Variation of the brachial artery emerging through an opening in the median nerve: a case report.

The median nerve maintains a close relationship with the brachial artery in the upper limb. Variability in the formation and distribution of upper extremity vessels is frequently encountered during donor body dissections or surgical procedures. This case presents a rare anatomical variation of the brachial artery emerging through an opening in the median nerve. The median nerve formed a small opening without the contribution from additional nerve roots and the remaining vasculature of the upper limb was otherwise normal. An abnormal arrangement of a neurovascular bundle in the arm can cause sensory and motor issues, as well as vascular implications. This variation has clinical significance in surgical interventions and potentially daily functioning. To our knowledge, this is the first report of a small median nerve opening pierced by the brachial artery.

Promotion of Cadaver-Based Military Trauma Education: Integration of Civilian and Military Trauma Systems.

INTRODUCTION: For the past few decades, there has been an emphasis on encouraging the partnership of civilian and military trauma care systems which would allow military personnel to maintain competency in life-saving skills and gain experience prior to or in between deployments. Currently, there are only five primary military-civilian training centers in the United States. Thus, the majority of service members do not get the opportunity to train at these facilities prior to scheduled deployments. To bridge this gap, a joint military-civilian hands-on supplemental training program was established to allow deploying National Guard Combat Medics to practice life-saving techniques on human cadaver tissue. The purpose of this report is to provide the feedback survey from this pilot training session in hopes to expand and improve the curriculum and encourage partnerships between military and civilian trauma centers. MATERIALS AND METHODS: Survey respondents include the 13 National Guard Combat Medic Specialists who attended the 6-hour voluntary training session. The survey asked qualitative and quantitative (using a 5-point Likert rating scale; 1 = insufficient/unacceptable/disagree; 5 = outstanding/exceeded expectations/strongly agree) questions regarding the structure of the session, likes and improvements about the classroom and cadaver lab portions, implementation into training, confidence in techniques before and after the session and overall rating of the session. This report has been reviewed and approved by the Institutional Review Board (IRB) at Rutgers University. RESULTS: Most attendees (12 of 13) agreed that the 6-hour total time length and division of classroom versus lab time was appropriate. Most attendees (12 of 13) agreed that this type of supplemental hands-on cadaver training should be a mandatory part of their medical training. The attendees' rated confidence in covered techniques was significantly increased from 3.77 ± 0.73 to 4.85 ± 0.38 (p < 0.01) before and after the session, respectively. The overall satisfaction rating of the session was 4.92 ± 0.28. CONCLUSIONS: This collaboration between military and civilian trauma care system was successful in giving National Guard combat medic specialists the opportunity to practice life-saving techniques on human tissue prior to deployment. This type of partnership can assist in maintaining readiness for trauma care and increasing the confidence of military pre-hospital providers in performing life-saving techniques.

Perinatal high-fat diet alters development of GABAA receptor subunits in dorsal motor nucleus of vagus.

Perinatal high-fat diet (pHFD) exposure increases the inhibition of dorsal motor nucleus of the vagus (DMV) neurons, potentially contributing to the dysregulation of gastric functions. The aim of this study was to test the hypothesis that pHFD increases the inhibition of DMV neurons by disrupting GABAA receptor subunit development. In vivo gastric recordings were made from adult anesthetized Sprague-Dawley rats fed a control or pHFD (14 or 60% kcal from fat, respectively) from embryonic day 13 (E13) to postnatal day 42 (P42), and response to brainstem microinjection of benzodiazepines was assessed. Whole cell patch clamp recordings from DMV neurons assessed the functional expression of GABAA α subunits, whereas mRNA and protein expression were measured via qPCR and Western blotting, respectively. pHFD decreased basal antrum and corpus motility, whereas brainstem microinjection of L838,417 (positive allosteric modulator of α2/3 subunit-containing GABAA receptors) produced a larger decrease in gastric tone and motility. GABAergic miniature inhibitory postsynaptic currents in pHFD DMV neurons were responsive to L838,417 throughout development, unlike control DMV neurons, which were responsive only at early postnatal timepoints. Brainstem mRNA and protein expression of the GABAA α1,2, and 3 subunits, however, did not differ between control and pHFD rats. This study suggests that pHFD exposure arrests the development of synaptic GABAA α2/3 receptor subunits on DMV neurons and that functional synaptic expression is maintained into adulthood, although cellular localization may differ. The tonic activation of slower GABAA α2/3 subunit-containing receptors implies that such developmental changes may contribute to the observed decreased gastric motility. NEW & NOTEWORTHY Vagal neurocircuits involved in the control of gastric functions, satiation, and food intake are subject to significant developmental regulation postnatally, with immature GABAA receptors expressing slower α2/3-subunits, whereas mature GABAA receptor express faster α1-subunits. After perinatal high-fat diet exposure, this developmental regulation of dorsal motor nucleus of the vagus (DMV) neurons is disrupted, increasing their tonic GABAergic inhibition, decreasing efferent output, and potentially decreasing gastric motility.