Female pelvic autonomic neuroanatomy based on conventional macroscopic and computer-assisted anatomic dissections

Purpose  

To confront nerve dissection, tissue staining, nerve immunolabelling and Computer-Assisted Anatomic Dissection (CAAD) in identifying the precise location and origin of intrapelvic autonomic nerve fibers and to provide a three-dimensional (3D) representation of their relationship to other anatomical structures.     

Evolution in the concept of erection anatomy

Purpose  

To review and to summarize the literature on anatomy and physiology of erection in the past three decades, especially the work done in our institution.     

Responses to pandemic AS03-adjuvanted A/California/07/09 H1N1 influenza vaccine in human immunodeficiency virus-infected individuals

ABSTRACT: BACKGROUND: Influenza infection may be more serious in human immunodeficiency virus (HIV)-infected individuals, therefore, vaccination against seasonal and pandemic strains is highly advised. Seasonal influenza vaccines have had no significant negative effects in well controlled HIV infection, but the impact of adjuvanted pandemic A/California/07/2009 H1N1 influenza hemaglutinin (HA) vaccine, which was used for the first time in the Canadian population as an authorized vaccine in autumn 2009, has not been extensively studied. OBJECTIVE: Assess vaccine-related effects on CD4+ T cell counts and humoral responses to the vaccine in individuals attending the Newfoundland and Labrador Provincial HIV clinic. METHODS: A single dose of ArepanrixTM split vaccine including 3.75 mug A/California/07/2009 H1N1 HA antigen and ASO3 adjuvant was administered to 81 HIV-infected individuals by intramuscular injection. Plasma samples from shortly before, and 1--5 months after vaccination were collected from 80/81 individuals to assess humoral anti-H1N1 HA responses using a sensitive microbead-based array assay. Data on CD4+ T cell counts, plasma viral load, antiretroviral therapy and patient age were collected from clinical records of 81 individuals. RESULTS: Overall, 36/80 responded to vaccination either by seroconversion to H1N1 HA or with a clear increase in anti-H1N1 HA antibody levels. Approximately 1/3 (28/80) had pre-existing anti-H1N1 HA antibodies and were more likely to respond to vaccination (22/28). Responders had higher baseline CD4+ T cell counts and responders without pre-existing antibodies against H1N1 HA were younger than either non-responders or responders with pre-existing antibodies. Compared to changes in their CD4+ T cell counts observed over a similar time period one year later, vaccine recipients displayed a minor, transient fall in CD4+ T cell numbers, which was greater amongst responders. CONCLUSIONS: We observed low response rates to the 2009 pandemic influenza vaccine among HIV-infected individuals without pre-existing antibodies against H1N1 HA and a minor transient fall in CD4+ T cell numbers, which was accentuated in responders. A single injection of the ArepanrixTM pandemic A/California/07/2009 H1N1 HA split vaccine may be insufficient to induce protective immunity in HIV-infected individuals without pre-existing anti-H1N1 HA responses.     

Profiling cellular bioenergetics,glutathione levels,and caspase activities in stomach biopsies of patients with upper gastrointestinal symptoms

AIM: To measure biochemical parameters in stomach biopsies and test their suitability as diagnostic biomarkers for gastritis and precancerous lesions.METHODS: Biopsies were obtained from the stomachs of two groups of patients(n = 40) undergoing fiberoptic endoscopy due to upper gastrointestinal symptoms. In the first group(n = 17), only the corpus region was examined. Biopsies were processed for microscopic examination and measurement of mitochondrial O2 consumption(cellular respiration), cellular adenosine triphosphate(ATP), glutathione(GSH), and caspase activity. In the second group of patients(n = 23), both corpus and antral regions were studied. Some biopsies were processed for microscopic examination, while the others were used for measurements of cellular respiration and GSH level.RESULTS: Microscopic examinations of gastric corpus biopsies from 17 patients revealed normal mucosae in 8 patients, superficial gastritis in 7 patients, and chronic atrophic gastritis in 1 patient. In patients with normal histology, the rate(mean ± SD) of cellular respiration was 0.17 ± 0.02 μmol/L O2 min-1 mg-1, ATP content was 487 ± 493 pmol/mg, and GSH was 469 ± 98 pmol/mg. Caspase activity was detected in 3 out of 8 specimens. The values of ATP and caspase activity were highly variable. The presence of superficial gastritis had insignificant effects on the measured biomarkers. In the patient with atrophic gastritis, cellular respiration was high andATP was relatively low, suggesting uncoupling oxidative phosphorylation. In the second cohort of patients, the examined biopsies showed either normal or superficial gastritis. The rate of cellular respiration(O2. μmol/L min-1 mg-1) was slightly higher in the corpus than the antrum(0.18 ± 0.05 vs 0.15 ± 0.04, P = 0.019). The value of GSH was about the same in both tissues(310 ± 135 vs 322 ± 155, P = 0.692).CONCLUSION: The corpus mucosa was metabolically more active than the antrum tissue. The data in this study will help in understanding the pathophysiology of gastric mucosa.     

A case report of lead paint poisoning during renovation of a Victorian farmhouse.

We describe a series of four cases of childhood lead poisoning and two cases of adult lead toxicity in a professional family exposed to lead dust and fume during renovation of a rural farmhouse. Initial blood lead levels in the children ranged from 2.70 to 4.20 microM/L (56 to 87 microns/dl) and all four required chelation therapy. Lead-based paint poisoning, a well recognized entity among young children in poor, urban neighborhoods, is not confined exclusively to such areas.     

Failure rate of inferior alveolar nerve block among dental students and interns

Objectives:

To report the failure rate of inferior alveolar nerve block (IANB) among dental students and interns, causes of failure, investigate awareness of different IANB techniques, and to report IANB-associated complications.

Methods:

A 3-page questionnaire containing 13 questions was distributed to a random sample of 350 third to fifth years students and interns at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia on January 2011. It included demographic questions (age, gender, and academic level) and questions on IANB failure frequency and reasons, actions taken to overcome the failure, and awareness of different anesthetic techniques, supplementary techniques, and complications.

Results:

Of the 250 distributed questionnaires, 238 were returned (68% response rate). Most (85.7%) of surveyed sample had experienced IANB failure once or twice. The participants attributed the failures most commonly (66.45%) to anatomical variations. The most common alternative technique used was intraligamentary injection (57.1%), although 42.8% of the sample never attempted any alternatives. Large portion of the samples stated that they either lacked both knowledge of and training for other techniques (44.9%), or that they had knowledge of them but not enough training to perform them (45.8%).

Conclusion:

To decrease IANB failure rates for dental students and interns, knowledge of landmarks, anatomical variation and their training in alternatives to IANB, such as the Gow-Gates and Akinosi techniques, both theoretically and clinically in the dental curriculum should be enhanced.Profound local anesthesia is administered in preparation for many dental procedures.1 The practice was pioneered by Halsted and Hall, who, in 1884, introduced the technique of injecting a cocaine solution into the region of the mandibular foramen.2 Today, the inferior alveolar nerve block (IANB) is commonly used to induce local anesthesia for various applications throughout modern dentistry.3 However, IANB failure rates can be substantial, reaching 15-20%,4 and often cannot be overcome with a repeat IANB injection.5 Inferior alveolar nerve block failure has been attributed to technical errors, pathological processes (namely, trismus), infection, inflammation, previous surgery and psychological causes, such as fear, anxiety and apprehension.3 Poor technique has been reported to be the most common reason for failure of conventional IANB.4,6 Specifically, poor technique may be related to inadequate mouth opening, incorrect needle placement (too anterior or posterior), or failure to give enough time for the anesthesia to work.6 Malamed5 has recommended waiting 3-5 minutes after the injection before starting the procedure. The standard IANB procedure (Figure 1A) is a direct technique wherein the practitioner places his or her thumb intra-orally at the deepest concavity of the anterior ascending ramus. The point of injection is located midway between the midpoint of the thumb nail and the pterygomandibular raphe. The needle is advanced 15-25 mm parallel to the occlusal plane of the contralateral premolars until it reaches the proper bony end point injection site.1 In a 2014 review, Khalil7 discussed alternative techniques for overcoming conventional IANB failure. The Gow-Gates technique (also known as the high mandibular block)8 and the Vazirani-Akinosi closed-mouth technique,9 for example, have been available for more than 40 years. Additionally, some have suggested that anesthesia quality can be improved by injecting anesthetic solution into intraligamentary and intra-osseous areas.10 The Gow-Gates technique8 (Figure 1B), which was introduced in 1973 is credited with several advantages, such as use of only a single injection, minimal positive aspiration rate, low risk of complications, higher success with anatomical variations, minimal pain, and stable landmarks.11 Notably, in a study of 4,275 cases, Malamed12 observed a decreased incidence of trismus with the Gow-Gates technique, relative to conventional IANB, upon evaluation of 4,275 cases.12 The Akinosi9 closed-mouth technique (Figure 1C), which was introduced in 196013 has also been advocated for overcoming IANB failure. It is simpler than the Gow-Gates technique and does not depend on bony contact. Both the Gow-Gates technique and the Vazirani-Akinosi technique involve anesthetizing the inferior alveolar nerve, lingual nerve, and long buccal nerve with a single injection.1 In a 2010 study, Aggarwal et al14 observed a significantly better success rate for mandibular molar anesthesia with the Gow-Gates technique (52%) than with conventional IANB (36%), with an intermediate success rate (41%) for the Vazirani-Akinosi technique, and a relatively poor success rate (27%) for infiltrations. Remarkably, Jung et al10 found that buccal-plus-lingual infiltrations could provide satisfactory anesthesia in 32-67% of patients if lidocaine was used, and in 57-92% of patients if articaine was used, even without the use of standard IANB. Although the mentioned alternative techniques are well-established, Johnson et al15 found that nearly half (47.5%) of Harvard dental students alumni (classes 2000-2006) not only had never used an alternative technique, but further stated that they felt no need for an alternatives. The aims of this study were 1) to assess IANB failure rate among dental students and interns, and how it was overcome, 2) to report the causes of failure, 3) to investigate the awareness of alternative techniques, and 4) to assess IANB-related complications.Open in a separate windowFigure 1Delivery of anesthesia by: A) standard inferior alveolar nerve block; B) Gow-Gates alternative technique; and C) Vazirani-Akinosi alternative technique.     

Transient ischemic dilatation with adenosine 99mTc-sestamibi stress: prognostic significance in patients with normal myocardial perfusion

Annals of Nuclear Medicine - To determine the significance of transient ischemic dilatation (TID) in patients with normal perfusion on adenosine stress/rest. We analyzed 430 consecutive patients...