rates of the three groups of rats were (352.9±4.0), (321.6±3.4) and (301±4.1) beats/min, and the blood pressure was (145.6±1.9), (124.8±1.7) and (130.4±4.4) mmHg at 10 weeks after surgery. The heart rate and blood pressure in the LSG group and RSG group at 30 min and 10 weeks after surgery were significantly lower than those in the control group; at 10 weeks after surgery, the heart rate in the RSG group was significantly lower than that in the LSG group ( P both<0.001). After 10 weeks, rats in the control group developed severe left ventricular dilatation. Degree of left ventricular hypertrophy was significantly reduced in the LSG group and RSG group than in the control group, the thickness of the ventricular septum was (3.2±0.3), (2.5±0.1) and (2.5±0.1) mm; the left ventricular end-diastolic diameters were (7.5±0.3), (5.5±0.3) and (5.7±0.2) mm; the left ventricular end-diastolic volume was (9.5±0.3), (4.5±0.2) and (4.8±0.2) ml; the left ventricular fractional shortening was (21.6±1.3)%, (49.1±3.9)% and (47.4±1.5)%; and the left ventricular ejection fraction was (50.9±2.5)%, (81.9±2.1)% and (80.0±2.3)%, respectively in the control group, LSG group and RSG group. Compared with the control group, the left ventricular posterior wall diameter, left ventricular end-diastolic diameter and left ventricular end-diastolic volume were significantly lower and the left ventricular fractional shortening and left ventricular ejection fraction were significantly higher in the LSG group and RSG group (all P <0.001). 10 weeks after operation, the values of type Ⅰ collagen in the control group, LSG group, and RSG group were (0.354±0.013), (0.211±0.012) and (0.243±0.013), respectively. Ratio of type Ⅰ/Ⅲ collagen was (1.109±0.065), (0.737±0.055) and (0.839±0.075), respectively. Compared with the control group, the ratio of type Ⅰcollagen and ratio of type Ⅰ/Ⅲ collagen were significantly lower in the LSG group and RSG group ( P <0.001). Conclusion: Both left and right stellate ganglion resection can similarly reduce ventricular remodeling caused by pressure overload and delay the progression of heart failure in tis TAC rat model.

Objective: To observe the perioperative efficacy of stellate ganglion block (SGB) in functional endoscopic sinus surgery (FESS) in chronic sinusitis patients with hypertension. Methods: A total of 60 patients with chronic sinusitis complicated with hypertension who were scheduled to undergo FESS in the Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University from April 2018 to December 2019 were selected and divided into SGB group and control group by random number table method. SGB were performed at 24 hours before surgery and induction of general anesthesia alternately, while the control group was not treated. During the operation, controlled hypotension were performed in both groups. Hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 24 hours before surgery(T(0)), before anesthesia induction (T(1)), at the beginning of surgery (T(2)), at the end of surgery (T(3)), and at 24 hours after surgery(T(4)).Plasma epinephrine and norepinephrine concentrations were measured at T(0), T(1), T(3) and T(4). The dosage of anesthesia and other drugs, operative time, bleeding amount and extubation time were recorded, while the quality of the operative field was evaluated. VAS scores were assessed at 1, 6 and 24 hours after surgery. Results: In the SGB group, SBP, DBP and MAP in T(1), T(2), T(3), T(4) and HR in T(1), T(4) were lower than those in the control group (all P< 0.05). Compared with T(0), SBP, DBP, MAP and HR in T(1), T(2), T(3), T(4) all decreased in SGB group (all P< 0.05); In the control group, SBP, DBP and MAP only decreased in T(2) and T(3), and HR fluctuated significantly ( P< 0.05). In the SGB group, plasma epinephrine and norepinephrine concentrations at T(1), T(3) and T(4) were lower than those in the control group ( P< 0.05). Compared with T(0), plasma epinephrine and norepinephrine concentrations in the SGB group fluctuated in positive and negative phases, while those in the control group increased ( P< 0.05). The pain scores in SGB group at 6 and 24 hours after surgery were 1.3±0.7 and 2.6±0.9, which were lower than 1.7±0.7 and 3.1±0.9 in the control group ( t= -2.290, -2.050, all P< 0.05). Conclusion: SGB may effectively improve hemodynamics, maintain homeostasis, reduce anesthesia and surgical complications in patients with chronic sinusitis and hypertension in perioperative period.

Objective: To compare the efficacy differences between catgut implantation at stellate ganglion combined with oral administration of alendronate sodium and oral administration of alendronate sodium alone on postmenopausal osteoporosis (PO)., Methods: Sixty patients of PO were randomly divided into an observation group and a control group, 30 cases in each one. The patients in the control group were treated with oral administration of alendronate sodium. Based on the treatment of control group, the patients in the observation group were treated with catgut implantation at stellate ganglion. The treatment was given once a week in the two groups; the consecution treatment of four weeks constituted one session, and totally six sessions were given. The changes of total syndrome score, bone mineral density of lumbar vertebra (L 1 to L 4 ) and femeral neck (FN) and estradiol were observed before and after treatment; the clinical efficacy was compared between the two groups., Results: Compared before treatment, the total syndrome score, bone mineral density of lumbar vertebra (L 1 to L 4 ) and FN and estradiol were significantly improved after treatment (all P <0.05); which were more significant in the observation group (all P <0.05). Compared before treatment, the level of estradiol in the control group was not significantly changed after treatment ( P >0.05), while that in the observation group was significantly changed after treatment ( P <0.05). After treatment, the level of estradiol in the observation group was higher than that in the control group ( P <0.05). The total effective rate was 93.3% (28/30) in the observation group, which was significantly higher than 83.3% (25/30) in the control group ( P <0.05)., Conclusion: Catgut implantation at stellate ganglion combined with oral administration of alendronate sodium are superior to oral administration of alendronate sodium alone for postmenopausal osteoporosis, which improve the clinical symptoms, regulate the hormone level and increase bone mineral density.

Objective: By summarize the Prevention and Treatment of Horner Syndrome of CT-guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis, reduce the occurrence of the complications. Methods: A retrospective analysis was made on 116 patients of CT-guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis in The First Hospital of Jiaxing from January 2010 to December 2016. Analysis the reasons of Horner syndrome and external management to sum up the corresponding prevention and treatment measures. Results: Under the guidance of CT positioning, 116 patients were successfully punctured to the intended target (both sides of the R3 above the rib head), after injection of local anesthetic plus contrast agent, CT scan showed there are 39 sides of the liquid parallel to the outside of pleural (26 sides) or over (13 sides) R1 above the rib head. CT scan again after the injection of anhydrous alcohol, there are 43 sides of the liquid parallel to the outside of pleural (24 sides) or over (19 sides) R1above the rib head.After the operation, 22 sides appeared Horner syndrome, 19 of which immediately give physiological saline 5 ml into the ipsilateral Satellite ganglion.Within 2 hours Horner's syndrome completely disappeared, while 3 cases were not treated, Horner syndrome lasts for 3 months to 2 years. Conclusion: The incidence of Horner syndrome relatively high during the CT-guided thoracic sympathetic nerve modulation to treatment of head and face Hyperhidrosis. Injecting 5 ml physiological saline into the ipsilateral Satellite ganglion immediately can completely eliminate this common complications.

The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO₂ of S group were significantly higher before CPB time of rewarming than that before SGB (P < 0.05), much higher than corresponding non-blocked side rSO₂ before CPB (P < 0.05), and much higher than rSO₂ level in group C before CPB and after CPB (P < 0.05). The non-blocked side rSO₂ in group S before anesthesia were much lower than basic levels and those in group C (P < 0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO₂ compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.

Objective: To determine the effect of stellate ganglion block on reconstruction of the left ventricle in spontaneously hypertensive rats (SHRs)., Methods: Thirty-two 10-week-old male SHRs were randomly assigned into 4 groups: a left stellate ganglion block group (group LS), a right stellate ganglion block group (group RS), a captopril group (group D) and a control group (group C). The arterial systolic blood pressure (SBP) was measured by ALC-NIBP measuring system. After 10 weeks, we observed the left ventricular mass index (LVMI), myocardial pathologic changes, and detected the endothelin (ET-1) and endothelial nitric oxide synthase (eNOS) level in the left ventricle by radioimmunoassay and the collagen protein level in the left ventricle by immunohistochemical method., Results: Compared with group LS and group C, the LVMI in group RS was lowered most notably (P<0.05) and pathological changes were improved obviously. The expression of eNOS in group RS was significantly increased and ET-1 significantly decreased (P<0.05) compared with that in group C and group LS. The expression of type I collagen fibers in group RS was significantly lower and type III collagen fibers significantly higher (P<0.05) when compared with that in group C and LS., Conclusion: Right stellate ganglion block can not only decrease the arterial pressure but also reverse the reconstruction of the left ventricle.

Objective: To investigate the effects of stellate ganglion block (SGB) on blood pressure in spontaneously hypertensive rats(SHRs)., Methods: Thirty-two 10-week-old male spontaneously hypertensive rats(SHRs) were assigned randomly into four groups: left stellate ganglion block group(Group LS), right stellate ganglion block group(Group RS), captopril group(Group D) and control group(Group C). Arterial systolic blood pressure(SBP) was measured, and endothelin (ET-1) and endothelial nitric oxide synthase(eNOS) in blood vessels were detected by radioimmunoassay., Results: Compared with baseline value, the blood pressure of Group LS gradually increased significantly (P<0.05 or P <0.01); however, the blood pressure of Group RS was stable(P >0.05) and increased only at week 2(P <0.05).The blood pressure of Group D decreased significantly at week 2 and week 4, and it remained stable compared with baseline value (P<0.05). The blood pressure of Group C gradually increased at weeks 2-10, compared with baseline values (P <0.01). Compared with Group LS and Group C, the expression of eNOS in blood vessels of Group RS significantly increased (P <0.05), and ET-1 decreased (P <0.05)., Conclusion: The right stellate ganglion block can significantly lower blood pressure, down-regulate ET-1 and up-regulate eNOS protein expression.

We treated 20 patients suffering from uncertainty statements syndrome (USS) with stellate ganglion block (SGB) therapy. The medical infrared thermography was examined before and after the SGB therapy. Analysis on the changes of surface temperature as well as the outcome of the patients was carried out. Among the mentioned 20 patients, 15 (75%) got obvious effect, 4 (20%) fairly good effect and 1 (5%) a little improvement after the SGB therapy. The corresponding surface temperatures of these patients were 1.32 +/- 0.27 degrees C, 0.97 +/- 0.31 degrees C, and 0.76 +/- 0.33 degrees C, respectively. The more the surface temperature changed, the better the efficacy of the therapy was. The medical infrared thermography may objectively represent the therapeutic effect of SGB on the USS.