Morphometry of spinal nerve composition and thicknesses of lumbar plexus nerves for use in clinical applications / Morfometría de la composición del nervio espinal y espesores de nervios del plexo lumbar para su uso en aplicaciones clínicas

SUMMARY: The aim of this study was to clarify the diverse spinal compositions of the branches of the lumbar plexus in terms of their prevalence rates and thicknesses. Thirty lumbar plexuses extracted from Korean adults were used in this study. The nerve fascicles were separated and traced with the aid of a surgical microscope. The thickness of each spinal nerve component was calculated based on the mean of the largest and smallest diameters using digital calipers under the surgical microscope. The most common patterns of the spinal composition of the branches of the lumbar plexus were as follows: The iliohypogastric nerve (IHN) and the ilioinguinal nerve (IIN) arose from the ventral ramus of the first lumbar nerve (L1), the genitofemoral nerve (GFN) arose from the anterior division of the ventral ramus of the second lumbar nerve (L2), and the lateral femoral cutaneous nerve (LFCN) arose from the posterior division of the ventral ramus of theL2, the femoral nerve (FN) arose from the posterior division of the ventral ramus of L2-the fourth lumbar nerve (L4), with the thickest spinal component derived from the third lumbar nerve (L3), and the obturator nerve (OBN) arose from the anterior division of the ventral ramus of L2-L4, with the thickest spinal component derived from L3. However, when L5 constituted the FN and OBN, the thickest spinal components of the FN and OBN was L4. This morphometric study has measured the thicknesses of diverse spinal components that constitute the branches of the lumbar plexus after separating the nerve fascicles. The thicknesses of the various spinal components of these branches can be compared in order to understand which make the main and minor contributions to the lower limb.

RESUMEN: El objetivo de este estudio fue evaluar las diversas composiciones espinales de los ramos del plexo lumbar en cuanto a sus tasas de prevalencia y grosor. Se utilizaron treinta plexos lumbares extraídos de individuos adultos coreanos. Se separaron y trazaron los fascículos nerviosos por medio de un microscopio quirúrgico. El grosor de cada componente del nervio espinal se calculó con base en la media de los diámetros mayor y menor utilizando calibradores digitales bajo el microscopio. Los patrones más comunes de la composición espinal de los ramos del plexo lumbar fueron los siguientes: el nervio iliohipogástrico (NIH) y el nervio ilioinguinal (NII) surgieron del ramo ventral del primer nervio lumbar (L1). El nervio genitofemoral (NGF) surgió de la división anterior del ramo ventral del segundo nervio lumbar (L2). El nervio cutáneo femoral lateral (NCFM) surgió de la división posterior del ramo ventral L2. El nervio femoral (NF) surgió de la división posterior del ramo ventral de L2. El cuarto nervio lumbar (L4), con el componente espinal más grueso derivado del tercer nervio lumbar (L3) y el nervio obturador (NOB) surgieron de la división anterior del ramo ventral de L2-L4, con el componente espinal más grueso derivado de L3. Sin embargo, cuando L5 constituía el NF y NOB, los componentes espinales más gruesos del NF y NOB eran de L4. Este estudio morfométrico analizó los espesores de diversos componentes espinales que constituyen las ramas del plexo lumbar después de separar los fascículos nerviosos. Es posible comparar los espesores de los diversos componentes espinales de estos ramos para comprender las contribuciones principales y menores al miembro inferior.

Neuroinflammation Mediates Faster Brachial Plexus Regeneration in Subjects with Cerebral Injury / 神经科学通报·英文版

Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel's test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.

Application of ultrasound-guided selective nerve branch blockage in lumbar spinal nerve posterior branch syndrome / 中国骨伤

OBJECTIVE@#To investigate the efficacy and safety of ultrasound-guided selective nerve branch blockage in the treatment of lumbar spinal nerve posterior branch syndrome.@*METHODS@#A total of 40 patients with lumbar spinal nerve posterior branch syndrome treated by Pain Clinic from May 2017 to December 2018 were selected. According to the method used in locating site for nerve blockage, the patients were divided into ultrasound-guided group and anatomical positioning group, with 20 cases in each group. In anatomical positioning group, there were 7 males and 13 females, aged (63.42±7.71) years old, weighted (63.65±10.72) kg, numerical rating scale (NRS) was (6.61±1.52) scores, course of disease was (16.55±4.68) months. Pain sites:4 cases at L@*RESULTS@#There were no statistically significant differences in gender, age, weight, NRS, course of disease and pain segment distribution between two groups (@*CONCLUSION@#Comparedwith anatomicalpositioning, ultrasound-guided selective nerve branch block for the treatment of posterior branch of the lumbar spinal cord syndrome can reduce the number of treatments and maintain a longer therapeutic effect, but it is also necessary to pay attention to the time of each treatment to avoid dizziness and other adverse reactions.

Description of brachial plexus of sloth (Bradypus variegatus) / Descrição do plexo braquial do bicho-preguiça (Bradypus variegatus)

The species Bradypus variegatus is known as the common sloth, an endemic mammal from neotropical regions, which has been suffering from devastating anthropogenic activities. Our study aimed to describe the brachial plexus of B. variegates, regarding the origin and distribution of nerves, through the sampling of 10 adult females. Analyses were carried out at the Anatomy Section, "Departamento de Morfologia e Fisiologia Animal", "Universidade Federal Rural de Pernambuco", under license no. 034/2015 of the Ethics Committee on the Use of Animals. The results determined that the brachial plexus of the common sloth starts from the fifth cervical spine segment until the second thoracic segment. This area contains the long and suprascapular thoracic nerves, which originate immediately from the medullary segment 5 and 6, respectively, and from the pectoral, subscapular, axillary, radial, musculocutaneous, medial, forearm and ulnar medial cutaneous nerves, arising from a trunk comprised of cervical spine nerves (C) 7, C8, C9, and thoracic (T) 1 and T2. Regarding other wild and domestic animals, different suggestions were observed about the origin of the plexus in B. variegatus, however, the constituent nerves and their innervation areas did not demonstrate any discrepancies.(AU)

A espécie Bradypus variegatus é conhecida como preguiça-comum. Trata-se de um mamífero endêmico de regiões neotropicais que vem sofrendo com a ação antrópica devastadora. Esses Bradipodídeos possuem três dedos nos membros torácicos e pélvicos, são arborícolas consagrados e descem ao solo apenas para excretar e trocar de árvore. O estudo teve como objetivo descrever o plexo braquial de B. variegatus em relação à origem e distribuição dos nervos. Para tal, utilizou-se 10 fêmeas adultas. As análises foram realizadas no Pavilhão de Anatomia do Departamento de Morfologia e Fisiologia Animal da Universidade Federal Rural de Pernambuco, sob a licença nº 034/2015 do Comitê de Ética no Uso de Animais. Os cadáveres foram obtidos após morte natural, fixados em formaldeído a 20%, conservados em solução salina a 30% em tanques e dissecados para a visualização dos nervos destinados a inervar os membros e músculos torácicos. Uma vez feito, constatou-se que o plexo braquial da preguiça-comum se origina do quinto segmento espinal cervical, se estendendo até o segundo segmento torácico. Sendo formado pelos nervos torácico longo e supraescapular, de origem imediatamente do segmento medular 5 e 6, respectivamente, e pelos nervos peitorais, subescapulares, axilar, radial, musculocutâneo, mediano, cutâneo medial do antebraço e ulnar, decorrentes de um tronco formado a partir de nervos espinais cervicais (C) 7, C8, C9, e torácicos (T) 1 e T2. Em comparação a outros animais silvestres e domésticos foram observadas diferentes disposições em relação à origem do plexo de B. variegatus, todavia, os nervos constituintes e suas áreas de inervação não apresentaram discrepâncias.(AU)

Nervio occipital mayor: trayecto, relaciones anatómicas e implicancias clínicas de sus posibles sitios de atrapamiento / Great occipital nerve: course, anatomical relations and clinical implications of their potential entrapment sites

RESUMEN: El nervio occipital mayor (NOM) se forma del ramo dorsal del nervio espinal C2 y asciende entre la musculatura cervical posterior para inervar la piel del cuero cabelludo. Diversos autores han descrito su recorrido, sin embargo, es escasa la información referente a la relación que presenta este nervio con el músculo oblicuo inferior de la cabeza (OIC) y su trayecto intramuscular. El objetivo de este estudio fue determinar el recorrido y relaciones que el NOM estableció en el intervalo existente entre los músculos OIC y músculo trapecio (T). Para ello, se midieron las distancias verticales y horizontales a la altura de la protuberancia occipital externa y línea mediana, y se dividió al músculo OIC en tercios para observar variaciones del recorrido de este nervio. Junto con medir el diámetro del NOM, se midieron las distancias vertical y horizontal de este nervio a través de cinco puntos de referencia muscular y un punto de referencia vascular. Estos puntos musculares fueron: a) sobre el vientre del músculo OIC (punto 1); b) en la cara profunda del músculo semiespinoso de la cabeza (SEC) (punto 2); c) en la cara superficial del músculo SEC (punto 3); d) en la cara profunda del músculo T (punto 4); y e) en la cara superficial del músculo T (punto 5). A este se sumó el punto 6, en el cual se establecieron las distancias vertical y horizontal con la arteria occipital a la altura de la cara superficial del músculo T. Para ello se disecaron 18 cabezas (36 triángulos suboccipitales) de cadáveres adultos brasileños pertenecientes al laboratorio de Anatomía de la Universidade Federal de Alagoas (UFAL), Maceió, Brasil. Las distancias verticales y horizontales obtenidas respecto de los seis puntos fueron: 63,67 y 27,15 mm (punto 1); 53,89 y 21,44 mm (punto 2); 30,61 y 14,49 mm (punto 3); 20,39 y 22,8 mm (punto 4); 5,86 y 33,46 mm (punto 5); 5,99 y 35,56 mm (punto 6), respectivamente. En relación al músculo OIC, el NOM se ubicó en un 72,22 % de las muestras en el tercio medio de este músculo, 19,44% en su tercio lateral y un 8,33 % en su tercio medial. Todos estos hallazgos deben ser considerados al momento de diagnosticar correctamente posibles atrapamientos del NOM en la región cervical profunda, siendo además, una contribución para el éxito de procedimientos quirúrgicos de esta región.

SUMMARY: The great occipital nerve (GON) is formed from the dorsal branch of the C2 spinal nerve and ascends between the posterior cervical musculature to innervate the skin of the scalp. Various authors have described its course, however, there is little information regarding the relationship that this nerve presents with the obliquus capitis inferior (OCI) and its intramuscular path. The objective of this study was to determine the route and relationships that the GON established in the interval between the OCI muscles and the trapezius muscle (T). For this, the vertical and horizontal distances were measured at the height of the external occipital protuberance and median line, and the OCI muscle was divided into thirds to observe variations in the path of this nerve. Along with measuring the diameter of the GON, the vertical and horizontal distances of this nerve were measured through five muscle reference points and one vascular reference point. These muscle points were: a) on the belly of the OCI muscle (point 1); b) in the deep face of the semispinalis capitis muscle (SCM) (point 2); c) on the surface of the SCM (point 3); d) on the deep face of the T (point 4); and e) on the surface face of the T (point 5). To this was added point 6, in which the vertical and horizontal distances were established with the occipital artery at the height of the superficial face of the T. For this, 18 heads (36 suboccipital triangles) of Brazilian adult corpses belonging to the Anatomy laboratory of the Universidade Federal de Alagoas (UFAL), Maceió, Brazil, were dissected. The vertical and horizontal distances obtained with respect to the six points were: 63.67 and 27.15 mm (point 1); 53.89 and 21.44 mm (point 2); 30.61 and 14.49 mm (point 3); 20.39 and 22.8 mm (point 4); 5.86 and 33.46 mm (point 5); 5.99 and 35.56 mm (point 6), respectively. In relation to the OCI, the GON was located in 72.22 % of the samples in the middle third of this muscle, 19.44 % in its lateral third and 8.33 % in its medial third. All these findings should be considered when correctly diagnosing possible entrapments of GON in the deep cervical region, being a contribution to the success of surgical procedures in this region.

The effect of thoracic paravertebral block on seroma reduction in breast surgery - a randomized controlled trial / Efeito do bloqueio paravertebral torácico na redução de seroma em cirurgia de mama - estudo randomizado controlado

Abstract Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

Resumo Introdução: Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão-ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática. Objetivo: Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares. Método: Foram incluídas no estudo 40 pacientes do sexo feminino ASA I-II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24ª hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS - do inglês Numeric Rating Scale). Resultados: A quantidade média de seroma na 24ª hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24ª hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001). Conclusões: O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.

Neurectomy of C2 for the Treatment of Occipital Neuralgia: Case Report

Occipital neuralgia (ON) is an uncommon cause of headache, and it is characterized by a stabbing paroxysmal pain that radiates to the occipital region. The present study includes a review of the literature and a case report. The etiology of this pathology can vary from traumas, infections, compressions of nerves or vertebrae, skull base surgeries, to degenerative changes and congenital anomalies. However, most of the time, the etiology is considered idiopathic. The diagnosis is essentially clinical. However, it is crucial that other types of primary headache are excluded. The treatment for ON may be based on nerve blocks, medications or surgeries. Neurectomy of the second spinal nerve is among the surgical techniques available.

Preganglionic Epidural Steroid Injection through Translateral Recess Approach

The approach we suggest was developed for cases in which the fourth and fifth lumbar and first sacral spinal nerves were affected in lumbar degenerative disc disease. Retrodiscal transforaminal epidural injection is known to be very effective for lumbar radiculopathy because of excellent access to primary pathology; however, access below L5 is often restricted by the anatomic characteristics of the L5–S1. In the translateral recess approach (TLR), proper final needle placement (i.e., in the axillary portion between the exiting and traversing nerve roots) can be achieved by setting the direction of the needle laterally and superiorly from the distal tip of the infra-adjacent spinous process toward the medial wall of the pedicle and neural foramen of the given level without neural injury. This approach is possible because of the wide interlaminar space in the L5–S1. Preganglionic epidural injection through TLR is an effective and safe spinal intervention for lumbosacral radiculopathy.

A multiply split femoral nerve and psoas quartus muscle / 대한해부학회지

Clinical manifestations and imaging analysis of cervicogenic headache / 中国骨伤

OBJECTIVE@#To investigate the clinical characteristics and mechanism of cervicogenic headache.@*METHODS@#Fifty-seven patients with cervicogenic headache who were treated from May 2013 to December 2017 and had complete imaging data were selected, including 18 males and 39 females with an average age of(43.26±10.39) years old ranging from 20 to 63 years old. The duration of the disease was 4 months to 35 years with a mean of (11.74±9.47) years. The pain situation, iconography and Tinel sign were analyzed.@*RESULTS@#The patients with cervicogenic headache often had bilateral pain. The regions mainly concentrated in the temporal region, with occipital, head or orbit pains. The VAS scores decreased with the duration of the disease. There were many cases of disc herniation(91.30%), vertebral instability(73.91%), atlantoaxial displacement(56.52%), curvature change of cervicogenic vertebra(54.35%). The number of positive Tinel sign points was between 3 and 24 (13.58±5.8) per patient. The number and extent of Tinel sign were significantly different between the affected side and healthy side(<0.05). C₂,₃ facet joints(92.98%), post mastoid(89.47%), occipital concavity(89.47%), C₃,₄ facet joints(84.21%), third occipital nerve(80.70%) were the positive Tinel sign points in patients with cervicogenic headache.@*CONCLUSIONS@#The iconography changes of cervicogenic headache and Tinel sign may contribute to the clinical diagnosis and mechanism of the disease.

Effects of Acute Sacral Neuromodulation at Different Pulse Widths on Bladder Overactivity in Pigs / 대한배뇨장애요실금학회지

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.

Analgesic Effect of Toll-like Receptor 4 Antagonistic Peptide 2 on Mechanical Allodynia Induced with Spinal Nerve Ligation in Rats

Neuroinflammation is one of the key mechanisms of neuropathic pain, which is primarily mediated by the Toll-like receptor 4 (TLR4) signaling pathways in microglia. Therefore, TLR4 may be a reasonable target for treatment of neuropathic pain. Here, we examined the analgesic effect of TLR4 antagonistic peptide 2 (TAP2) on neuropathic pain induced by spinal nerve ligation in rats. When lipopolysaccharide (LPS)-stimulated BV2 microglia cells were treated with TAP2 (10 µM), the mRNA levels of proinflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, cyclooxygenase (COX)-2, and inducible nitric oxide synthase (iNOS), were markedly decreased by 54–83% as determined by quantitative PCR (qPCR) analysis. Furthermore, when TAP2 (25 nmol in 20 µL PBS) was intrathecally administered to the spinal nerve ligation-induced rats on day 3 after surgery, the mechanical allodynia was markedly decreased for approximately 2 weeks in von Frey filament tests, with a reduction in microglial activation. On immunohistochemical and qPCR analyses, both the level of reactive oxygen species and the gene expression of the proinflammatory mediators, such as TNF-α, IL-1β, IL-6, COX-2, and iNOS, were significantly decreased in the ipsilateral spinal dorsal horn. Finally, the analgesic effect of TAP2 was reproduced in rats with monoiodoacetate-induced osteoarthritic pain. The findings of the present study suggest that TAP2 efficiently mitigates neuropathic pain behavior by suppressing microglial activation, followed by downregulation of neuropathic pain-related factors, such as reactive oxygen species and proinflammatory molecules. Therefore, it may be useful as a new analgesic for treatment of neuropathic pain.

Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study

STUDY DESIGN: A retrospective study. PURPOSE: The first research on the erector spinae plane (ESP) block was published in 2016. To our knowledge, no cohort studies or randomized controlled trials of the ESP block were performed in 2016 and 2017. OVERVIEW OF LITERATURE: This study retrospectively investigated the efficacy of the ESP block in pain management after lumbar spinal surgery. METHODS: Patients who underwent lumbar spinal surgery in 2017 were enrolled in the study. Those who underwent secondary surgery with local anesthesia other than the ESP block were excluded. The primary outcome was the Numerical Rating Scale (NRS) pain score at various time points until the morning of postoperative day 2. The secondary outcomes were the amount of intravenous fentanyl administered during the first 24 hours following the surgery and the number of patients with complaints of complications such as nausea and vomiting until the morning of postoperative day 2. RESULTS: The data of 41 patients undergoing lumbar spinal surgery were retrospectively analyzed. Of these, 23 received only general anesthesia (G group), whereas the other 18 patients received the ESP block in addition to general anesthesia (E group). The NRS pain scores and the amount of fentanyl administered were lower in the G group than in the E group at all measured time points (all data were less than p<0.05). There was no significant difference in the incidence of complications between the two groups (p=0.11). CONCLUSIONS: The ESP block provides effective postoperative analgesic effect for 24 hours in patients undergoing lumbar spinal surgery.

Ansa cervicalis: a comprehensive review of its anatomy, variations, pathology, and surgical applications / 대한해부학회지

The ansa cervicalis is a neural loop in the neck formed by connecting the superior root from the cervical spinal nerves (C1–2) and the inferior root descending from C2–C3. It has various anatomical variations and can be an important acknowledgment in specific operations of the neck region. This is a review the anatomy, variations, pathology and clinical applications of the ansa cervicalis.

Amitriptyline inhibits the MAPK/ERK and CREB pathways and proinflammatory cytokines through A3AR activation in rat neuropathic pain models / 대한마취과학회지

BACKGROUND: The pain-relief properties of tricyclic antidepressants can be attributed to several actions. Recent observations suggest that adenosine is involved in the antinociceptive effect of amitriptyline. The A3 adenosine receptor (A3AR) is the only adenosine subtype overexpressed in inflammatory and cancer cells. This study was performed to investigate the role of A3AR in the anti-nociceptive effect of amitriptyline. METHODS: Spinal nerve-ligated neuropathic pain was induced by ligating the L5 and L6 spinal nerves of male Sprague-Dawley rats. The neuropathic rats were randomly assigned to one of the following three groups (8 per group): a neuropathic pain with normal saline group, a neuropathic pain with amitriptyline group, and a neuropathic pain with amitriptyline and 3-ethyl-5-benzyl- 2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS) group. Amitriptyline or saline was administered intraperitoneally and 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS-1191), an A3AR antagonist, was injected subcutaneously immediately before amitriptyline administration. The level of extracellular signal-regulated kinase P44/42 (ERK1/2), cyclic AMP response element-binding protein (CREB), and proinflammatory cytokines were assessed using immunoblotting or reverse-transciption polymerase chain reaction. RESULTS: Amitriptyline increased the mechanical withdrawal threshold of the neuropathic rats. The level of phospho-ERK1/2 and phospho-CREB proteins, and proinflammatory cytokines produced by spinal nerve ligation were significantly reduced by amitriptyline administration. However, the use of MRS-1191 before amitriptyline administration not only reduced the threshold of mechanical allodynia, but also increased the signaling protein and proinflammatory cytokine levels, which were reduced by amitriptyline. CONCLUSIONS: The results of this study suggest that the anti-nociceptive effect of amitriptyline involves the suppression of ERK1/2 and CREB signaling proteins, and A3AR activation also affects the alleviation of the inflammatory response.

Spinal Nerve Position and Morphometric Analysis with Silicon Molds in the Cadaveric Lumbar Intervertebral Foramen / 체질인류학회지

The intervertebral foramen is formed by two adjacent vertebrae and an intervertebral disc. Previous studies examining the foramen have been performed using various methods. The author obtained characteristics of the intervertebral foramen based on silicon mold. The author used 18 cadavers and dissected the lumbar intervertebral foramen. First, positional levels of the spinal nerve in the intervertebral foramen were measured. Second, after being removed all tissues covering the intervertebral, bony foramen was filled with melted silicon to mold the cross section. Subsequently, the solidified silicon mold was removed and stamped on a paper. The paper was scanned and analyzed area, perimeter, height and width of the intervertebral foramen on a computer. Area (average, 9.43 mm²) and perimeter (average, 48.02 mm) did not show any statistical significant pattern for any lumbar vertebral levels. However, the height and width significantly differed at the fifth lumbar vertebra, which had the shortest height (the fifth, 13.00 mm; average, 15.78 mm) and longest width (the fifth, 8.61 mm; average, 7.87 mm), although there were similar patterns in case of area and perimeter of the first to fourth lumbar vertebra. Height had a decrease tendency while width had an increase tendency both from the second to fifth lumbar vertebra. Spinal nerves went through near the intervertebral disc level from the first to fourth lumbar vertebra, although they passed below the disc at the fifth level. This study provides a different view of methodology for the 3-dimensional aspect for the intervertebral foramen. Results of this study may indicate that height and width of the intervertebral foramen changed along all lumbar vertebral levels; nevertheless, area and perimeter of the intervertebral foramen remained constant.

Utilidad de la 18F-FDG PET/TC en la valoración de tumores de la vaina nerviosa / The Value of 18F-FDG PET/TC in the Assessment of Peripheral Nerve Sheath Tumors

La 18F-FDG PET/TC tiene un papel importante en la evaluación de los tumores de la vaina nerviosa periférica, especialmente para determinar la posibilidad de malignidad y el sitio idóneo para la toma de biopsia. Se expone el caso de una mujer de 34 años de edad con diagnóstico de tumor de vaina nerviosa periférica, localizado en el mediastino posterior, que generó síndrome de vena cava superior y síndrome de Horner. Se realizó 18F-FDG PET/TC para hacer el diagnóstico diferencial entre benignidad y malignidad. Se encontró masa heterogénea con áreas hipermetabólicas que alcanzaban un SUVmax (valor de captación estándar máximo) de 8,5, hallazgos que sugerían origen maligno con diferentes grados de diferenciación. La biopsia de los lugares con mayor metabolismo arrojó el resultado de tumor maligno de vaina nerviosa periférica.

18F-FDG PET/CT is a useful imaging modality in the diagnosis and follow-up of peripheral nerve sheath tumors, especially in the assessment of tumor grade and biopsy guidance. The case of a 34-years-old woman diagnosed with peripheral nerve sheath tumor located in the posterior mediastinum that generated superior vena cava syndrome and Horner syndrome is presented. 18F-FDG PET/TC was performed to assess the possibility of malignancy. An 18F-FDG PET/CT was performed to determine whether it was benign or malignant, a heterogeneous mass with hypermetabolic areas with a maximum standardized uptake value (SUVmax) of 8.5 was found, and suggested malignancy with multiple grades of differentiation. A tumor biopsy from the region of higher metabolism was recommended with pathology result of malignant peripheral nerve sheath tumor.