PURPOSE The predominant neurotransmitters and receptors for acute and delayed chemotherapy-induced nausea and vomiting (CINV) are represented in the current paradigm, which reflects successful control of emesis. However, control of nausea (N) lags behind management of vomiting (V). This review aims to re-examine and incorporate new information about the mechanisms of V and N. METHODS The initial literature search focused on CINV. Keywords in articles led to subsequent discovery of publications focused on N&V in other medical and scientific fields (e.g., gastroenterology, neurology, cannabinoid science, neuropharmacology, and motion sickness). Using keywords to identify other sources continued until no further recent, meaningful publications were found. RESULTS More than 86% of references were from recent non-oncology journals and books, suggesting there are many areas for cross-fertilization research into mechanisms and management of N&V-particularly of N, which involves overlapping and dissimilar CNS areas from V. Information from cited articles was incorporated into visual representation of N&V, which is certainly not exhaustive but supports highly complex processes in the stomach and gut, the vagus nerve and spinal cord neurons, the nucleus tractus solitarii, and the anterior insular cortex and anterior cingulate cortex with input from the amygdala. CONCLUSIONS These data support the idea that mechanisms for N, whatever the cause, must be highly similar. Continued research into nausea, including patient-reported evaluation and outcomes, is important; interventions for nausea could be considered adjuvants to current standard of care antiemetics and be individualized, depending on patient-reported efficacy and adverse effects and preferences.

中文翻译：

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重新审视恶心和呕吐的生理学——挑战范式。

目的 急性和延迟化疗引起的恶心和呕吐 (CINV) 的主要神经递质和受体在当前范式中得到体现，这反映了呕吐的成功控制。然而，恶心 (N) 的控制落后于呕吐 (V) 的管理。这篇综述旨在重新审视和整合关于 V 和 N 机制的新信息。 方法 最初的文献搜索集中在 CINV。文章中的关键词导致随后在其他医学和科学领域（例如，胃肠病学、神经病学、大麻素科学、神经药理学和晕动病）中发现了专注于 N&V 的出版物。继续使用关键字来识别其他来源，直到没有发现更近期的、有意义的出版物。结果超过 86% 的参考文献来自最近的非肿瘤学期刊和书籍，表明对 N&V 的机制和管理有许多交叉研究领域，尤其是 N，这涉及与 V 重叠和不同的 CNS 区域。来自引用文章的信息被纳入 N&V 的视觉表示，这当然不是详尽的，但支持胃和肠道、迷走神经和脊髓神经元、孤束核、前岛叶皮层和前扣带皮层中高度复杂的过程，来自杏仁核的输入。结论 这些数据支持这样一种观点，即无论是什么原因，N 的机制都必须高度相似。继续研究恶心，包括患者报告的评估和结果，很重要；恶心的干预措施可以被认为是目前止吐剂护理标准的辅助手段，并且是个体化的，