Coexistence of adrenergic and cholinergic nerves in the inferior hypogastric plexus: anatomical and immunohistochemical study with 3D reconstruction in human male fetus

Classic anatomical methods have failed to determine the precise location, origin and nature of nerve fibres in the inferior hypogastric plexus (IHP). The purpose of this study was to identify the location and nature (adrenergic and/or cholinergic) of IHP nerve fibres and to provide a three-dimensional (3D) representation of pelvic nerves and their relationship to other anatomical structures. Serial transverse sections of the pelvic portion of two human male fetuses (16 and 17 weeks' gestation) were studied histologically and immunohistochemically, digitized and reconstructed three-dimensionally. 3D reconstruction allowed a 'computer-assisted dissection', identifying the precise location and distribution of the pelvic nerve elements. Proximal (supra-levator) and distal (infra-levator) communications between the pudendal nerve and IHP were observed. By determining the nature of the nerve fibres using immunostaining, we were able to demonstrate that the hypogastric nerves and pelvic splanchnic nerves, which are classically considered purely sympathetic and parasympathetic, respectively, contain both adrenergic and cholinergic nerve fibres. The pelvic autonomic nervous system is more complex than previously thought, as adrenergic and cholinergic fibres were found to co-exist in both 'sympathetic' and 'parasympathetic' nerves. This study is the first step to a 3D cartography of neurotransmitter distribution which could help in the selection of molecules to be used in the treatment of incontinence, erectile dysfunction and ejaculatory disorders.     

Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment

Chronic pelvic pain syndrome is a conundrum that may be explained partly by pudendal nerve entrapment (PNE), which causes neuropathic pain. In men with PNE, aberrant development and subsequent malpositioning of the ischial spine appear to be associated with athletic activities during their youth. The changes occur during the period of development and ossification of the spinous process of the ischium.     

Anatomical and clinical study of the common fibular nerve. Part 1: Anatomical study

The aims of this research were: (1) to minimize injury to the common fibular nerve by a detailed anatomical study of the nerve and its branches and (2) clinically to establish a protocol for preoperative and postoperative assessment of patients undergoing surgery on the proximal third of the leg. Thus the incidence of fibular nerve palsy would definitely be negligible. The first part of the research consisted of an anatomical study of the common fibular nerve and its branches, paying particular attention to the motor nerve branches innervating different muscles of the leg. Dissections were done on 20 unselected lower limbs of cadavers, of unknown gender, age and dominant side, to study the anatomy of the common fibular nerve and its branches and the neighboring structures, such as the tibia, the fibula and the muscles of the leg. It was found that 76.7% of all motor nerve branches were located in the proximal third of the leg, 19.5% in the middle third and 3.8% in the distal third. The free courses of the motor nerve branches were 48.5% in the proximal third, 44.4% in the middle third and 7.1% in the distal third. Within a distance of 6 cm from the fibular head we found 51.1% of the motor nerve branches and from 6 to 11 cm there were only 25.5%. Hence there were danger zones of high and low risk for injury to the common fibular nerve and its branches. Results obtained are evaluated and discussed with regard to safer surgical approaches and insertion of Steinmann pins in the proximal third of the leg.     

头颈部CT血管造影的三维重建视神经与鼻窦的关系

目的 视神经管毗邻的结构复杂,建立三维视神经模型,以达到多角度直观观察视神经的目的。方法 拷贝头颈CT血管造影（CTA）并对视神经、蝶窦及后组筛窦进行数字化三维重建,分析三维立体图像上视神经的毗邻结构及分型。结果 获得了视神经、蝶窦及后组筛窦的三维模型。根据视神经的三维立体毗邻结构将其分为3种类型,即：蝶窦型、筛窦型和蝶筛型。分析了视神经毗邻位置的分型所对应的蝶窦与筛窦气化程度的关系。结论 三维立体模型中可以全方位直观观察视神经的毗邻结构。     

面听神经血管压迫综合征患者小脑下前动脉血管袢与患者典型面听神经症状的MRI研究

目的 探讨小脑下前动脉前(AICA)血管袢的位置对面听神经血管压迫综合征患者典型面、听神经症状的影响。方法 回顾性研究。纳入兰州大学第二医院核磁共振科311例患者(622侧耳)内耳MR可变翻转角三维快速自旋回波(3D-SPACE)序列影像资料,其中男113例、女198例,年龄22~77(48±10.8)岁。统计AICA血管袢发生率及其Chavda分型占比。311例中,单侧面肌痉挛患者107例,比较其患侧(107侧)与健侧(107侧)AICA血管袢发生率、Chavda分型占比,以及AICA走行全程与神经有无接触。自血管袢阳性患者中选择90例(148侧)为血管袢组,比较不同Chavda分型AICA血管袢患者临床表现的差异;将ChavdaⅡ型及Ⅲ型的63侧耳纳入内耳道内血管袢组,将内耳道中的神经分布分为4个象限,观察AICA血管袢与面、听神经接触的位置象限不同的患者间典型面、听神经症状的差异。结果 本组311例622侧患者AICA血管袢的发生率为65.43%(407/622),其中双侧AICA血管袢形成144例、单侧119例,ChavdaⅠ型170侧(41.77%)、Ⅱ型189侧(46.44%)、Ⅲ型48侧(11.79%)。107例单侧面肌痉挛患者健侧AICA血管袢发生率为71.96%(77/107)、患侧70.09%(75/107),两侧比较差异无统计学意义(P＞0.05);健侧和患侧神经血管接触率分别为57.9%(62/107)、43.9%(47/107),差异有统计学意义(χ²=4.207, P＜0.05)。血管袢组90例(148侧)中,不同Chavda分型患者面肌痉挛、听力下降、耳鸣症状的发生率比较,差异均无统计学意义(P值均＞0.05);内耳道内血管袢组共63侧,内耳道内AICA血管袢所处象限不同患者的典型面、听神经症状比较,差异均无统计学意义(P值均＞0.05)。结论 内耳MR 3D-T₂-SPACE成像可清晰显示AICA血管袢及其与内耳道的位置关系,血管袢深度、位置对面听神经压迫综合征典型面、听神经症状无明显影响。     

Anatomical study of the neural ganglionated plexus in the canine right atrium: implications for selective denervation and electrophysiology of the sinoatrial node in dog.

The aim of the present study was to elucidate the topography and architecture of the intrinsic neural plexus (INP) in the canine right atrium because of its importance for selective denervation of the sinoatrial node (SAN). The morphology of the intrinsic INP was revealed by a histochemical method for acetylcholinesterase in whole hearts of 36 mongrel dogs and examined by stereoscopic, contact, and electron microscopes. At the hilum of the heart, nerves forming a right atrial INP were detected in five sites adjacent to the right superior pulmonary veins and superior vena cava (SVC). Nerves entered the epicardium and formed a INP, the ganglia of which, as a wide ganglionated field, were continuously distributed on the sides of the root of the SVC (RSVC). The epicardiac ganglia located on the RSVC were differentially involved in the innervation of the sinoatrial node, as revealed by epicardiac nerves emanating from its lower ganglia that proceed also into the atrial walls and right auricle. The INP on the RSVC (INP-RSVC) varied from animal to animal and in relation to the age of the animal. The INP-RSVC of juvenile dogs contained more small ganglia than that of adult animals. Generally, the canine INP-RSVC included 434+/-29 small, 17+/-4 medium-sized, and 3+/-1 large epicardiac ganglia that contained an estimated 44,700, 6,400, and 2,800 neurons, respectively. Therefore, the canine right atrium, including the SAN, may be innervated by more than 54,000 intracardiac neurons residing mostly in the INP-RSVC. In conclusion, the present study indicates that epicardiac ganglia that project to the SA-node are distributed more widely and are more abundant than was previously thought. Therefore, both selective and total denervation of the canine SAN should involve the whole region of the RSVC containing the INP-RSVC.     

MRI三维重建及旋转分割法对膝关节骨性关节炎患者半月板形态、位置变化的临床对比研究

目的　利用MRI三维重建及旋转分割方法对膝骨性关节炎患者及正常人半月板的形态及位置进行定量测量并对比分析,探讨膝骨性关节炎患者半月板的形态、位置变化及其临床意义。 方法　选取2013年1月-2014年2月在我院诊治的膝骨性关节炎II、III级患者20例（共20膝）作为关节炎组,另选择年龄、性别、体重指数相匹配的正常人10例（共10膝）作为正常组。所有研究对象先行MRI 3D薄层扫描,后行三维重建及旋转分割,在分割后的图像上对半月板进行定量测量,以半月板整体宽度、半月板覆盖胫骨平台宽度和半月板厚度作为量化指标进行两组间对比研究。 结果　内侧半月板整体宽度在所有方向上两组间差异无统计学意义;覆盖胫骨平台宽度从60°~120°位关节炎组明显变小,两组间差异具有统计学意义;厚度在60°~130°位关节炎组明显变厚,两组间差异具有统计学意义。外侧半月板整体宽度及覆盖胫骨平台宽度在10°~50°及140°~170°位关节炎组显著变宽,两组间差异具有统计学意义;厚度在120°~170°位关节炎组明显变厚,两组间差异有统计学意义。 结论　本研究为临床上半月板的MRI检查提供了一个新的方法和思路;通过测量发现膝骨性关节炎患者半月板的形状、位置与正常人相比发生了明显的变化,且这种变化同膝关节骨性关节炎具有一定相关性。     

Comparing vasculogenic mimicry with endothelial cell-lined vessels: techniques for 3D reconstruction and quantitative analysis of tissue components from archival paraffin blocks.

We previously described techniques to generate 3-dimensional reconstructions of the tumor microcirculation using immunofluorescence histochemistry and laser scanning confocal microscopy on serial sections from archival formalin-fixed, paraffin-embedded tissues. By aligning sequential z-stacks in an immersive visualization environment (ImmersaDesk), the need to insert fiduciary markers into tissue was eliminated. In this study, we developed methods to stitch overlapping confocal z-series together to extend the surface area of interest well beyond that captured by the confocal microscope objective and developed methods to quantify the distribution of markers of interest in 3 dimensions. These techniques were applied to the problem of comparing the surface area of nonendothelial cell-lined, laminin-rich looping vasculogenic mimicry (VM) patterns that are known to transmit fluid, with the surface area of endothelial cell-lined vessels in metastatic uveal melanoma to the liver in 3 dimensions. After labeling sections with antibodies to CD34 and laminin, the surface area of VM patterns to vessels was calculated by segmenting out structures that labeled with laminin but not with CD34 from those structures labeling with CD34, or CD34 and laminin. In metastatic uveal melanoma tissues featuring colocalization of high microvascular density [66.4 microvessels adjusted for 0.313 mm2 area (range 56.7 to 72.7)] and VM patterning, the surface area of VM patterns was 11.6-fold greater (range 10.8 to 14.1) than the surface provided by CD34-positive vessels. These methods may be extended to visualize and quantify molecular markers in 3 dimensions in a variety of pathologic entities from archival paraffin-embedded tissues.     

Autoradiographic identification of D1 dopamine receptors labelled with [3H]dopamine: distribution, regulation and relationship to coupling.

On the basis of experiments made on striatal membranes, Leff and Creese [Molec. Pharmac. (1985) 27, 184-192] have proposed that tritiated dopamine binds to a high-affinity agonist state of D1 dopamine receptors (D1h) which adopt this conformation when they are associated with the GTP-binding protein involved in the transduction process. Quantitative autoradiography was thus used to look for the distribution of these D1h sites in the rat brain and to compare it with that of D1 receptors labelled with [3H]7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benz aze pine [( 3H]SCH23390), a D1 antagonist. The effects of unilateral 6-hydroxydopamine lesion of the ascending dopamine pathways on the density of [3H]dopamine D1h and [3H]SCH23390 binding sites in the striatum and the nucleus accumbens were also analysed. In the striatum, when D2 receptors were blocked by spiroperidol (20 nM), [3H]dopamine was found to bind specifically to dopamine receptors of the D1 type. Complementary experiments made with dopamine uptake blockers indicated that high-affinity dopamine uptake sites were not labelled by [3H]dopamine under our experimental conditions. The anatomical distribution of [3H]dopamine D1h binding sites was found to be markedly different from that of [3H]SCH23390 binding sites. This was particularly the case in the substantia nigra, some amygdaloid nuclei and the prefrontal cortex--structures in which the ratios between [3H]SCH23390 and [3H]dopamine binding sites were more than seven-fold higher than that observed in the striatum. [3H]SCH23390 binding was not significantly affected in either the striatum or the nucleus accumbens six weeks after a complete unilateral destruction of ascending dopamine pathways. In contrast, a marked decrease in [3H]dopamine D1h binding sites was found in both structures, but this effect was lower in the medioventral (-60%) than in the laterodorsal (-81%) part of the striatum, even though dopamine denervation was uniform throughout the structure. Preincubation of the sections with dopamine (0.5 microM) led to a partial recovery (+126%) in the lesioned striatum and an increase of [3H]dopamine labelling in the control striatum (+68%). This suggest that the presence of dopamine stabilizes the D1h state of D1 receptors. The absence or low amount of dopamine, either due to dopamine denervation or naturally occurring (prefrontal cortex), would then impair the [3H]dopamine D1h binding. In addition, a lower coupling of D1 receptors with adenylate cyclase was observed in the substantia nigra when compared to that in the striatum: this may explain the relatively weak [3H]dopamine binding in the substantia nigra.(ABSTRACT TRUNCATED AT 400 WORDS)     

Radioautographic study of 5-hydroxytryptamine-containing nerve terminals in central ganglia of Planorbis corneus: comparison with other species and characteristics of the serotoninergic nerve terminal.

Summary Central ganglia fromPlanorbis corneus were incubated with [³H] 5-hydroxytryptamine and [³H]-leucine. After fixation, sections were examined by light and electron microscopic autoradiography. With [³H] 5-hydroxytryptamine there was a high level of uptake into a small number of axons and terminal processes in the neuropil. The terminal processes contained granular vesicles (diameter 50–120 nm), some of which possessed eccentrically placed cores, and agranular vesicles (mean diameter 60 nm). No membrane synaptic specializations were observed. With [³H] leucine there was a general distribution of radioactivity throughout the ganglia.The vesicular inclusions and non-specialized nature of the labelled terminal processes were very similar to presumed 5-hydroxytryptamine-containing terminals in other invertebrates and in the mammalian brain. It appears that several anatomical features of serotoninergic nerve terminals are common in all animals studied, although there is no specific characteristic which allows positive identification.     

Localization of motoneurons that extend axons through the ventral rami of cervical nerves to innervate the trapezius muscle: a study using fluorescent dyes and 3D reconstruction method

It has been suggested that in addition to motor axons, which extend directly into the spinal accessory nerve (SAN), ventral rami-associated motor fibers of cervical nerves also innervate the trapezius muscle. Using fluorescent dye labeling and 3D reconstruction in adult rats, this study clarifies the localization of motoneurons, which extend axons either directly through the SAN or through the ventral rami of cervical nerves to innervate the trapezius. DiI or DiI and DiO were used to label the ventral rami of cervical nerves entering the SAN, as well as branches of the SAN. We show that motoneurons whose axons pass through the ventral rami of cervical nerves and then enter the SAN, and those extending axons directly through the SAN are distributed within the same area. The neurons that extend axons through the SAN had a greater diameter than those axons that pass through the cervical nerves en route to the trapezius muscle. In addition, the axons that ultimately extend through the SAN exit the spinal cord dorsolaterally, while those that pass through the cervical nerves extend out the spinal cord through the ventral roots. We presume that the neurons that extend axons through the SAN are mainly alpha-motoneurons and that those projecting axons through the cervical nerves to the trapezius are mainly gamma-motoneurons. Taken together, these results could explain why patients in whom the SAN was used to treat brachial plexus injury retain some control of the trapezius muscle.     

Attention-deficit hyperactivity disorder: a study of association with both the dopamine transporter gene and the dopamine D4 receptor gene.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood. The role of genetic factors in its etiology is strongly supported by family, adoption, and twin studies. Several investigations have reported associations between ADHD and both the 7-repeat allele of the 48 bp VNTR at the DRD4 gene and the 10-repeat allele of the 40 bp VNTR at the DAT1 gene, but the results have been inconsistent. A sample of 81 Brazilian ADHD children and adolescents and their parents were screened for these DRD4 and DAT1 VNTRs. An excess of the DRD4 7-repeat allele was observed when both ADHD probands and their parents were compared with an ethnically matched control sample (chi-square = 11.55, P = 0.03; chi-square = 12.17, P = 0.03, respectively). However, haplotype relative risk (HRR) analysis showed no preferential transmission of the DRD4 7-repeat allele. No evidence of association with the DAT1 polymorphism was detected by both approaches. Nevertheless, an interaction effect of both genes on ADHD hyperactive/impulsive dimension was observed (F = 4.68; P = 0.03). These results add to the group of studies that together suggest a small effect of these genes in the susceptibility to ADHD.     

Quality of care in patients with asthma and rhinitis treated by respiratory specialists and primary care physicians: a 3-year randomized and prospective follow-up study.

BACKGROUND: Previous studies evaluating asthma care provided by primary care providers and respiratory specialists (RSs) are limited by short observation periods and nonrandomized designs. OBJECTIVE: To evaluate long-term outcomes in patients with asthma and rhinitis randomly selected to be cared for by RSs or primary care specialists. METHODS: In a randomized, 3-year, longitudinal study, 472 patients with asthma and allergic rhinitis were cared for by RSs or primary care physicians. Outcome measures, including disease severity, lung function, medication use, compliance, and self-management knowledge, were compared between groups. RESULTS: Compared with patients followed up by primary care providers, those in the RS group had reduced asthma severity (P = .046), significantly fewer days with asthma symptoms (P < .01), and improved asthma self-management knowledge (P < .01). At baseline, most patients were undertreated. This value was significantly reduced from 74% to 37% in the RS group and from 71% to 57% in the primary care physician group. We found odds ratios of 8.5 (95% confidence interval, 2-43; P < .01) for worsening of asthma and 0.3 (95% confidence interval, 0.1-0.9; P = .04) for asthma improvement when followed up by primary care physicians, which indicates that primary care follow-up increases the risk of worsening of asthma and decreases the chance of improving. Similar results were observed in patients with allergic rhinitis, although the findings were less pronounced. CONCLUSION: Treatment and follow-up by an RS ensured better quality of care in patients with asthma and rhinitis.     

蒙古族冠心病人群与MTHFRC677T等5个相关基因和基因多态性的相关性研究

目的针对内蒙古蒙古族人群的MTHFRC677T、eNOSG894T、ADRBlG1165C、GNB3C825T、ACEI／D、AGTM235T、CYP11B2基因C-344T多态性进行多因素分析,探讨蒙古族人群冠心病人群的遗传易感因素。方法应用PCR—RFLP技术及Sequenom系统检测患者与116名冠心病患者的和156名健康对照组MTHFRC677T、eNOSG894T、ADRB1G1165C、GNB3C825T、ACEI／D、AGTM235T、CYP11B2基因C-344T多态性。结果冠心病组和对照组在年龄、收缩压、舒张压等方面存在统计学差异P〈0．05,eNOS基因G894T位点GT基因型与GG基因型在单因素及多因素分析中均有统计学差异,单因素分析中P值为0．023,多因素分析中P值为0．024,OR=2．405,95％可信区间为1．119～4．807。结论eNOS基因G894T位点GT基因型可能是蒙古族人群患冠心病的易感基因位点。