The Surgical Vascular Anatomy of the Lower Lumbar Arteries and Its Implications in Minimally Invasive Spine Surgery: A Cadaveric Study.

BACKGROUND: Minimally invasive lateral lumbar interbody fusion is a technique that has become increasingly popular for the treatment of degenerative lumbar spine disease; however, the pertinent surgical vascular anatomy has not been examined in detail. The goal of this study is to examine the anatomy of the lower lumbar and median sacral arteries, which are important determinants of these surgical outcomes. METHODS: This is an observational, experimental study based on cadaveric models, including 20 embalmed adult human cadavers. The following measurements were made: length of the lumbar and median sacral arteries, vertical distance between the third and fourth lumbar arteries and the superior end plate of the corresponding vertebrae, anterior vertebral body height, and intervertebral disc height. RESULTS: Our sample showcased considerable variability regarding vascular anatomy around the lower lumbar spine. In 10% of specimens, the abdominal aorta bifurcated at the level of the L3-L4 intervertebral disc, and 20% showed variations in vena cava origin. Regarding the lumbar arteries, in 10% of the sample, the fourth lumbar artery was absent on the right side, and 10% presented a fifth lumbar artery. The median sacral artery was present in all cadavers; however, in 15% of specimens, it originated from a common trunk that also gave rise to the fourth pair of lumbar arteries. Anterior vertebral body height was smaller in L3 comparing with L5 (P = 0.003), and there was a significant cephalocaudal increase in the anterior intervertebral disc height in the analyzed levels (P < 0.001). Bilaterally, the distance between the fourth lumbar arteries and the superior end plate of the L4 vertebral body was shorter than this distance at the L3 vertebral body (P < 0.001 and P = 0.002 on the right and left, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: These data may be useful in spine surgery planning and operative management. These anatomic variations should be identified beforehand to prevent difficulties during surgery and possible complications.

Behavioral and brain morphological analysis of non-inflammatory and inflammatory rat models of preterm brain injury.

Investigations using preclinical models of preterm birth have much contributed, together with human neuropathological studies, for advances in our understanding of preterm brain injury. Here, we evaluated whether the neurodevelopmental and behavioral consequences of preterm birth induced by a non-inflammatory model of preterm birth using mifepristone would differ from those after inflammatory prenatal transient hypoxia-ischemia (TSHI) model. Pregnant Wistar rats were either injected with mifepristone, and pups were delivered on embryonic day 21 (ED21 group), or laparotomized on the 18th day of gestation for 60 min of uterine arteries occlusion. Rat pups were tested postnatally for characterization of developmental milestones and, after weaning, they were behaviorally tested for anxiety and for spatial learning and memory. One month later, brains were processed for quantification of doublecortin (DCX)- and neuropeptide Y (NPY)-immunoreactive cells, and cholinergic varicosities in the hippocampus. ED21 rats did not differ from controls with respect to neonatal developmental milestones, anxiety, learning and memory functions, and neurochemical parameters. Conversely, in TSHI rats the development of neonatal reflexes was delayed, the levels of anxiety were reduced, and spatial learning and memory was impaired; in the hippocampus, the total number of DCX and NPY cells was increased, and the density of cholinergic varicosities was reduced. With these results we suggest that a preterm birth, in a non-inflammatory prenatal environment, does not significantly change neonatal development and adult neurologic outcome. On other hand, prenatal hypoxia and ischemia (inflammation) modifies developmental trajectory, learning and memory, neurogenesis, and NPY GABAergic and cholinergic brain systems.

Adhesive dentistry sensory stimulus technique as a neuromechanism for the treatment of orofacial pain associated to temporomandibular disorders: Case study.

PURPOSE: The authors intend, by presenting a case study, emphasize the neuromodulation process of orofacial pain induced by the stimulation of the sensory and motor stimulation of the trigeminal nerve, which can play an important role on pain modulation. MATERIALS AND METHODS: A 25 year-old woman presenting orofacial pain was referred to the stomatology service at the Centro Hospitalar do Porto. After collecting the patient's anamnesis, the thermographic camera FLIR i7 was used to record the thermal status of the orofacial structures, before the adhesive dentistry sensory stimulus protocol, after 45 minutes, and after one week. RESULTS: This study suggests the relation of adhesive dentistry sensory stimulus technique in the neuromodulation of orofacial pain and its association with the temporomandibular disorders . As the tongue senses the stimulus of the resin composite placed on the palatal surface of the 1st premolar, 2nd premolar and 1st molar of the maxilla, this can promote and induce an effect regarding a peripheral nerve neuromodulation resulting in a blockage of the nociceptive trigeminal pathway from temporomandibular disorders. CONCLUSION: Orofacial pain is a common complaint among the patients that come to a dentistry appointment, which may have different diagnosis and treatments. A positive effect on the patient's symptomatology was confirmed clinically on subsequent dental appointments and monitored by infrared thermography.

Cafeteria-diet effects on cognitive functions, anxiety, fear response and neurogenesis in the juvenile rat.

Early life, covering childhood and adolescence in humans, is an important period of brain development and maturation. Experimental works in rodents have shown that high-caloric diets are particularly detrimental to young rats, affecting cognition. We studied the effects of two different high-caloric diets, prevalent in human adolescents, on male Wistar rats aged 4 weeks at the beginning of the experiment. Rats were randomly allocated to control (C, n = 10), high-sugar diet (HS, n = 10) and cafeteria diet (CAF, n = 10) groups and fed accordingly for 8 weeks. At the end of this period, behavioral tests were performed to analyze (1) anxiety behavior in the elevated plus-maze and open field tests, (2) learning and memory processes in the Morris water maze and novel object recognition test, (3) fear response in the fear conditioning test, and (4) depression state in the forced swim test. We also examined neurogenesis in the dentate gyrus using the marker of neuroproliferation doublecortin (DCX). Our results show that CAF rats have impaired spatial learning and memory and increased anxiety, without changes in the remaining aspects of behavior, associated with a reduction of the total number of DCX-immunoreactive cells in the subgranular layer of the dentate gyrus. Conversely, HS rats displayed no changes in behavior and neurogenesis. These data demonstrate that diets rich in saturated fats and sugar are more detrimental for juvenile rats than diets with high sugar content in what concerns their effects in anxiety-related behaviors, spatial learning and memory, and neurogenesis. These findings may help explain the cognitive disturbances observed in obese human adolescents, who consume high-caloric diets.

NGF and NT-3 exert differential effects on the expression of neuropeptides in the suprachiasmatic nucleus of rats withdrawn from ethanol treatment.

Some neurotrophins have the capability of enhancing neuropeptide expression in several regions of the brain. It was also recently shown that NGF, infused over 1 month, offsets the decreased synthesis and expression of vasopressin (VP) and vasoactive intestinal polypeptide (VIP) in the suprachiasmatic nucleus (SCN) of rats submitted to chronic ethanol treatment and withdrawal. In the present study we examined the effectiveness of neutrotrophin-3 (NT-3) in promoting such effects, given that SCN neurons express both the high and the low affinity receptors for this neurotrophin. NT-3 was intraventricularly infused during 10 days to rats withdrawn from prolonged ethanol treatment. The total number, and the mean somatic volume, of VP- and VIP-immunoreactive neurons was compared with the estimates obtained from control rats and withdrawn rats treated with either NGF or cerebrospinal fluid during the same period. The infusion of cerebrospinal fluid and of NT-3 did not prevent the reduction in the number of peptide-producing neurons induced by withdrawal from ethanol treatment. Conversely, NGF infusion increased their number to control levels and led to neuronal hypertrophy. Our results show that, unlike NGF, NT-3 does not display the capacity of enhancing neuropeptide expression in the SCN. Because SCN neurons express the low affinity p75(NTR), which is equally activated by both neurotrophins, our results additionally indicate that the effects of NGF upon SCN neurons are not receptor-mediated. Taken together, our data suggest that indirect mechanisms, rather than direct neutrophin signaling, are likely to mediate the trophic effects exerted by NGF upon SCN neurons.

Effects of age and sex on the water maze performance and hippocampal cholinergic fibers in rats.

We have examined if age-related deterioration of spatial memory and cholinergic innervation of the dentate gyrus is gender-specific. Aging progressively affected the performance of male and female rats in place discrimination version of the water maze task. On repeated acquisition task, only old males, but not old females, were significantly impaired relative to young and adult animals of both sexes. In parallel, we found that the age-associated reduction of the density of cholinergic fibers in the dentate gyrus was significantly more profound in old males than in age-matched females. These results suggest that, although male and female rats have an identical pattern of reference memory decline, impairment of the working memory and deterioration of the hippocampal cholinergic system are slower to develop in females than in males.