Pathways and nerve densities in cerebrovascular innervation

It is gradually becoming clear that cerebrovascular nerves contribute to the control of the cerebral circulation although the knowledge of the functional mechanisms is far from complete. However, many aspects of the morphologic substrate have been identified. The basal cerebral arteries receive sympathetic, parasympathetic and sensory innervation, utilizing the superior cervical and stellate, the pterygopalatine and otic, and the trigeminal ganglia, respectively, as the main peripheral sources. Many of the neural pathways to the cerebral arteries have been elucidated. Those to the supratentorial arterial tree are distributed via the cavernous sinus and surrounding regions. Not only the "classical" neurotransmitters, but also many neuropeptides are found in cerebrovascular nerves. This will lead to new insights since the concepts of cotransmission and neuromodulation have been established now. In the arterial wall, a multilayered organization of nerves has been recognized, consisting of paravascular nerve bundles of passage, a superficial plexus and a terminal plexus located at the adventitial-medial border. Human basal cerebral arteries display a topographical heterogeneity of densities of terminal nerve plexuses. Highest nerve densities are found in arterial segments forming the circle of Willis, in the efferent part of the posterior cerebral artery and in the anterior choroidal artery. Nerve density appears to be determined by locality rather than vascular diameter. Furthermore, local decreases in nerve density are observed with ageing and disease in animals and humans.Biomedical Reviews 1995; 4: 35-46

Endoscopic vs. microscopic stapes surgery:An anatomical feasibility study

OBJECTIVES: To investigate the feasibility of the endoscopic approach vs. microscopic approach during stapes surgery, focusing on the visualization of the important anatomical structures of the middle ear, the volume of the resected scutum and chorda tympani (CT) injury. METHODS: Fresh frozen human cadaveric heads underwent two stapes surgeries using an operating microscope on one ear and an endoscope on the other ear. The surgeon documented the visualization of critical landmarks, as well as exposure and injury of the CT. The volume of resected scutum was evaluated using cone beam computed tomography scanning and three-dimensional imaging. RESULTS: We performed endoscopic stapes surgery in 10 ears and microscopic stapes surgery in 11 ears. A stapes prosthesis was placed in all ears. The volume of bony scutum resection was significantly lower in the endoscopic group (median = 2.20 mm 3, IQR = 4.17) than in the microscopic group (median 13.25 mm 3, IQR = 8.71). No scutum was removed in two endoscopic ears, while scutum was removed in all microscopic ears. The endoscopic and microscopic group had similar CT injury. CONCLUSIONS: This study showed that the endoscopic stapes surgery procedure is feasible and might be less invasive than microscopic stapes surgery. Future clinical prospective and functional studies will be needed to support our findings

THE INITIATION OF BINOCULAR RIVALRY

Binocular rivalry refers to the perceptual alternation that occurs while viewing incompatible images, in which one monocular image is dominant and the other is suppressed. Rivalry has been closely studied but the neural site at which it is initiated is still controversial. The central claim of this thesis is that primary visual cortex is responsible for its initiation. This claim is supported by evidence from four experimental studies. The first study (described in Chapter 4) introduces the methodology for measuring visual sensitivity during dominance and suppression and compares several methods to see which yields the greatest difference between these two sensitivities. Suppression depth was measured by comparing the discrimination thresholds to a brief test stimulus delivered during dominance and suppression phases. The deepest suppression was achieved after a learning period, with the test stimulus presented for 100 ms and with post-test masking. The second study (Chapter 5) compares two hypotheses for the mechanism of binocular rivalry. Under eye suppression, visibility decreases when the tested eye is being suppressed, regardless of the test stimulus’s features. Feature suppression, however, predicts that reduction of visibility is caused by suppression of a stimulus feature, no matter which eye is suppressed. Eye suppression claims that monocular channels in the visual system alternate between dominance and suppression, while Feature suppression assumes that the features of stimuli inhibit each other perceptually in the high-level cortex. The experiment used a test stimulus similar in features to one, but not the other, rivalry-inducing stimulus. Test sensitivity was found to be lowered when the test stimulus was presented to the eye whose rivalry-inducing stimulus was suppressed. Sensitivity was not lowered when the test stimulus was presented to the other eye, even when the test shared features with the suppressed stimulus. The conclusion is that feature suppression is weak or does not exist without eye suppression, and that rivalry therefore originates in the primary visual cortex. If binocular rivalry is initiated in the primary visual cortex, stimuli producing no coherent activity in that area should produce no rivalry. In the third study (Chapter 6) this idea was tested with rotating arrays of short-lifetime dots. The dots with the shortest lifetime produced an image with no rotation signal, and an infinite lifetime produced rigid rotation. Subjects could discriminate the rotation direction with high accuracy at all but the shortest lifetime. When the two eyes were presented with opposite directions of rotation, there was binocular rivalry only at the longest lifetimes. Stimuli with short lifetimes produce a coherent motion signal, since their direction can be discriminated, but do not produce rivalry. A simple interpretation of this observation is that binocular rivalry is initiated at a level in the visual hierarchy below that which supports the motion signal. The model supported by the results of previous chapters requires that binocular rivalry suppression be small in the primary visual cortex, and builds up as signals progress along the visual pathway. This model predicts that for judgements dependent on activity in high visual cortex: 1. Binocular rivalry suppression should be deep; 2. Responses should be contrast invariant. The fourth and last study (chapter 7) confirmed these predictions by measuring suppression depth in two ways. First, two similar forms were briefly presented to one eye: the difference in shapes required for their discrimination was substantially greater during suppression than during dominance. Second, the two forms were made sufficiently different in shape to allow easy discrimination at high contrast, and the contrast of these forms was lowered to find the discrimination threshold. The results in the second experiment showed that contrast sensitivity did not differ between the suppression and dominance states. This invariance in contrast sensitivity is interpreted in terms of steep contrast-response functions in cortex beyond the primary visual area. The work in this thesis supports the idea that binocular rivalry is a process distributed along the visual pathway. More importantly, the results provide several lines of evidence that binocular rivalry is initiated in primary visual cortex

A cost effeciency approach to universal access for public transport for disabled people

Purpose To determine the intervendor variability of Agatston scoring determined with state-of-the-art computed tomographic (CT) systems from the four major vendors in an ex vivo setup and to simulate the subsequent effects on cardiovascular risk reclassification in a large population-based cohort. Materials and Methods Research ethics board approval was not necessary because cadaveric hearts from individuals who donated their bodies to science were used. Agatston scores obtained with CT scanners from four different vendors were compared. Fifteen ex vivo human hearts were placed in a phantom resembling an average human adult. Hearts were scanned at equal radiation dose settings for the systems of all four vendors. Agatston scores were quantified semiautomatically with software used clinically. The ex vivo Agatston scores were used to simulate the effects of different CT scanners on reclassification of 432 individuals aged 55 years or older from a population-based study who were at intermediate cardiovascular risk based on Framingham risk scores. The Friedman test was used to evaluate overall differences, and post hoc analyses were performed by using the Wilcoxon signed-rank test with Bonferroni correction. Results Agatston scores differed substantially when CT scanners from different vendors were used, with median Agatston scores ranging from 332 (interquartile range, 114-1135) to 469 (interquartile range, 183-1381; P < .05). Simulation showed that these differences resulted in a change in cardiovascular risk classification in 0.5\%-6.5\% of individuals at intermediate risk when a CT scanner from a different vendor was used. Conclusion Among individuals at intermediate cardiovascular risk, state-of the-art CT scanners made by different vendors produced substantially different Agatston scores, which can result in reclassification of patients to the high- or low-risk categories in up to 6.5\% of cases. © RSNA, 2014

Nebuliser therapy in the intensive care unit

The relationship between identity, lived experience, sexual practices and the language through which these are conveyed has been widely debated in sexuality literature. For example, ‘coming out’ has famously been conceptualised as a ‘speech act’ (Sedgwick 1990) and as a collective narrative (Plummer 1995), while a growing concern for individuals’ diverse identifications in relations to their sexual and gender practices has produced interesting research focusing on linguistic practices among LGBT-identified individuals (Leap 1995; Kulick 2000; Cameron and Kulick 2006; Farqhar 2000). While an explicit focus on language remains marginal to literature on sexualities (Kulick 2000), issue of language use and translation are seldom explicitly addressed in the growing literature on intersectionality. Yet intersectional perspectives ‘reject the separability of analytical and identity categories’ (McCall 2005:1771), and therefore have an implicit stake in the ‘vernacular’ language of the researched, in the ‘scientific’ language of the researcher and in the relationship of continuity between the two. Drawing on literature within gay and lesbian/queer studies and cross-cultural studies, this chapter revisits debates on sexuality, language and intersectionality. I argue for the importance of giving careful consideration to the language we choose to use as researchers to collectively define the people whose experiences we try to capture. I also propose that language itself can be investigated as a productive way to foreground how individual and collective identifications are discursively constructed, and to unpack the diversity of lived experience. I address intersectional complexity as a methodological issue, where methodology is understood not only as the methods and practicalities of doing research, but more broadly as ‘a coherent set of ideas about the philosophy, methods and data that underlie the research process and the production of knowledge’ (McCall 2005:1774). My points are illustrated with examples drawn from my ethnographic study on ‘lesbian’ identity in urban Russia, interspersed with insights from existing literature. In particular, I aim to show that an explicit focus on language can be a productive way to explore the intersections between the global, the national and the local in cross-cultural research on sexuality, while also addressing issues of positionality and accountability to the communities researched

A comparative anatomical and histological study on the presence of an apical splenic nerve in mice and humans

The cranial pole of the mouse spleen is considered to be parasympathetically innervated by a macroscopic observable nerve referred to as the apical splenic nerve (ASN). Electrical stimulation of the ASN resulted in increased levels of splenic acetylcholine, decreased lipopolysaccharide-induced levels of systemic tumor necrosis factor alpha and mitigated clinical symptoms in a mouse model of rheumatoid arthritis. If such a discrete ASN would be present in humans, this structure is of interest as it might represent a relatively easily accessible electrical stimulation target to treat immune-mediated inflammatory diseases. So far, it is unknown if a human ASN equivalent exists. This study aimed to provide a detailed description of the location and course of the ASN in mice. Subsequently, this information was used for a guided exploration of an equivalent structure in humans. Microscopic techniques were applied to confirm nerve identity and compare ASN composition. Six mice and six human cadavers were used to study and compare the ASN, both macro- and microscopically. Macroscopic morphological characteristics of the ASN in both mice and humans were described and photographs were taken. ASN samples were resected, embedded in paraffin, cut in 5 μm thin sections where after adjacent sections were stained with a general, sympathetic and parasympathetic nerve marker, respectively. Neural identity and nerve fiber composition was then evaluated microscopically. Macroscopically, the ASN could be clearly identified in all mice and was running in the phrenicosplenic ligament connecting the diaphragm and apical pole of the spleen. If a phrenicosplenic ligament was present in humans, a similar configuration of potential neural structures was observed. Since the gastrosplenic ligament was a continuation of the phrenicosplenic ligament, this ligament was explored as well and contained white, potential discrete nerve-like structures as well which could represent an ANS equivalent. Microscopic evaluation of the ASN in mice and human showed that this structure did not represent a nerve, but most likely connective tissue strains. White nerve-like structures, which could represent the ASN, were macroscopically observed in the phrenicosplenic ligament in both mice and human and in the gastrosplenic ligament in humans. The microscopic investigation did not confirm their neural identity and therefore, this study disclaims the existence of a parasympathetic ASN in both mice and human

Eating Fish and Risk of Type 2 Diabetes: A population-based, prospective follow-up study

Objective: To investigate the relation between total fish, type of fish (lean and fatty), and EPA&DHA intake and risk of type 2 diabetes in a population-based cohort. Research design and methods: The analysis included 4,472 Dutch participants aged =55 years without diabetes at baseline. Dietary intake was assessed with a semi-quantitative food frequency questionnaire. Hazard ratios (RR) with 95% confidence intervals (95% CI) were used to examine risk associations adjusted for age, sex, lifestyle, and nutritional factors. Results: After 15 years of follow-up, 463 participants developed type 2 diabetes. Median fish intake, mainly lean fish (81% ), was 10 g/d. Total fish intake was associated positively with risk of type 2 diabetes; the RR was 1.32 (95% CI 1.02, 1.70) in the highest total fish group (=28 g/d) compared with non-fish eaters (p for trend= 0.04). Correspondingly, lean fish intake tended to be associated positively with type 2 diabetes (RR highest group (=23 g/d): 1.30 (95% CI 1.01, 1.68), p for trend= 0.06), but fatty fish was not. No association was observed between EPA&DHA intake and type 2 diabetes (RR highest group (=149.4 mg/d): 1.22 (95% CI 0.97, 1.53)). When additionally adjusted for intake of selenium, cholesterol, and vitamin D this RR decreased to 1.05 (95% CI 0.80, 1.38) (p for trend= 0.77). Conclusion: The findings do not support a beneficial effect of total fish, type of fish, or EPA&DHA intake on the risk of type 2 diabetes. Alternatively, other dietary components, like selenium, and unmeasured contaminants present in fish might explain our result

Quantitative analysis of the anterolateral ossification mass in diffuse idiopathic skeletal hyperostosis of the thoracic spine

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition leading to ossification of spinal ligaments and has been shown to behave similarly to ankylosing spondylitis (AS) often leading to unstable hyperextension fractures. Currently, no quantitative data are available on the spatial relationship between the bridging anterolateral ossification mass (ALOM) and the vertebral body/intervertebral disc to explain the propensity in DISH to fracture through the vertebral body instead of through the intervertebral disc as more often seen in AS. Furthermore, no reasonable explanation is available for the typical flowing wax morphology observed in DISH. In the current study, a quantitative analysis of computed tomography (CT) data from human cadaveric specimens with DISH was performed to better understand the newly formed osseous structures and fracture biomechanics. Additionally, the results were verified using computed tomography angiography data from ten patients with DISH and ten controls. Transverse CT images were analyzed to obtain ALOM area and centroid angle relative to the anteroposterior axis; intervertebral disc and adjacent cranial and caudal levels. The ALOM area at the mid-vertebral body level averaged 57.9 ± 50.0 mm2; at the mid-intervertebral disc space level it averaged 246.4 ± 95.9 mm2. The mean ALOM area at the adjacent level caudal to the mid-vertebral body level was 169.6 ± 81.3 mm2; at the adjacent cranial level, it was 161.7 ± 78.2 mm2. The main finding was the significant difference between mean ALOM area at the mid-vertebral body level and other three levels (p < 0.0001). The subsequent verification study showed the presence of vertebral segmental arteries at the mid-vertebral body level in nearly all images irrespective of the presence of DISH. A larger area of ALOM seemed associated with increased counter-clockwise rotation (away from the aorta) of the centroid relative to the anteroposterior axis. The results from the present study suggest a predisposition for fractures through the vertebral body and a role for the arterial system in the inhibition of soft tissue ossification

The apron of the greater omentum of gastric cancer patients contains various lymphoid structures including lymph nodes

Purpose: To gain more insight into the pattern of peritoneal cancer dissemination and optimize cancer treatment, it is important to improve our understanding of the omental lymphatic system. Although omental milky spots (OMSs) are considered the only lymphoid structures in the omentum, clinical studies mention the presence of lymph nodes (LNs) as well. This discrepancy may be explained by the fact that OMSs are highly dynamic structures and may erroneously be mistaken for LNs. The aim of this study was to evaluate the lymphoid structures, and mainly the presence of lymph nodes, in the apron of the greater omentum. Basic procedures: In this study, diagnostic samples of the greater omentum of 17 gastric cancer patients that were previously reported to contain LNs were re-evaluated for their presence. Paraffin embedded omental samples were stained with Picrosirius red, smooth muscle actin and CD20 and CD3, and microscopically re-examined according to predefined criteria to distinguish OMSs from LNs. Main findings: Pathology records reported 47 LNs in 17 patients. Upon re-evaluation, 20/47 LNs could be classified as true LNs and were located in both the upper and lower quadrants of the greater omentum. The other 27 structures could not be classified as LNs or OMSs and were defined as intermediate lymphoid structures. Conclusions: The omental apron of gastric cancer patients contains LNs and intermediate lymphoid structures, the latter most likely representing activated OMSs. These observations underline that our understanding of the lymphatic system of the greater omentum is incomplete and requires additional studies to gain further insight in its structure and function in both health and disease