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“Because the vagus nerve is implicated in control of inflammation, we investigated if brain death (BD) causes impairment of the parasympathetic nervous system, thereby contributing to inflammation. BD was induced in rats. Anaesthetised ventilated rats (NBD) served as control. Heart rate buy ARN-509 variability (HRV) was assessed by ECG. The vagus nerve was electrically stimulated (BD + STIM) during BD. Intestine, kidney, heart and liver were recovered after 6 hours. Affymetrix chip-analysis was performed
on intestinal RNA. Quantitative PCR was performed on all organs. Serum was collected to assess TNF alpha concentrations. Renal transplantations were performed to address the influence of vagus nerve stimulation on graft outcome. HRV was significantly lower in BD animals. Vagus nerve stimulation inhibited the increase in serum TNF alpha concentrations and resulted in down-regulation of a multiplicity of pro-inflammatory genes in intestinal tissue. In renal tissue vagal stimulation significantly decreased the expression of
E-selectin, IL1 beta and ITGA6. Renal function was significantly better in recipients that received a graft from a BD + STIM donor. Our study demonstrates impairment of the parasympathetic nervous system during BD and inhibition of serum TNF alpha through vagal stimulation. selleck kinase inhibitor Vagus nerve stimulation variably affected gene expression in donor organs and improved renal function in recipients.”
“Study Design. Retrospective radiographic study of the technique for C1 lateral mass screw (C1LMS) and C2 pedicle screw (C2PS) fixation.
Objective. To evaluate (1) the accuracy of the C1LMS and C2PS placement; (2) the fusion rate between C1 and C2; (3) the risk for vertebral artery (VA) injury.
Summary of Background Data. C1LMS and C2PS fixation
is widely used when treating atlantoaxial instability. Several authors have reported their experience focusing on the technical outcomes, with selleck many reporting fusion rates near 100%. However, most of them are relatively small series, and many have applied only plain postoperative radiographs instead of computed tomography (CT). Thus, we feel that the accuracy of C1LMS and C2PS placement has not been fully analyzed, as well as the anatomic relationship between the VA and the screws.
Methods. Between December 2000 and September 2008, the fusion status and accuracy of the screws were evaluated on the postoperative reconstructive CT of 319 patients with atlantoaxial instability. Cases with malpositioned screws underwent CT angiography or magnetic resonance angiography after surgery, to evaluate potential VA injury.
Results. C1LMS of 95.5% and C2PS of 92.8% were found to be in a “”good”" position. After 2007, six cases had malpositioned screws, which were all in the “”out”" or “”down”" area of the C2 pedicle. Five cases underwent CT angiography and 1 had magnetic resonance angiography to evaluate potential VA injury. No occlusion, associated aneurysm or fistula of the VA was found.