Shp2 in myocytes is essential for cardiovascular and neointima development.

Mutations in the PTPN11 gene, which encodes the protein tyrosine phosphatase Shp2, cause Noonan syndrome and LEOPARD syndrome, inherited multifaceted diseases including cardiac and vascular defects. However, the function of Shp2 in blood vessels, especially in vascular smooth muscle cells (VSMCs), remains largely unknown. We generated mice in which Shp2 was specifically deleted in VSMCs and embryonic cardiomyocytes using the SM22α-Cre transgenic mouse line. Conditional Shp2 knockout resulted in massive hemorrhage, cardiovascular defects and embryonic lethality at the late embryonic developmental stage (embryonic date 16.5). The thinning of artery walls in Shp2-knockout embryos was due to decreased VSMC number and reduced extracellular matrix deposition. Myocyte proliferation was decreased in Shp2-knockout arteries and hearts. Importantly, cardiomyocyte-specific Shp2-knockout did not cause similar vascular defects. Shp2 was required for TGFß1-induced expression of ECM components, including collagens in VSMCs. In addition, collagens were sufficient to promote Shp2-inefficient VSMC proliferation. Finally, Shp2 was deleted in adult mouse VSMCs by using SMMHC-CreERT2 and tamoxifen induction. Shp2 deletion dramatically inhibited the expression of ECM components, proliferation of VSMCs and neointima formation in a carotid artery ligation model. Therefore, Shp2 is required for myocyte proliferation in cardiovascular development and vascular remodeling through TGFß1-regulated collagen synthesis.

Fetal carotid-jugular fistula: A case report.

RATIONALE: Fetal carotid-jugular fistula is an extremely rare clinical entity that presents as an abnormal passage between the carotid artery and the jugular vein. It is difficult to treat and the chance for a cure is very low. The fetal carotid-jugular fistula causes congestive heart failure and death of the fetus. PATIENT CONCERNS: We report a case of fetal carotid-jugular fistula diagnosed at 27 weeks of pregnancy. She had no history of viral infection, no history of toxic and radiation exposure, no trauma during pregnancy, and no known family history of malformations or genetic disease. DIAGNOSES: Ultrasound revealed fetal left carotid-jugular fistula formation, massive reflux in the fetal tricuspid, a large amount of fetal pericardial effusion, fetal left ear microtia and full heart enlargement. INTERVENTIONS: The pregnant patient experienced termination of the pregnancy at 27 weeks. OUTCOMES: There were no complications in the patient. Post-termination, diagnosis of carotid-jugular fistula and left ear microtia was confirmed in the fetus. LESSONS: Our case indicated that the congenital neck artery and venous fistula of the fetus are extremely rare, and its most serious clinical symptom is congestive heart failure leading to intrauterine cessation of pregnancy. In addition, it is difficult to treat and the chance for a cure is very low. At present, there is no treatment record related to the fetal carotid artery and venous fistula, so it is very important to make a correct diagnosis as early as possible for the health of pregnant women.

Congenital Aplasia of the Common Carotid Artery: A Comprehensive Review.

In an attempt to describe the morphofunctional consequences of uni- and bilateral aplasia of the common carotid artery (CCA), which is usually a vascular source of the external carotid (ECA) and internal carotid (ICA) arteries, we investigated online databases of anatomical and clinical papers published from the 18th century to the present day. We found 87 recorded cases of uni- and bilateral CCA aplasia in subjects from the first hours to the eighth decade of life, which had been discovered in 14 (known) countries. Four crucial parameters were described: the embryology of the carotid arteries, morphophysiology of the carotid arteries, CCA aplasia, and unilateral versus bilateral CCA aplasia, including history, general data, diagnosing, vascular sources, caliber, course of the separated ECA and ICA, associated vascular variants, and pathological disorders. To complete the knowledge of the morphofunctional consequences of the absence of some artery of the carotid system, and risking the possibility of repeating some words, as "carotid artery", or "carotid aplasia" and the headings from our previous article about bilateral ICA absence, this review is the first in the literature that recorded all cases of the CCA aplasia published and/or cited for the past 233 years. Main characteristic of the CCA absence is its association with 21 different diseases, among which the aneurysms were in 13.69% of cases, and 17.80% of cases were without pathology.

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis.

BACKGROUND Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where typical carotid bifurcation is not recognizable with its typical branches of the external carotid artery (ECA) and internal carotid artery (ICA). This paper describes a case of this anomaly and reviews the embryogenesis of the carotid arteries for explanation. CASE REPORT A 66-year-old man received a routine health examination at our hospital. Initial carotid ultrasound indicated an absence of bifurcation in the right cervical carotid artery, and magnetic resonance imaging of the brain indicated an absence of the proximal cervical segment of the right ICA, with a remnant arterial stump at the expected bifurcation level. No evidence of the carotid bulb was identified. The common carotid artery seemed to continue cranially in the trunk of the ECA, where it exhibited extracranial branches. After distributing these branches, the carotid artery coursed medially at the C2 level, where it ascended into the carotid canal to become the petrosal segment of the ICA. This carotid anomaly was labelled an NBCA. No aberrant intracranial arteries were derived from the NBCA in this case. CONCLUSIONS In this case, the arterial stump was considered a remnant from agenesis of the right ICA. We assumed that the NBCA most likely developed because of false regression of the third embryogenic aortic arch with persistence of the second aortic arch.

MicroRNA-132 targeting PTEN contributes to cilostazol-promoted vascular smooth muscle cell differentiation.

BACKGROUND AND AIMS: Cilostazol, beyond its antiplatelet effect, is also capable of promoting vascular smooth muscle cell (VSMC) differentiation. The aim of this study was to explore the potential role of PTEN, known to associate with VSMC differentiation, and its related microRNA (miRNA) in cilostazol-dependent effects. METHODS AND RESULTS: Microarray analysis in balloon-injured rat carotid arteries comparing with and without balloon injury revealed that miR-132 was differentially expressed. Bioinformatic analysis predicts PTEN as a novel target of miR-132. Western blot and quantitative real-time reverse transcription-polymerase chain reaction along with in situ hybridization documented that cilostazol treatment enhanced PTEN and reduced miR-132 expression in the neointima of balloon-injured arteries. Treatment of cultured rat VSMCs with cilostazol resulted in the up-regulation of PTEN mRNA and the down-regulation of miR-132, supporting an in vitro relevance. Co-transfection experiments showed that transfection of miR-132 mimic into VSMCs suppressed PTEN 3'UTR activities, further reflecting that PTEN is the direct target of miR-132. Over-expression of miR-132 in VSMCs led to an attenuation of cilostazol-induced PTEN and its downstream VSMC differentiation marker (calponin) expression, confirming the critical role of miR-132 in VSMC differentiation. Transient transfection studies demonstrated that cilostazol reduced the activity of miR-132 promoter, which was mediated via cyclic AMP response element-binding protein. Notably, the use of lentivirus to over-express miR-132 in the neointima of balloon-injured arteries could reverse the effect of cilostazol in vivo. CONCLUSIONS: These results suggest that miR-132 by targeting PTEN may be an important regulator in mediating cilostazol actions on VSMC differentiation.

Carotid-vertebrobasilar Anastomoses with Reference to Their Segmental Property.

The primitive carotid-vertebrobasilar anastomoses are primitive embryonic cerebral vessels that temporarily provide arterial supply from the internal carotid artery to the longitudinal neural artery, the future vertebrobasilar artery in the hindbrain. Four types known are the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries. The arteries are accompanied by their corresponding nerves and resemble an intersegmental pattern. These vessels exist in the very early period of cerebral arterial development and rapidly involute within a week. Occasionally, persistence of the carotid to vertebrobasilar anastomosis is discovered in the adult period, and is considered as the vestige of the corresponding primitive embryonic vessel. The embryonic development and the segmental property of the primitive carotid-vertebrobasilar anastomoses are discussed. This is followed by a brief description of the persisting anastomoses in adults.

Intima-media complex thickness: preliminary workup of comparative evaluation of abdominal aorta and carotid artery of small-for-gestation-age term newborns and normal size term newborns.

BACKGROUND: Increased intima-media thickness (IMT) has shown to be a good predictor of increased incidence of cardiovascular disease. The use of noninvasive measurement of abdominal aortic intima-media thickness (aIMT) and carotid artery intima-media thickness (cIMT) is an attractive modality to further explore and define possible intrauterine factors that may be associated with increased risk of atherosclerosis. PURPOSE: The aim of this study was to compare intima-media thickness of abdominal aorta and carotid artery in small-for-gestation-age (SGA) term newborns with appropriate for gestation age (AGA or normal sized) term newborns. MATERIAL AND METHODS: We measured the intima-media thickness of the abdominal aorta (aIMT) and carotid artery (cIMT) by high resolution ultrasonography of 50 SGA and 50 AGA term newborns. RESULTS: Mean aIMT and cIMT were significantly greaterin the SGA term newborns group as compared to AGA term newborns (0.54 +/- 0.06 mm and 0.44 +/- 0.04 mm in SGA term newborns vs. 0.50 +/- 0.04 mm and 0.40 +/- 0.04 mm in AGA term newborns; P < 0.008 and P < 0.001, respectively). The significance was even more apparent after adjustment for birthweight. A negative correlation of aIMT and cIMT was seen with birthweight, Ponderal index, length and head circumference. CONCLUSION: SGA term newborns have significantly increased aortic and carotid intima-media thickness as compared to AGA term newborns. This might be associated with higher risk for atherosclerosis. Longitudinal studies are required to further enhance the possible correlation between birthweight and intima-media thickness in SGA babies.

Dynamics of thymus organogenesis and colonization in early human development.

The thymus is the central site of T-cell development and thus is of fundamental importance to the immune system, but little information exists regarding molecular regulation of thymus development in humans. Here we demonstrate, via spatial and temporal expression analyses, that the genetic mechanisms known to regulate mouse thymus organogenesis are conserved in humans. In addition, we provide molecular evidence that the human thymic epithelium derives solely from the third pharyngeal pouch, as in the mouse, in contrast to previous suggestions. Finally, we define the timing of onset of hematopoietic cell colonization and epithelial cell differentiation in the human thymic primordium, showing, unexpectedly, that the first colonizing hematopoietic cells are CD45(+)CD34(int/-). Collectively, our data provide essential information for translation of principles established in the mouse to the human, and are of particular relevance to development of improved strategies for enhancing immune reconstitution in patients.

Contribution of increased VEGF receptors to hypoxic changes in fetal ovine carotid artery contractile proteins.

Recent studies suggest that vascular endothelial growth factor (VEGF) can modulate smooth muscle phenotype and, consequently, the composition and function of arteries upstream from the microcirculation, where angiogenesis occurs. Given that hypoxia potently induces VEGF, the present study explores the hypothesis that, in fetal arteries, VEGF contributes to hypoxic vascular remodeling through changes in abundance, organization, and function of contractile proteins. Pregnant ewes were acclimatized at sea level or at altitude (3,820 m) for the final 110 days of gestation. Endothelium-denuded carotid arteries from full-term fetuses were used fresh or after 24 h of organ culture in a physiological concentration (3 ng/ml) of VEGF. After 110 days, hypoxia had no effect on VEGF abundance but markedly increased abundance of the Flk-1 (171%) and Flt-1 (786%) VEGF receptors. Hypoxia had no effect on smooth muscle α-actin (SMαA), decreased myosin light chain (MLC) kinase (MLCK), and increased 20-kDa regulatory MLC (MLC(20)) abundances. Hypoxia also increased MLCK-SMαA, MLC(20)-SMαA, and MLCK-MLC(20) colocalization. Compared with hypoxia, organ culture with VEGF produced the same pattern of changes in contractile protein abundance and colocalization. Effects of VEGF on colocalization were blocked by the VEGF receptor antagonists vatalanib (240 nM) and dasatinib (6.3 nM). Thus, through increases in VEGF receptor density, hypoxia can recruit VEGF to help mediate remodeling of fetal arteries upstream from the microcirculation. The results support the hypothesis that VEGF contributes to hypoxic vascular remodeling through changes in abundance, organization, and function of contractile proteins.

Suprahyoid neck fascial configuration, especially in the posterior compartment of the parapharyngeal space: a histological study using late-stage human fetuses.

The fascial configuration in the suprahyoid parapharyngeal space was evaluated using semiserial sagittal sections of 15 late-stage human fetal heads. The prevertebral fascia covered the longus colli, longus capitis, and rectus capitis lateralis muscles, but was most evident along the longus colli muscle. The carotid sheath and its extension were located around the internal and external carotid arteries and the lower cranial nerves. The superior cervical ganglion was also inside the sheath. Even near full term, the fetal suprahyoid neck was short, with the jugular foramen and hypoglossal canal located at the posterolateral side of the oropharynx. Thus, the glossopharyngeal and accessory nerves ran across the upper part of the carotid sheath. Fasciae of the stylopharyngeus, styloglossus, and stylohyoideus muscles were attached to and joined the anterosuperior aspect of the carotid sheath. All these neurovascular and muscle sheaths are communicated with the visceral fascia covering the pharynx at multiple sites, and, together, they formed a mesentery-like bundle. This communication bundle was made narrow by the anteriorly protruding longus capitis muscle. The mesentery-like bundle was covered by the posterior marginal fascia of the prestyloid compartment of the parapharyngeal space. The external carotid artery ran on the lateral and posterior sides of the posterior marginal fascia. Consequently, the typical carotid sheath configuration was modified by muscle sheaths from the styloid process, communicated with the visceral fascia and, anteriorly, constituted the posterior margin of the prestyloid space.

Eagle's syndrome: embryology, anatomy, and clinical management.

BACKGROUND: Eagle's syndrome refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by pathologic elongation or angulation of the styloid process and styloid chain. First described in 1652 by Italian surgeon Piertro Marchetti, the clinical syndrome was definitively outlined by Watt Eagle in the late 1940s and early 1950s. METHODS: This article reviews how underlying embryologic and anatomic pathology predicts clinical symptomatology, diagnosis, and ultimately treatment of the syndrome. RESULTS: The length and direction of the styloid process and styloid chain are highly variable. This variability leads to a wide range of relationships between the chain and the neurovascular elements of the neck, including cranial nerves 5, 7, 9, and 10 and the internal carotid artery. In the classic type of Eagle's syndrome, compressive cranial neuropathy most commonly leads to the sensation of a foreign body in the throat, odynophagia, and dysphagia. In the carotid type, compression over the internal carotid artery can cause pain in the parietal region of the skull or in the superior periorbital region, among other symptoms. CONCLUSIONS: Careful recording of the history of the present illness and review of systems is crucial to the diagnosis of Eagle's syndrome. After the clinical examination, the optimal imaging modality for styloid process pathology is spiral CT of the neck and skull base. Surgical interventions are considered only after noninvasive therapies have failed, the two most common being intraoral and external resection of the styloid process.

Carotid baroreceptor reaction after stenting in 2 locations of carotid bulb lesions of different embryologic origin.

BACKGROUND AND PURPOSE: The carotid bulb is innervated by the sinus nerve of Hering, a branch of the glossopharyngeal nerve, derived from the third pharyngeal arch. The aim of this study was to determine the frequency, predictors, and outcome of the carotid BR after carotid stent placement according to the location of the plaque lesion. MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions were prospectively analyzed in 95 consecutive patients who underwent carotid stent placement. Patients with hypertension after stent placement were excluded, and transient (<3 hours) and prolonged (3-24 hours) BR, together with AEs such as strokes and death, were assessed in the 2 lesion locations (apical versus body). Other factors known to affect the carotid baroreceptor were also investigated, and the results were analyzed by χ(2) or Mann-Whitney U tests. RESULTS: Transient BR occurred in 30% of apical lesions in contrast to 70% of body lesions (P = .001). Transient BR showed a significant relationship to lesion location (P = .001), occurring most frequently in body lesions, and to the distance of maximum stenosis from the ICA ostium (P = .001). Hyperperfusion and AE rates (P = .076) in 1 month occurred more frequently in apical lesions. CONCLUSIONS: The frequency of transient BR after carotid stent placement was lower in the apical region of the carotid bulb. Different cardiovascular disturbances after carotid stent placement can be attributed to anatomically different areas of the carotid bulb.

Principles of cranial base ossification in humans and rats.

CONCLUSIONS: 1. The principle of bilateral symmetry depends on the chordal cartilage that is the keystone in cranial base ossification in rats and humans, due to its anatomical situation and for the production of the chordin protein that regulates the bone morphogenetic protein BMP-7. 2. In humans and in rats, foramen lacerum closure follows a line of intramembranous ossification that depends on BMP-7, regulated by the first branchial pouch. 3. The cranial base ossification patterns and centres are similar in humans and in rats, except in the otic capsule, palate and the lateral pterygoid plate. 4. The neural crest may induce cranial ossification through the cranial nerves. OBJECTIVES: To study the patterns of cranial base ossification in humans and in rats, considering the chordal cartilage, and the otic, nasal and orbit capsules, as well as the participation of the branchial arches and pouches. METHODS: This was a light microscopy study of human fetal specimens obtained from spontaneous abortions with the following crown-rump-lengths (crl) 45, 74, 90, 134, 145 and 270 mm, and a 1-day-old neonate (360 mm crl), who had died of sudden death syndrome. We also examined Webster albino rat embryos of 16, 18 and 20 days of gestation and a postnatal series of rats 8 h and 1, 3, 4, 6, 7, 10 and 13 days old, as well as adult animals. RESULTS: In the 45 mm human fetus, the chordal cartilage with the nasal, otic and orbit capsules initiates cranial base ossification. Foramen lacerum closure begins in the 16-day-old rat embryo, following a line of membranous ossification between the external pterygoid process and the lateral alisphenoidal wing at ovalis foramen level. This is not a timing symmetrical process, which may persist until the 10th postnatal day in the rat. In the human fetus of 74 mm, the foramen lacerum space is closed by a membranous fusion ossification between the chordal cartilage and otic capsule, finishing at the 270 mm specimen. Endochondral ossification of the human otic capsule first appeared in the 145 mm (18 weeks) fetal specimen with four ossifying centres. The rat otic cartilaginous capsule showed rapid endochondral ossification, in the third and fourth postnatal day specimens.

Unilateral variation in the origin of the inferior alveolar and buccal arteries: a case report / Variación unilateral en el origen de las arterias alveolar inferior y bucal: reporte de un caso

The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and is located in the infratemporal fossa (IF). Some of the branches in this region are the inferior alveolar artery (IAA) and the buccal artery (BA), both descending branches. Here, we report an unusual unilateral origin of the IAA and the BA from a common trunk directly from the ECA. We conducted a routine dissection of both IF in a 54-year-old hispanic male cadaver. Fixed with Universidad de los Andes® conservative solution and red latex for vascular filling. On each side, the MA is observed superficially located over the lateral pterygoid muscle. On the right side, the IAA and the BA originate from a common trunk from the ECA approximately 5 mm prior to the bifurcation into their terminal branches. On the left side, the IAA originates from the MA that is immediately next to its origin, making a common trunk with the pterygoid branches. Knowing the morphology of the MA and its branches at the IF is important for oral and maxillofacial surgery procedures; and any variation in the origin or course of these arteries may result in the patient's increased morbidity during some invasive procedure in the area.

La arteria maxilar (AM) es una rama terminal de la arteria carótida externa (ACE), y se ubica en la región infratemporal (RI). Algunas de sus ramas en esta región son la arteria alveolar inferior (AAI) y la arteria bucal (AB), ambas ramas descendentes. En este trabajo informamos de un inusual origen unilateral de la AAI y de la AB a partir de un tronco común desde la ACE. Se realizó una disección de rutina de ambas regiones infratemporales en un cadáver de 54 años, sexo masculino, caucásico. Fijado con solución conservadora Universidad de los Andes® y repleción vascular con látex rojo. A cada lado, se observa la AM en ubicación superficial sobre el músculo pterigoideo lateral. Al lado derecho, la AAI y la AB se originan de un tronco común desde la ACE aproximadamente 5 mm antes de la bifurcación en sus ramas terminales. Al lado izquierdo la AAI se origina de la AM inmediato a su origen, formando un tronco común con los ramos pterigoideos. El conocimiento de la morfología de la AM y de sus ramas en la RI es de importancia en procedimientos odontológicos, de cirugía oral y maxilofacial. Por lo que cualquier variación en el origen o trayecto de estas arterias puede predisponer a un paciente a una mayor morbilidad durante algún procedimiento invasivo en la zona.

Effect of age and gender on the progression of adult vascular dysfunction in a mouse model of fetal programming lacking endothelial nitric oxide synthase.

The objective of this study was to investigate vascular function at different ages in a transgenic murine model of fetal vascular programming using a model of uteroplacental insufficiency induced by lack of endothelial nitric oxide synthase. Homozygous NOS3 knockout (KO) and wild-type (WT) mice were cross bred to produce WT, KO, and heterozygous that developed in WT (KOP) or KO (KOM) mothers. Male/female offspring from the four groups were killed at 7, 14, and 21 wk of age (n = 5-10/group), and carotid arteries were used for in vitro vascular studies. Responses to phenylephrine (PE), with/without N(G)-nitro-L-arginine methyl ester (L-NAME), angiotensin (ANG), acetylcholine (ACh), sodium nitroprusside, and isoproterenol (ISO) were studied. At 7 wk, only KO offspring showed higher contractile response to PE, whereas, at 14 and 21 wk, both KO and KOM had a higher response. Incubation with L-NAME abolished these differences. ANG contraction was higher in male KO in all age groups and in 21-wk-old females. Relaxation to ACh and ISO was absent in KO, and significantly decreased in KOM offspring in all age groups compared with KOP and WT, independent of gender. Sodium nitroprusside was not different between groups. The effect of the altered intrauterine environment on the development of abnormal vascular function was limited at 7 wk of age and most evident at 14 wk; further deterioration was limited to ANG-mediated vascular contractility in KO offspring. Our findings provide some hope that at least the first seven postnatal weeks may be an appropriate therapeutic window to prevent cardiovascular disease later in life.

Arch of aorta with bi-carotid trunk, left subclavian artery, and retroesophageal right subclavian artery.

We report a case of left sided aortic arch with three branches - a bi-carotid trunk, left subclavian, artery and right subclavian artery. The anomalous right subclavian artery presented a retroesophageal course. A right non-recurrent laryngeal nerve was noticed. The embryonic development of this branching pattern is discussed.

Fetal anatomy of the human carotid sheath and structures in and around it.

The aim of this study was to find basic rules governing the morphological development of the typical neurovascular sheath. We carried out histological examination of 15 paraffin-embedded mid-term fetuses at 9-25 weeks of gestation (three fetuses each at 9, 12, 15, 20, and 25 weeks). As the result, the vagus nerve showed a high propensity to change its topographical relationship with the common carotid artery (CCA) during 9-20 weeks of gestation: that is, from a primitive ventral course to a final dorsal course. The adventitia of the great arteries, which was distinct from other fascial structures, became evident by 15 weeks. The carotid sheath appeared at and after 20 weeks: it was clearly separated from the prevertebral lamina of the deep cervical fasciae, but fused with the pretracheal lamina covering the strap muscles. Thus the carotid sheath, as well as the topographical relationships of structures within it, seems to become established much later than the prevertebral and pretracheal laminae of the deep cervical fasciae. However, the adventitia of the cervical great arteries consistently becomes evident much earlier than the sheath, and it seems to be regarded as one of the basic components of the fetal deep cervical fasciae.

The role of the neural sympathetic and parasympathetic systems in diurnal and sleep state-related cardiovascular rhythms in the late-gestation ovine fetus.

The efferent mechanisms mediating the well-known diurnal cardiovascular rhythms in the late-gestation fetus are only partially understood. In the present study, we evaluated the contribution of the parasympathetic and sympathetic nervous systems (SNS) to these rhythms. Chronically instrumented fetal sheep at a mean (SE) of 122 (1) days gestation (term is 147 days) underwent either chemical sympathectomy with 6-hydroxydopamine the day after surgery (n = 8), vagotomy at surgery (n = 8), or were sham controls (n = 8). Fetal heart rate (HR), fetal HR variability (HRV), mean arterial blood pressure (MAP), carotid blood flow (CaBF), electrocorticogram (ECoG) activity, and nuchal activity were measured continuously for 24 h. Changes between sleep states were determined in a 6-h interval. Control fetal sheep showed consistent diurnal rhythms in fetal HR, HRV, MAP, and CaBF, with maximal activity in the evening, but not in nuchal activity. Sympathectomy was associated with a significant reduction of both fetal HR and HRV, while vagotomy was associated with a fall in fetal HRV (P < 0.05) but no change in HR. Despite this, most animals in the two intervention groups still showed diurnal rhythms for fetal HR, HRV, MAP, and CaBF, although peak HR may have been delayed in the sympathectomy group (mean 02:22 vs. 23:54 h in controls, P = 0.06). There was no effect of either intervention on sleep state cycling, although state-related cardiovascular rhythms were significantly modulated. These data indicate that, neither the SNS nor vagal activity, in isolation at least, is essential for generating cardiovascular diurnal rhythms in the late-gestation fetus.

Anatomical variation of the brachiocephalic trunk and common carotid artery in neck dissection / Variación anatómica del tronco braquicefálico y arteria carótida común en disecciones de cuello

Variations in the trajectory of the brachiocephalic trunk and the common carotid artery predispose to disorders which might be critical in a tracheotomy and/or surgeries. Dissection of 110 formol fixed adult cadavers, both sexes, were performed to increase the anatomic knowledge of the neck vessels and its variations. Cadavers were from the Laboratory of Descriptive and Topographic Anatomy of the Federal University of São Paulo- Paulista Medical School- UNIFESP-EPM. In 109 of these cadavers no variations were found while in one (0.9%) it was possible to observe a variation in the trajectory of the brachiocephalic trunk and in the right common carotid artery.

Las variaciones en el trayecto del tronco braquiocefálico y de la arteria carótida común predisponen a complicaciones que pueden ser fatales durante una traqueotomía y/o cirugías. Con el objetivo de ampliar el conocimiento anatómico de estos vasos del cuello y de sus variaciones, decidimos diseccionar 110 cadáveres, formalizados, adultos, de ambos los sexos, provenientes del Laboratorio de Anatomía Descriptiva y Topográfica de la Universidad Federal de São Paulo-Escuela Paulista de Medicina ¡ UNIFESP-EPM. En 109 (99,1%) de los cadáveres no encontramos variaciones En un caso (0,9%) observamos variación en el trayecto del tronco braquiocefálico y de la arteria carótida común derecha.

Proatlantal intersegmental artery: a review of normal and pathological features.

OBJECTS: Primitive carotid-vertebral and carotid-basilar anastomoses are formed early during human embryogenesis at approximately 24 days. From cephalic to caudal direction, these anastomoses are cranial extensions of the primitive internal carotid, trigeminal, otic, hypoglossal and proatlantal intersegmental arteries. MATERIALS AND METHODS: Normal and/or abnormal morphofunctional aspects of prenatal and postnatal forms of the proatlantal intersegmental artery, from the 24th day of gestation to postnatal eight decades, are described according to personal and literature data. Many (ab) normal carotid-vertebral anastomoses are also marked in differential diagnosis of the proatlantal intersegmental artery. CONCLUSIONS: The proatlantal intersegmental artery maintains the posterior circulation until the vertebral arteries are fully developed between the seventh and eighth gestational weeks. When this artery fails to obliterate, it becomes persistent one. The proatlantal intersegmental artery, most commonly, is an incidental finding or it may be of clinical significance in some patients.