Age and individual anatomical variability of intercostal nerves in human fetuses.

Performing fetal operations on the walls of the thorax and abdomen requires detailed information dealing with the anatomical variability of the intercostal nerves (IN) in human fetuses. Therefore, our study aimed at determining the topographic and anatomical characteristics of the I-XII IN during the period of human ontogenesis. The study involved 70 specimens of fetuses aged 4-10 months, by means of macromicroscopic preparation, superficial staining of dissected vessels and nerves and morphometry. The variability of the topography and asymmetry of the trunks of IN and their branches were revealed. The direction of the lateral musculocutaneous branches of the inferior IN does not coincide with the direction of the muscle bundles of the external abdominal oblique muscle. The branches of the I IN are functionally different, since the superior branch branches out in the skin and vessels, and the inferior one - in the stratum of the internal intercostal muscle. The anterior musculocutaneous branches of the II-VII IN occur in the front of the parasternal neurovascular bundle and are related with each other, with parasternal nerve or with the nerve plexus of the internal thoracic artery. The trunks of adjacent IN relate to one another by means of rare connecting branches, numerous and diverse in shape links are observed between the anterior and lateral musculocutaneous branches of the VIII-XII IN in the area of the anterior-lateral regions of the abdominal wall. The connecting branches descend from the nodes of the thoracic section of the sympathetic trunk to the IN.

Remote ischemic preconditioning and endothelial function in patients with acute myocardial infarction and primary PCI.

BACKGROUND: Remote ischemic preconditioning by transient limb ischemia reduces myocardial ischemia-reperfusion injury in patients undergoing percutaneous coronary intervention. The aim of the study we report here was to assess the effect of remote ischemic preconditioning on endothelial function in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention. METHODS: Forty-eight patients with acute myocardial infarction were enrolled. All participants were randomly divided into 2 groups. In Group I (n = 23), remote ischemic preconditioning was performed before primary percutaneous coronary intervention (intermittent arm ischemia-reperfusion through 4 cycles of 5-minute inflation and 5-minute deflation of a blood-pressure cuff to 200 mm Hg). In Group II (n = 25), standard percutaneous coronary intervention without preconditioning was performed. We assessed endothelial function using the flow-mediated dilation test on baseline, then within 1-3 hours after percutaneous coronary intervention, and again on days 2 and 7 after percutaneous coronary intervention. RESULTS: The brachial artery flow-mediated dilation results were significantly higher on the first day after primary percutaneous coronary intervention in the preconditioning group (Group I) than in the control group (Group II) (12.1% vs 0.0%, P = .03, and 11.1% vs 6.3%, P = .016, respectively), and this difference remained on the seventh day (12.3% vs 7.4%, P = .0005, respectively). CONCLUSION: We demonstrated for the first time that remote ischemic preconditioning before primary percutaneous coronary intervention significantly improves endothelial function in patients with acute myocardial infarction, and this effect remains constant for at least a week. We suppose that the improvement of endothelial function may be one of the possible explanations of the effect of remote ischemic preconditioning.