Cybersickness. A systematic literature review of adverse effects related to virtual reality.

BACKGROUND: Virtual Reality (VR) uses computer technology to create a simulated environment. VR is a growing technology with promising extensive applications in different areas such as Medicine, entertainment, sports, gaming, and simulation. However, information about VR side effects is still limited. We aimed to identify the most frequent physical side effects caused by VR therapeutic applications. METHODOLOGY: All available full-text articles evaluating VR as a therapeutic intervention and side effects using the Simulator Sickness Questionnaire (SSQ) between 2016 and 2021 were consulted across 4 electronic (Entrez Pubmed, Scopus, Science Direct, and Wiley databases). The methodological quality was assessed using the PEDro scale. RESULTS: Ten out of 55 reviewed articles (18%) met inclusion/exclusion criteria, including a sample of 416 patients, mean age of 24.54 (15-52.6)years old. According to the PEDro scale, two articles (20%) were considered good or excellent. Side effects were reported more frequently with head-mounted displays compared to desktop systems, especially disorientation, followed by nausea and oculomotor disturbances. CONCLUSIONS: Although VR might have positive effects as a therapeutic tool, VR can also cause side events. As in any other therapeutic intervention, it is important to understand the effectiveness and safety before planning a VR intervention using a well-designed scientific methodology.

Combined Method Comprising Low Burden Physiological Measurements with Dry Electrodes and Machine Learning for Classification of Visually Induced Motion Sickness in Remote-Controlled Excavator.

The construction industry is actively developing remote-controlled excavators to address labor shortages and improve work safety. However, visually induced motion sickness (VIMS) remains a concern in the remote operation of construction machinery. To predict the occurrence and severity of VIMS, we developed a prototype system that acquires multiple physiological signals with different mechanisms under a low burden and detects VIMS from the collected data. Signals during VIMS were recorded from nine healthy adult males operating excavator simulators equipped with multiple displays and a head-mounted display. Light gradient-boosting machine-based VIMS detection binary classification models were constructed using approximately 30,000 s of time-series data, comprising 23 features derived from the physiological signals. These models were validated using leave-one-out cross-validation on seven participants who experienced severe VIMS and evaluated through area under the curve (AUC) scores. The mean receiver operating characteristic curve AUC score was 0.84, and the mean precision-recall curve AUC score was 0.71. All features were incorporated into the models, with saccade frequency and skin conductance response identified as particularly important. These trends aligned with subjective assessments of VIMS severity. This study contributes to advancing the use of remote-controlled machinery by addressing a critical challenge to operator performance and safety.

The prevalence of seasickness in a population of French civilian sailors.

BACKGROUND: Motion sickness, is the onset of a series of clinical signs when travelling in a means of locomotion. Boats are the most common source of kinetosis, causing seasickness. Although this condition is often benign, it can severely affect the quality of life of seafarers, as well as the quality of their work. The aim of this study is to focus on the point prevalence and characteristics of seasickness in a population of French civilian seafarers from all shipping sectors. MATERIALS AND METHODS: During two months in 2023, we conducted a cross-sectional study based on a questionnaire containing 28 questions. RESULTS: One hundred nine men and 10 women completed the questionnaire. Of these, 34% said they were seasick. The main symptoms described by the sailors were nausea and cold sweats in 87.5% and 50% of cases, respectively. The prevalence of naupathy appears to be higher in women (60% compared with 31% in men). Women also seem to be less accustomed to the marine environment than men, with 71% of men and only 33% of women indicating that they get accustomed to life at sea. However, the symptoms of seasickness seem to disappear more slowly in men than in women. In terms of treatment, men (38%) were more likely to take medication than women (17%). CONCLUSIONS: Our study shows a greater susceptibility to seasickness among women. This interpretation should be treated with caution given the small number of women who took part in the study. The relatively low point prevalence of seasickness (34%) could be due to under-reporting. Although ways of thinking are changing, seasickness is still a taboo subject for many sailors. Yet seasickness has major professional and personal repercussions. So it's important to raise the subject and discuss strategies for improving well-being at work.

SmoothRide: A Versatile Solution to Combat Cybersickness in Elevation-Altering Environments.

Cybersickness continues to bar many individuals from taking full advantage of virtual reality (VR) technology. Previous work has established that navigating virtual terrain with elevation changes poses a significant risk in this regard. In this paper, we investigate the effectiveness of three cybersickness reduction strategies on users performing a navigation task across virtual elevation-altering terrain. These strategies include static field of view (FOV) reduction, a flat surface approach that disables terrain collision and maintains constant elevation for users, and SmoothRide, a novel technique designed to dampen a user's perception of vertical motion as they travel. To assess the impact of these strategies, we conducted a within-subjects study involving 61 participants. Each strategy was compared against a control condition, where users navigated across terrain without any cybersickness reduction measures in place. Cybersickness data were collected using the Fast Motion Sickness Scale (FMS) and Simulator Sickness Questionnaire (SSQ), along with galvanic skin response (GSR) data. We measured user presence using the IGroup Presence questionnaire (IPQ) and a Single-Item Presence Scale (SIP). Our findings reveal that users experienced significantly lower levels of cybersickness using SmoothRide or FOV reduction. Presence scores reported on the IPQ were statistically similar between SmoothRide and the control condition. Conversely, terrain flattening had adverse effects on user presence scores, and we could not identify a significant effect on cybersickness compared to the control. We demonstrate that SmoothRide is an effective, lightweight, configurable, and easy-to-integrate tool for reducing cybersickness in simulations featuring elevation-altering terrain.

Deep insights into the mechanism of isorhamnetin's anti-motion sickness effect based on photoshoproteomics.

Isorhamnetin has recently been found to exhibit a remarkable anti-motion sickness effect, yet the underlying mechanism is still unclear. Herein, network pharmacology was employed to conduct a preliminary analysis on the possible biological processes involved. Results showed that common targets were localized in membranes, mitochondria, and glutamatergic synapses. In particular, protein phosphorylation, protein serine/threonine/tyrosinase activity and signal transduction might play a role in isorhamnetin's anti-motion sickness effect. Thus, mice phosphoproteomics analysis was further performed to explore the phosphorylated protein changes in the motion sickness process. Results showed that differentially phosphorylated proteins have an effect on postsynaptic density, glutamatergic synapses and other sites and are involved in various neurodegenerative disease pathways, endocytic pathways, cAMP signaling pathways and MAPK signaling pathways. Two key differentially phosphorylated proteins in glutamatergic synapses, namely, DLGAP and EPS8, might play key roles in isorhamnetin's anti-motion sickness process. The final molecular experimental verification results from qRT-PCR and western blot analyses indicated that isorhamnetin firstly regulates glutamatergic synapses and then reduces the excitability of the vestibular nucleus through inhibiting the NMDAR1/CaMKII/CREB signaling pathway, ultimately alleviating a series of symptoms of motion sickness in mice. The findings of this study provide valuable insights and a useful theoretical basis for the application of isorhamnetin as a new anti-motion sickness food ingredient.

Motion sickness and visual impairment.

Motion sickness (MS) is caused by exposure to unfamiliar movements. The theory is that MS is due to a conflict between information perceived by the vestibular, visual, and somatosensory systems. This study examines the role of vision in MS by comparing MS susceptibility among individuals with varying degrees of visual impairments to sighted individuals. We hypothesized that subjects with no perception of light would be less susceptible to MS than less impaired subjects, who would themselves be less susceptible than sighted subjects. To address these, the Motion Sickness Susceptibility Questionnaire (MSSQ1) was administered to 340 subjects (170 visually impaired paired with 170 sighted subjects) to assess their susceptibility to various modes of transport under real conditions. Visually impaired subjects were divided into subgroups according to the presence (partially sighted) or absence (totally blind) of light perception, as well as the period of onset of impairment (congenital or acquired). Totally blind individuals are significantly less susceptible to MS than partially sighted (p = 0.001), and sighted (p < 0.001) subjects, with no difference between partially sighted and sighted subjects (p = 0.526). Additionally, acquired totally blind subjects are less susceptible to MS than congenitally blind subjects (p = 0.038). Thus, despite a lower susceptibility totally blind subjects may still be susceptible to MS. The absence of vision reduces MS susceptibility but does not completely prevent it. This suggests that vision is more a mediator, than an essential condition for MS appearance.

Scopolamine for patients with motion sickness: a systematic review and meta-analysis with trial sequential analysis.

BACKGROUND: Scopolamine has been demonstrated to relieve motion sickness. However, repeated significance testing may increase false-positive results. OBJECTIVES: Review the efficacy and safety of scopolamine in the prevention of motion sickness by performing a meta-analysis with Trial Sequential Analysis (TSA). MATERIAL AND METHODS: Randomized controlled trials (RCTs) compared scopolamine with other medications or placebo were included. Primary outcomes were nausea reported and head movement time. RESULTS: Twenty studies with 753 participants were included. Scopolamine had a greater reported reduction in nausea than placebo (relative risk [RR] 0.35; 95% confidence interval [CI] 0.24 to 0.52; p<0.00001; I2 = 45%), while TSA showed the included sample size exceeded the required information size (RIS). There is no difference in head movement time between scopolamine and placebo (mean difference [MD] 2.02; 95% CI -1.2 to 5.25; p = 0.6; I2 = 0%), while the included sample size did not reach RIS. CONCLUSION: Scopolamine is effective for motion sickness nausea compared to placebo. The TSA recommends conducting more head movement trials to validate the objective efficacy of scopolamine. SIGNIFICANCE: Clarifying the efficacy of scopolamine for motion sickness, the TSA highlights the need for more prospective studies using head movement as an outcome.

Is Video Gaming a Cure for Cybersickness? Gamers Experience Less Cybersickness Than Non-Gamers in a VR Self-Motion Task.

Cybersickness remains a major drawback of Virtual Reality (VR) headsets, as a breadth of stationary experiences with visual self-motion can result in visually-induced motion sickness. However, not everybody experiences the same intensity or type of adverse symptoms. Here we propose that prior experience with virtual environments can predict ones degree of cybersickness. Video gaming can enhance visuospatial abilities, which in-turn relate negatively to cybersickness - meaning that consistently engaging in virtual environments can result in protective habituation effects. In a controlled stationary VR experiment, we found that 'VR-naive' video gamers experienced significantly less cybersickness in a virtual tunnel-travel task and outperformed 'VR-naive' non-video gamers on a visual attention task. These findings strongly motivate the use of non-VR games for training VR cybersickness resilience, with future research needed to further understand the mechanism(s) by which gamers become cybersickness resilient - potentially expanding access to VR for even the most susceptible participants.

Effects of within-day intervals on adaptation to visually induced motion sickness in a virtual-reality motorcycling simulator.

This study investigated the effects of the time interval between virtual reality (VR) sessions on visually induced motion sickness (VIMS) reduction to better understand adaptation to and recovery from a nauseating VR experience. The participants experienced two 6-min VR sessions of a first-person motorcycle ride through a head-mounted display with (1) a 6-min interval, (2) an interval until the VIMS score reached zero, and (3) a 60-min interval. The results showed that for each condition, VIMS in the second session was aggravated, unchanged, or attenuated, respectively, indicating that additional resting time was necessary for VIMS adaptation. This study suggests that a certain type of multisensory learning attenuates VIMS symptoms within a relatively short time, requiring at least 20 min of additional resting time after subjective recovery from VIMS symptoms. This finding has important implications for reducing the time interval between repeated challenges when adapting to nauseating stimuli during VR experiences.

Rapid reconfiguration of cortical networks after repeated exposure to visual-vestibular conflicts.

Visual-vestibular conflicts can induce motion sickness and further postural instability. Visual-vestibular habituation is recommended to reduce the symptoms of motion sickness and improve postural stability with an altered multisensory reweighting progress. However, it is unclear how the human brain reweights multisensory information after repeated exposure to visual-vestibular conflicts. Therefore, we synchronized a rotating platform and a virtual scene to present visual-vestibular congruent (natural visual stimulation) and incongruent (conflicted visual stimulation) conditions and collected EEG and center of pressure (COP) data. We constructed the effective brain connectivity of region of interest (ROI) derived from source-space EEG in theta-band activity, and quantified the postural stability and the inflow and outflow of each ROI. We found repeated exposure to congruent and incongruent conditions both decreased COP path length and increased COP complexity. Besides, we found that repeated exposure to the incongruent environment decreased the inflow into visual cortex, suggesting the brain down-weighted the less reliable visual information for postural stability. In contrast, repeated exposure to the congruent environment increased the inflow into posterior parietal cortex and the outflow from visual cortex and S1, suggesting an increase in efficiency of multisensory integration. We concluded that repeated exposure to congruent and incongruent conditions both improved postural stability with different multisensory reweighting patterns as revealed by different dynamic changes of brain networks.

Neuro-ophthalmic and Neuro-otologic Evaluation in Individuals with Motion Sickness Susceptibility.

Since the physiological background of motion sickness is not entirely clear, it was aimed to examine the physiological differences in groups consisting of individuals susceptible and non-susceptible to motion sickness. Sixty subjects [motion sickness (MS) group: 33 female, 3 male; 28.8 ± 8.1 years; control group: 19 female, 5 male; 24.5 ± 4.3 years] were included in the study. Near visual acuity test on the treadmill in the presence of visual stimulation, pattern visual-evoked potentials, oculomotor tests, and computerized dynamic posturography were applied. Receiver operating characteristic analysis was performed to determine the parameter that provides the excellent discrimination between the groups. The most effective parameter in differentiating the study groups was determined as dynamic visual acuity with 77.8% sensitivity and 95.8% specificity. Significant differences were found in the vestibular (mean ± standard deviation: 0.63 ± 0.17), visual (0.77 ± 0.18), and composite scores (73.11 ± 11.89) of the patients (P=.000) in posturographic evaluation. In the visual-evoked potential examination, a significant decrease was found in the amplitude values between the P100-N145 waves in the binocular (5.0 ± 2.8, P=.002), right eye (7.6 ± 3.2, P=.009) and left eye (7.9 ± 2.9, P=.016) in the symptomatic patients. In binocular oculomotor evaluation, directional asymmetric findings were obtained. It has been shown that the most effective test parameter that distinguishes the MS susceptible and non-susceptible individuals is the dynamic visual acuity value. Based on the results of neuro-physiological tests, it was suggested that a possible visual-vestibular integration disorder in individuals susceptible to motion sickness may affect visual and vestibular performance.

Alpha tACS on Parieto-Occipital Cortex Mitigates Motion Sickness Based on Multiple Physiological Observation.

Approximately one third of the population is prone to motion sickness (MS), which is associated with the dysfunction in the integration of sensory inputs. Transcranial alternating current stimulation (tACS) has been widely used to modulate neurological functions by affecting neural oscillation. However, it has not been applied in the treatment of motion sickness. This study aims to investigate changes in brain oscillations during exposure to MS stimuli and to further explore the potential impact of tACS with the corresponding frequency and site on MS symptoms. A total of 19 subjects were recruited to be exposed to Coriolis stimuli to complete an inducing session. After that, they were randomly assigned to tACS stimulation group or sham stimulation group to complete a stimulation session. Electroencephalography (EEG), electrocardiogram, and galvanic skin response were recorded during the experiment. All the subjects suffering from obvious MS symptoms after inducing session were observed that alpha power of four channels of parieto-occipital lobe significantly decreased (P7: t =3.589, p <0.001; P8: t =2.667, p <0.05; O1: t =3.556, p <0.001; O2: t =2.667, p <0.05). Based on this, tACS group received the tACS stimulation at 10Hz from Oz to CPz. Compared to sham group, tACS stimulation significantly improved behavioral performance and entrained the alpha oscillation in individuals whose alpha power decrease during the inducing session. The findings show that parieto-occipital alpha oscillation plays a critical role in the integration of sensory inputs, and alpha tACS on parieto-occipital can become a potential method to mitigate MS symptoms.

Unleashing the Potential of ß -cyclodextrin Inclusion Complexes in Bitter Taste Abatement: Development, Optimization and Evaluation of Taste Masked Anti-emetic Chewing Gum of Promethazine Hydrochloride.

Motion sickness also known as kinetosis is a condition in which there exists a disagreement between visually perceived movement and the vestibular system's sense of movement. Nausea, vomiting, dizziness, fatigue, and headache are the most common symptoms of motion sickness. This study mainly focuses on the taste masking of Promethazine Hydrochloride (PMZ) by inclusion complexation method, its formulation development in the chewing gum form by using directly compressible gum base HIG® and its quality and performance testing. Different molar ratios (1:1, 1:2, 1:3 and 1:4) of PMZ-cyclodextrin complexes were prepared by using ß-Cyclodextrin (ß-CD) as a taste masking agent. These complexes were evaluated for FTIR, DSC, % Entrapment Efficiency, % drug yield, and taste evaluation by E-Tongue. The optimized ratio was further evaluated by sophisticated analytical techniques such as Scanning Electron Microscopy (SEM) and X-Ray Diffraction (XRD). A central composite design (CCD) (3 ^2) was utilized to examine the effects of independent variables (amount of gum-X1 and amount of plasticizer-X2) on dependent variables (%CDRY1 and hardness Y2). The prepared gums were evaluated for drug content, organoleptic properties, in-vitro dissolution testing by fabricated disintegration apparatus, texture analysis, etc. The optimization statistics showed that on decreasing the amount of gum, in- vitro drug release increases and hardness decreases. The optimized batch MCG-2 of Promethazine MCG showed 92.34 ± 0.92% of drug release, whereas for marketed formulation (Phenergan®-25 mg) drug release value was 86.19 ± 1.88%. Results provided evidence that PMZ MCGs could be a better alternative to conventional tablet formulations with improved drug release, palatability and texture.

Detection of virtual reality motion sickness based on EEG using asymmetry of entropy and cross-frequency coupling.

The existence of Virtual Reality Motion Sickness (VRMS) is a key factor restricting the further development of the VR industry, and the premise to solve this problem is to be able to accurately and effectively detect its occurrence. In view of the current lack of high-accuracy and effective detection methods, this paper proposes a VRMS detection method based on entropy asymmetry and cross-frequency coupling value asymmetry of EEG. First of all, the EEG of the four selected pairs of electrodes on the bilateral brain are subjected to Multivariate Variational Mode Decomposition (MVMD) respectively, and three types of entropy values on the low-frequency and high-frequency components are calculated, namely approximate entropy, fuzzy entropy and permutation entropy, as well as three types of phase-amplitude coupling features between the low-frequency and high-frequency components, namely the mean value, standard deviation and correlation coefficient; Secondly, the difference of the entropies and the cross-frequency coupling features between the left electrodes and the right electrodes are calculated; Finally, the final feature set are selected via t-test and fed into the SVM for classification, thus realizing the automatic detection of VRMS. The results show that the three classification indexes under this method, i.e., accuracy, sensitivity and specificity, reach 99.5 %, 99.3 % and 99.7 %, respectively, and the value of the area under the ROC curve reached 1, which proves that this method can be an effective indicator for detecting the occurrence of VRMS.

Feature extraction method of EEG based on wavelet packet reconstruction and deep learning model of VR motion sickness feature classification and prediction.

The surging popularity of virtual reality (VR) technology raises concerns about VR-induced motion sickness, linked to discomfort and nausea in simulated environments. Our method involves in-depth analysis of EEG data and user feedback to train a sophisticated deep learning model, utilizing an enhanced GRU network for identifying motion sickness patterns. Following comprehensive data pre-processing and feature engineering to ensure input accuracy, a deep learning model is trained using supervised and unsupervised techniques for classifying and predicting motion sickness severity. Rigorous training and validation procedures confirm the model's robustness across diverse scenarios. Research results affirm our deep learning model's 84.9% accuracy in classifying and predicting VR-induced motion sickness, surpassing existing models. This information is vital for improving the VR experience and advancing VR technology.

Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder where individuals consistently feel self-motion, often triggered by motion like being on a boat (MT-MdDS). Due to the unknown pathophysiological mechanism, available treatment options for managing symptoms are limited. Our objective was to develop a virtual reality application (VRA) to simulate the full field optokinetic stimulation (OKS) booth and evaluate its efficacy compared to the standard treatment. In our randomized, open, non-inferiority clinical trial with 30 â€‹MT-MdDS patients, 15 received the OKS booth and 15 the new VRA over four consecutive days. Two 4-min treatment blocks were scheduled in the morning and afternoon, with a total of four blocks. Treatment effectiveness was evaluated through questionnaires and posturography. Our findings suggest that the choice of modality does not significantly differ in achieving an overall improvement in symptoms. We advocate that the VRA can be used as an accessible alternative to the booth method worldwide, effectively mitigating MdDS symptoms and enhancing the QoL of numerous MdDS patients.

[Development and evaluation of the simplified Chinese versions of motion sickness susceptibility questionnaire].

Objective: To develop and evaluate the simplified Chinese versions of motion sickness susceptibility questionnaire (MSSQ)-long (MSSQ-L) and MSSQ-short (MSSQ-S). Methods: A cross-sectional study was conducted in May 2023 among 3 426 university students at North China University of Science and Technology. The Chinese versions of MSSQ-L and MSSQ-S were distributed, and item selection for Simplified Chinese versions of MSSQ-L and MSSQ-S was performed based on item response rates, item-total correlations, Cronbach's alpha coefficients, and standard deviations. Forty-five male and forty-five female participants were recruited from the initial survey population to complete Coriolis acceleration endurance testing and fill out the simplified Chinese versions of MSSQ-L and MSSQ-S, and Graybiel symptom severity score questionnaire. Internal consistency, external consistency, criterion validity, discriminant validity, and predictive accuracy for motion sickness severity were assessed. Results: A total of 3 111 valid responses were received for the Chinese versions of MSSQ, yielding an effective response rate of 90.8% (3 111/3 426). Among the 3 111 students surveyed, there were 965 males and 2 146 females, with a mean age of (19.5±1.4) years. The highest usage rates for item were observed for cars (98.9%, 3 077/3 111) and buses (98.8%, 3 073/3 111). The simplified Chinese versions of MSSQ-L and MSSQ-S consisted of four and eight items, respectively. The Cronbach's alpha coefficients were 0.900 and 0.953 for the simplified Chinese versions of MSSQ-S and MSSQ-L, respectively, with test-retest reliabilities of 0.895 and 0.908. Criterion validity coefficients were 0.814 and 0.765 for the simplified Chinese versions of MSSQ-S and MSSQ-L, respectively. In terms of discriminant validity, significant differences were observed between mild and moderate susceptibility groups [0(0, 3) vs 6(2, 10), P=0.006] and between moderate and severe susceptibility groups [6(2, 10) vs 9(6, 13), P=0.030] for the simplified Chinese version of MSSQ-S. Significant differences were also observed between mild and moderate susceptibility groups [5(0, 3) vs 7(3, 10), P=0.001], but not between moderate and severe susceptibility groups [7(3, 10) vs 7(3, 10), P=0.081] for simplified Chinese version of MSSQ-L. The overall predictive accuracy for motion sickness severity improved from 55.6% (50/90) to 62.2% (56/90) for the simplified Chinese version of MSSQ-S and from 54.4% (49/90) to 58.9% (53/90) for the simplified Chinese version of MSSQ-L, but with no statistically significant differences (both P>0.05). Conclusions: The simplified Chinese versions of MSSQ-L and MSSQ-S demonstrates good reliability and validity. The simplified Chinese version of MSSQ-S exhibits satisfactory discriminant validity, and can serve as a simple and efficient tool for assessing motion sickness susceptibility.

Classification of Visually Induced Motion Sickness Based on Phase-Locked Value Functional Connectivity Matrix and CNN-LSTM.

To effectively detect motion sickness induced by virtual reality environments, we developed a classification model specifically designed for visually induced motion sickness, employing a phase-locked value (PLV) functional connectivity matrix and a CNN-LSTM architecture. This model addresses the shortcomings of traditional machine learning algorithms, particularly their limited capability in handling nonlinear data. We constructed PLV-based functional connectivity matrices and network topology maps across six different frequency bands using EEG data from 25 participants. Our analysis indicated that visually induced motion sickness significantly alters the synchronization patterns in the EEG, especially affecting the frontal and temporal lobes. The functional connectivity matrix served as the input for our CNN-LSTM model, which was used to classify states of visually induced motion sickness. The model demonstrated superior performance over other methods, achieving the highest classification accuracy in the gamma frequency band. Specifically, it reached a maximum average accuracy of 99.56% in binary classification and 86.94% in ternary classification. These results underscore the model's enhanced classification effectiveness and stability, making it a valuable tool for aiding in the diagnosis of motion sickness.

Compliance of volunteers in a fully-enclosed patient rotation system for MR-guided radiation therapy: a prospective study.

BACKGROUND: Particle therapy makes a noteworthy contribution in the treatment of tumor diseases. In order to be able to irradiate from different angles, usually expensive, complex and large gantries are used. Instead rotating the beam via a gantry, the patient itself might be rotated. Here we present tolerance and compliance of volunteers for a fully-enclosed patient rotation system in a clinical magnetic resonance (MR)-scanner for potential use in MR-guided radiotherapy, conducted within a prospective evaluation study. METHODS: A patient rotation system was used to simulate and perform magnetic resonance imaging (MRI)-examinations with 50 volunteers without an oncological question. For 20 participants, the MR-examination within the bore was simulated by introducing realistic MRI noise, whereas 30 participants received an examination with image acquisition. Initially, body parameters and claustrophobia were assessed. The subjects were then rotated to different angles for simulation (0°, 45°, 90°, 180°) and imaging (0°, 70°, 90°, 110°). At each angle, anxiety and motion sickness were assessed using a 6-item State-Trait-Anxiety-Inventory (STAI-6) and a modified Motion Sickness Assessment Questionnaire (MSAQ). In addition, general areas of discomfort were evaluated. RESULTS: Out of 50 subjects, three (6%) subjects terminated the study prematurely. One subject dropped out during simulation due to nausea while rotating to 45°. During imaging, further two subjects dropped out due to shoulder pain from positioning at 90° and 110°, respectively. The average result for claustrophobia (0 = no claustrophobia to 4 = extreme claustrophobia) was none to light claustrophobia (average score: simulation 0.64 ± 0.33, imaging 0.51 ± 0.39). The mean anxiety scores (0% = no anxiety to 100% = maximal anxiety) were 11.04% (simulation) and 15.82% (imaging). Mean motion sickness scores (0% = no motion sickness to 100% = maximal motion sickness) of 3.5% (simulation) and 6.76% (imaging) were obtained across all participants. CONCLUSION: Our study proves the feasibility of horizontal rotation in a fully-enclosed rotation system within an MR-scanner. Anxiety scores were low and motion sickness was only a minor influence. Both anxiety and motion sickness showed no angular dependency. Further optimizations with regard to immobilization in the rotation device may increase subject comfort.

Atrial Natriuretic Peptide Alleviates Motion Sickness Potentially through Regulating Endolymph Volume in the Inner Ear Increased by Arginine Vasopressin.

INTRODUCTION: Dimenhydrinate and scopolamine are frequently used drugs, but they cause drowsiness and performance decrement. Therefore, it is crucial to find peripheral targets and develop new drugs without central side effects. This study aimed to investigate the anti-motion sickness action and inner ear-related mechanisms of atrial natriuretic peptide (ANP). METHODS: Endolymph volume in the inner ear was measured with magnetic resonance imaging and expression of AQP2 and p-AQP2 was detected with Western blot analysis and immunofluorescence method. RESULTS: Both rotational stimulus and intraperitoneal arginine vasopressin (AVP) injection induced conditioned taste aversion (CTA) to 0.15% sodium saccharin solution and an increase in the endolymph volume of the inner ear. However, intraperitoneal injection of ANP effectively alleviated the CTA behaviour and reduced the increase in the endolymph volume after rotational stimulus. Intratympanic injection of ANP also inhibited rotational stimulus-induced CTA behaviour, but anantin peptide, an inhibitor of ANP receptor A (NPR-A), blocked this inhibitory effect of ANP. Both rotational stimulus and intraperitoneal AVP injection increased the expression of AQP2 and p-AQP2 in the inner ear of rats, but these increases were blunted by ANP injection. In in vitro experiments, ANP addition decreased AVP-induced increases in the expression and phosphorylation of AQP2 in cultured endolymphatic sac epithelial cells. CONCLUSION: Therefore, the present study suggests that ANP could alleviate motion sickness through regulating endolymph volume of the inner ear increased by AVP, and this action of ANP is potentially mediated by activating NPR-A and antagonising the increasing effect of AVP on AQP2 expression and phosphorylation.