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The aim of the study was to elucidate the involvement of cholinergic receptor nicotinic alpha 1 subunit (CHRNA1) in the pathogenesis of primary focal hyperhidrosis (PFH). The hyperhidrosis mouse model was constructed using pilocarpine injection. The expression levels of CHRNA1 in sweat gland tissues of PFH patients and hyperhidrosis mice were compared using Western blots and quantitative real-time PCR (qRT-PCR) analyses. Sweat secretion in hyperhidrosis mice treated with small-interfering RNA (siRNA) targeting CHRNA1 (si-CHRNA1) or non-specific siRNA were compared. Sweat secretory granules in the sweat gland cells of hyperhidrosis mice were examined using transmission electron microscopy. The serum level of acetylcholine was measured using enzyme-linked immunosorbent assay, while markers associated with PFH, including Aquaporin 5 (AQP5) and Calcium Voltage-Gated Channel Subunit Alpha1 C (CACNA1C), were assessed using immunohistochemical assay and Western blots. Brain-derived neurotrophic factor (BDNF) and Neuregulin 1 (NRG-1) in sympathetic ganglia axons of hyperhidrosis mice were quantified using Western blots. CHRNA1 up-regulation is a characteristic of the sweat glands of PFH patients and Hyperhidrosis mice. Silencing CHRNA1 decreased sweat secretion and the number of sweat secretory granules of hyperhidrosis mice. Serum acetylcholine, as well as AQP5 and CACNA1C expression in the sweat glands, was reduced by siCHRNA1. BDNF1 and NRG-1 levels in the sympathetic ganglia axons were also attenuated by siCHRNA1 treatment. CHRNA1 up-regulation is a potential biomarker of PFH and downregulating CHRNA1 could alleviate the symptoms of PFH through inactivating the sympathetic system., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The pathogenesis of primary focal hyperhidrosis (PFH) is still not clear. PFH is thought to be a genetic disease. Whether activin A receptor type 1 (ACVR1) is involved in the pathogenesis of PFH is unknown. In this study, the expression of ACVR1 in sweat glands of patients with PAH was detected by western blot and immunofluorescence. The primary sweat gland cells obtained from primary axillary hyperhidrosis (PAH) patients were transfected with acvr1 vector. Cell proliferation, apoptosis and cell cycling of gland cells were measured after transfection with acvr1 vector. The mRNA and protein expression of aquaporin 5 (AQP5) and Na:K:2Cl Cotransporter 1 (NKCC1/SLC12A2) were detected. Our data showed that ACVR1 expression in axillary sweat gland tissue of PAH patients was significantly higher than that of normal control group. The function of ACVR1 was further investigated in the gland cells obtained from PAH patients. Compared with NC group, ACVR1 overexpression significantly promoted the proliferation of sweat gland cells and inhibited the apoptosis of sweat gland cells. Meanwhile, ACVR1 overexpression significantly reduced the percentage of cells in G0/G1 and G2/M phases, and increased the percentage of cells in S phase. In addition, ACVR1 overexpression significantly promoted the expression of AQP5 and NKCC1 at both mRNA and protein levels. Together, ACVR1 expression is related to PFH and ACVR1 overexpression can promote the proliferation of sweat gland cells and inhibit apoptosis by promoting the expression of AQP5 and NKCC1., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis., Methods: From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope., Results: ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (P<0.01). Postoperative sore throat occurred in 37 patients in group B, whereas none of the patients in group A complained about sore throat after surgery (P<0.01). The mean incision length was 5.1±0.1 mm with needle endoscope and 11.0±0.8 mm with traditional thoracoscope (P<0.01). The mean postoperative pain score was 1.1±0.8 in group A and 3.2±0.8 in group B (P<0.01). The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients (P<0.01). Follow-up was 100% completed. The mean cosmetic scores were higher in group A than in group B (P<0.01). Residual pain occurred in 2 patients in group A and in 18 patients in group B (P<0.01)., Conclusions: Nonintubated needlescopic thoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.

Background: Traditional endoscopic thoracic sympathicotomy is usually performed through an axillary incision with 5-mm thoracoscope under general anesthesia with endotrachea intubation. Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique in managing primary palmar hyperhidrosis (PPH)., Methods: From May 2012 to May 2014, a total of 85 male patients with severe PPH underwent transareolar single-port thoracic sympathicotomy by use of a 2-mm needle scope under total intravenous anesthesia without endotrachea intubation., Results: All procedures were successfully performed with a mean operating time of 13.5 min. The palms of all patients became dry and warm as soon as the sympathetic chain was cut off. There were no sore throat, and all the patients regained consciousness rapidly after surgery. Eighty-two patients (96.5 %) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner's syndrome. At 6 months postoperatively, there is no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory sweating appeared in 31 patients. No recurrent symptoms were observed in our study. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction., Conclusions: Nonintubated transareolar single-port needlescopic thoracic sympathicotomy is a safe, effective and minimally invasive therapeutic procedure, which can be performed in routine clinical practice for male PPH patients.

Objective: To investigate the prevalence and epidemiological characteristics of primary palmar hyperhidrosis (PPH) among adolescents in PR China., Methods: A nationwide survey was performed, including all seven geological areas of Mainland China. Stratified cluster sampling was performed, and a cross-sectional epidemiological survey was applied via questionnaire among 10,000 college students in each geological area., Results: The prevalence rate of PPH was 2.08%. The prevalence in female adolescents was slightly higher than the prevalence in male adolescents (2.29 vs. 1.94%). The prevalence of PPH in coastal areas was higher than the prevalence of PPH in inland areas (2.81 vs. 1.53%). The peak age of onset is 7-15 years, accounting for 97.3% of the PPH population. Positive family history was found in 25.40% of PPH cases. In addition to palms, axillae and soles can also be affected., Conclusions: PPH affects a larger group of individuals than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.

Objective: To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH)., Methods: Retrospective study was conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011., Results: All operations were successfully performed without severe complication and mortality. No conversion into open technique was necessary. The mean unilateral operative duration was 5.8 (5-8) min. It was calculated from the time of skin incision to the application of dressing over wound. The mean follow-up period was 25 (8-38) months. All patients achieved excellent cosmetic effects with undetectable incision., Conclusion: Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH. Incision is undetectable with excellent cosmetic effect. It is worthy of wider popularization.

Objective: To evaluate the cosmetic effects and safety profiles of trans-areola single port endoscopic thoracic sympathectomy., Methods: A retrospective study was conducted for 45 males and 7 females with palmar hyperhidrosis undergoing trans-areola single port endoscopic thoracic bilateral sympathectomy during April and June 2011., Results: All operations were successfully performed without severe morbidity and mortality. No conversion to open technique was necessary. The mean unilateral operative duration was 6 minutes (range: 5 - 8). The time was calculated from the time of skin incision to that of dressing application over wound. The mean hospitalization duration was 2.2 days (range: 2 - 3). The mean follow-up period was 2.8 months (range: 1 - 7). All patients achieved excellent cosmetic effects. No incision scar was found., Conclusion: Trans-areola single port endoscopic thoracic sympathectomy is a safe and effective therapeutic procedure for primary palmar hyperhidrosis. The incision is undetectable with excellent cosmetic effects. The trans-areola route is a new ideal and promising approach for endoscopic thoracic sympathectomy.

Background: Limiting the extent of sympathectomy in palmar hyperhidrosis was recently recognized as an effective method to minimize the incidence and severity of troublesome compensatory sweating. However, the levels at which transection should be performed remain controversial. In this study, we proposed that the level of ablation varies and should be adjusted for each individual patient. Guided by palmar skin temperature and laser Doppler blood flow, we try to find the correct target level in each case., Methods: Fifty patients with severe primary palmar hyperhidrosis received bilateral endoscopic thoracic sympathectomy. Different levels of transection from T4 to T2 were performed step by step until the successful extirpation was implied by the intraoperative monitoring. The results of the operations were studied. All patients were followed up and evaluated for symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating., Results: Of a total of 100 lateral procedures, 76 laterals (76%) ended the procedure at the T4 level, 23 laterals (23%) ended the procedure at the T3 level, and 1 lateral (1%) ended the procedure at the T2 level. The postoperative complication was minor, and no Horner's syndrome was detected. The rate of symptom resolution was 100% and no recurrence was found. The satisfaction rate was 92%, and the incidence of mild, moderate, and severe compensatory sweating were 12%, 8%, and 6%, respectively., Conclusions: Concerning the sympathectomy for palmar hyperhidrosis, there is a possibility that the level of the transection varies and should be adjusted for each individual patient. Intraoperative monitoring of temperature and blood flow may be a useful tool in establishing a kind of standardized reference for finding the correct target level.

Background: Compensatory sweating is a major and troublesome complication noted frequently after sympathectomy in patients with primary palmar hyperhidrosis. This randomized clinical trial was projected to measure the impact of limited denervation on compensatory sweating while performing endoscopic thoracic sympthectomy., Methods: Two hundred thirty-two patients with primary palmar hyperhidrosis were randomly allocated to either a T3 sympathectomy treatment, called group T3, or a T2-4 sympathetic treatment, called group T2-4. The patients underwent bilateral sympathetic ablation at corresponding levels. All patients were followed up and evaluated for comparison of symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating between the two groups., Results: Sex, age, family history, and distribution of sweating were similar in both groups. The postoperative complications were minor, and Horner's syndrome was not detected in either group. The frequency of mild and moderate compensatory sweating was not significantly different between the two groups, but the incidence of severe compensatory sweating was significantly lower after T3 sympathectomy (3% versus 10%). As for satisfaction rate, group T3 was superior to group T2-4 (96.6% versus 89.6%). The rate of symptom resolution was 100%, and no recurrence was found in either group., Conclusions: The single-level sympathetic denervation under thoracoscopy is a safe and effective procedure to treat primary palmar hyperhidrosis. This method reduces the incidence of severe compensatory sweating postoperatively without compromising the patient's satisfaction.

Background: Despite recent advances in recognition and treatment of primary palmar hyperhidrosis (PPH), the epidemiological survey has hardly been conducted. The aim of this study was to investigate the prevalence and epidemiological characteristics of primary PPH among adolescents in three cities of southeast China., Methods: Stratified-cluster sampling was carried out and cross-sectional epidemiological survey by questionnaire was applied among 33 000 college and high school students., Results: The prevalence rate of PPH was 4.36% affecting both sexes equally. Prevalence rate of severe PPH was 0.27%. The average age of onset was 12.27 +/- 2.12 years. The peak age of onset was 6 - 16 years, accounting for 97.2% of PPH population. Positive family history was found in 17.9% PPH cases. Besides palms, axillae and soles can be also affected., Conclusions: PPH affects a larger group of individual than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.

Objective: To evaluate the efficacy of video-assisted thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis and introduce the clinical experience in the prevention of complications., Methods: The clinic data of 588 cases of palmar hyperhidrosis who underwent bilateral sympathectomy from January 2003 and March 2007 was analyzed retrospectively. The curative results were compared between the T(2) levels denervation group (group A) and the T(2) levels remained denervation group (group B)., Results: All operations were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 99.8%. Accompanied axillary sweating and plantar sweating were improved in 84.0% and 71.0% patients respectively. All the patients were evaluated by a follow-up for 1 to 48 months with an average time of (20.3 +/- 2.3) months on the aspects of curative effect and occurrence of compensatory sweating. During one week after surgery, the transient postoperative hand sweating recurred in 10 cases and then disappeared within 1 to 3 days. Two cases experienced gustatory hyperhidrosis. One case experienced hand sweating at 8 th month postoperative. Side-effect of compensatory sweating were observed in 28.0 percent of group A and 13.4 percent of group B (P < 0.01)., Conclusions: Video-assisted thoracoscopic sympathectomy is an effective, safe and minimally invasive method for the treatment of hyperhidrosis. The method of T(2) levels remained denervation appears associated with less compensatory sweating.

Objective: To investigate the prevalence and epidemiological characteristics of primary palmar hyperhidrosis (PPH) among adolescents in Fuzhou City of PR China., Methods: Stratified cluster sampling was carried out and a cross-sectional epidemiological survey by questionnaire was applied among 13,000 college and high school students., Results: The prevalence rate of PPH was 4.59% affecting both sexes equally. The peak age of onset is 6-16 years, accounting for 95.6% of the PPH population. Positive family history was found in 15.3% PPH cases. Besides palms, axillae and soles can be also affected., Conclusions: PPH affects a larger group of individuals than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.

Objective: To compare the curative effects of sympathectomy at different segments on palmar hyperhidrosis., Methods: Four hundred patients with palmar hyperhidrosis, 191 males and 209 females, aged 21.9 +/- 3.4 (10 - 53), underwent bilateral sympathectomy However, bilateral sympathectomy was forced to be given up and replaced by unilateral sympathectomy in 2 patients because of severe pleural adhesion The 398 patients on which bilateral sympathectomy was successfully performed were randomly divided into 3 groups: Group A (n = 207) undergoing T2-4 sympathectomy, Group B (n = 131) undergoing T3 sympathectomy, and Group C (n = 60) undergoing T3-4 sympathectomy. The curative effects were compared., Results: Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related post-operative complication occurred. The compensatory hyperhidrosis (CH) rate of Group B was 5.3%, not significantly different from that of Group C (6.7%, P > 0.05). The CH rate of the combined group, Group B + C was 5.8%, significantly lower than that of Group A (28.0%, P < 0.01)., Conclusion: Safe and mini-invasive, T3 or T3-4 sympathectomy effectively reduce the development of CH and improves the patients' quality of life post-operatively.