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      Morphometric analysis of the splenic artery using contrast-enhanced computed tomography (CT)

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          Abstract

          Purpose

          To evaluate the morphology and course of the splenic artery, which might impact the surgical implantation of systems that stimulate the nerves surrounding the splenic artery. Experimental studies indicate that these nerves play an important part in immune modulation, and might be a potential target in the treatment of autoimmune diseases.

          Methods

          This retrospective cohort study made use of contrast-enhanced CT images from 40 male and 40 female patients (age 30–69) that underwent a CT examination of the aorta, kidneys or pancreas. Anatomic features were described including total splenic artery length, calibers, tortuosity, the presence of arterial loops and the branching pattern of the splenic artery.

          Results

          No age-gender-related differences could be found related to tortuosity or branching pattern. The length of splenic artery in contact with pancreatic tissue decreased with increasing age, but was not different between genders. Artery diameters were wider in male compared to female subjects. Loops of variable directions, that represent a part of the artery that curls out of the pancreatic tissue, were identified in each age-gender category and were present in nearly all subjects (86%).

          Conclusion

          This study suggests that although some anatomic features of the splenic artery are subject to factors as age and gender, the tortuosity of the splenic artery is not age dependent. Most subjects had one or multiple loops, which can serve as a target for neuromodulatory devices. Future studies should investigate whether splenic nerve stimulation is safe and feasible.

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          Most cited references19

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          Splenic nerve is required for cholinergic antiinflammatory pathway control of TNF in endotoxemia.

          The autonomic nervous system maintains homeostasis through its sympathetic and parasympathetic divisions. During infection, cells of the immune system release cytokines and other mediators that cause fever, hypotension, and tissue injury. Although the effect of cytokines on the nervous system has been known for decades, only recently has it become evident that the autonomic nervous system, in turn, regulates cytokine production through neural pathways. We have previously shown that efferent vagus nerve signals regulate cytokine production through the nicotinic acetylcholine receptor subunit alpha7, a mechanism termed "the cholinergic antiinflammatory pathway." Here, we show that vagus nerve stimulation during endotoxemia specifically attenuates TNF production by spleen macrophages in the red pulp and the marginal zone. Administration of nicotine, a pharmacological agonist of alpha7, attenuated TNF immunoreactivity in these specific macrophage subpopulations. Synaptophysin-positive nerve endings were observed in close apposition to red pulp macrophages, but they do not express choline acetyltransferase or vesicular acetylcholine transporter. Surgical ablation of the splenic nerve and catecholamine depletion by reserpine indicate that these nerves are catecholaminergic and are required for functional inhibition of TNF production by vagus nerve stimulation. Thus, the cholinergic antiinflammatory pathway regulates TNF production in discrete macrophage populations via two serially connected neurons: one preganglionic, originating in the dorsal motor nucleus of the vagus nerve, and the second postganglionic, originating in the celiac-superior mesenteric plexus, and projecting in the splenic nerve.
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            α7-cholinergic receptor mediates vagal induction of splenic norepinephrine.

            Classically, sympathetic and parasympathetic systems act in opposition to maintain the physiological homeostasis. In this article, we report that both systems work together to restrain systemic inflammation in life-threatening conditions such as sepsis. This study indicates that vagus nerve and cholinergic agonists activate the sympathetic noradrenergic splenic nerve to control systemic inflammation. Unlike adrenalectomy, splenectomy and splenic neurectomy prevent the anti-inflammatory potential of both the vagus nerve and cholinergic agonists, and abrogate their potential to induce splenic and plasma norepinephrine. Splenic nerve stimulation mimics vagal and cholinergic induction of norepinephrine and re-establishes neuromodulation in α7 nicotinic acetylcholine receptor (α7nAChR)-deficient animals. Thus, vagus nerve and cholinergic agonists inhibit systemic inflammation by activating the noradrenergic splenic nerve via the α7nAChR nicotinic receptors. α7nAChR represents a unique molecular link between the parasympathetic and sympathetic system to control inflammation.
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              • Article: not found

              Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass.

              Smaller coronary artery diameter portends worse outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The suggestion that women have smaller coronary artery diameters than men has not been validated by a large-scale study.
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                Author and article information

                Contributors
                daan.brinkman@catharinaziekenhuis.nl
                Journal
                Surg Radiol Anat
                Surg Radiol Anat
                Surgical and Radiologic Anatomy
                Springer Paris (Paris )
                0930-1038
                1279-8517
                26 October 2020
                26 October 2020
                2021
                : 43
                : 3
                : 377-384
                Affiliations
                [1 ]GRID grid.413532.2, ISNI 0000 0004 0398 8384, Department of Surgery, , Catharina Hospital, ; Postbus 1350, 5602 ZA Eindhoven, The Netherlands
                [2 ]Tytgat Institute for Liver and Intestinal Research, Amsterdam UMCUniversity of Amsterdam, Amsterdam, The Netherlands
                [3 ]GRID grid.413532.2, ISNI 0000 0004 0398 8384, Department of Radiology, , Catharina Hospital, ; Eindhoven, The Netherlands
                [4 ]Galvani Bioelectronics, Stevenage, UK
                [5 ]GRID grid.17635.36, ISNI 0000000419368657, Department of Surgery, , University of Minnesota Medical School, ; Minneapolis, USA
                Author information
                http://orcid.org/0000-0003-1862-9256
                Article
                2598
                10.1007/s00276-020-02598-1
                7897610
                33104863
                886b5026-46a9-4b3d-ac76-afe8f45083b0
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 13 August 2020
                : 10 October 2020
                Funding
                Funded by: Galvani Bioelectronics
                Funded by: Amsterdam UMC (Vrije Universiteit Amsterdam)
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag France SAS, part of Springer Nature 2021

                Surgery
                splenic artery,tortuosity,computed tomography,neuromodulation
                Surgery
                splenic artery, tortuosity, computed tomography, neuromodulation

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