The human cortical amygdaloid nucleus (CoA) receives exteroceptive sensory stimuli, modulates the functions coded by the intrinsic amygdaloid circuit, and constitutes the beginning of the limbic lobe continuum with direct and indirect connections toward subcortical, allocortical, and higher order neocortical areas. To provide basic data on the human CoA, we characterized and classified the neurons using the thionin and the "single-section" Golgi method adapted for postmortem brain tissue and light microscopy. We found 10 different types of neurons named according to the morphological features of the cell body, dendritic branches, and spine distribution. Most cells are multipolar spiny neurons with two or more primary dendrites, including pyramidal-like ones. Three-dimensional reconstructions evidenced the types and diversity of the dendritic spines in each neuron. The unlike density of spines along dendritic branches, from proximal to distal ones, indicate that the synaptic processing and plasticity can be different in each CoA neuron. Our study provides novel data on the neuronal composition of the human CoA indicating that the variety of cells in this region can have phylogenetic, ontogenetic, morphological, and likely functional implications for the integrated human brain function. This can reflect both a more complex subcortical synaptic processing of sensory and emotional information and an adaptation for species-specific social behavior display.

Human cortical and subcortical areas integrate emotion, memory, and cognition when interpreting various environmental stimuli for the elaboration of complex, evolved social behaviors. Pyramidal neurons occur in developed phylogenetic areas advancing along with the allocortex to represent 70–85% of the neocortical gray matter. Here, we illustrate and discuss morphological features of heterogeneous spiny pyramidal neurons emerging from specific amygdaloid nuclei, in CA3 and CA1 hippocampal regions, and in neocortical layers II/III and V of the anterolateral temporal lobe in humans. Three-dimensional images of Golgi-impregnated neurons were obtained using an algorithm for the visualization of the cell body, dendritic length, branching pattern, and pleomorphic dendritic spines, which are specialized plastic postsynaptic units for most excitatory inputs. We demonstrate the emergence and development of human pyramidal neurons in the cortical and basomedial (but not the medial, MeA) nuclei of the amygdala with cells showing a triangular cell body shape, basal branched dendrites, and a short apical shaft with proximal ramifications as “pyramidal-like” neurons. Basomedial neurons also have a long and distally ramified apical dendrite not oriented to the pial surface. These neurons are at the beginning of the allocortex and the limbic lobe. “Pyramidal-like” to “classic” pyramidal neurons with laminar organization advance from the CA3 to the CA1 hippocampal regions. These cells have basal and apical dendrites with specific receptive synaptic domains and several spines. Neocortical pyramidal neurons in layers II/III and V display heterogeneous dendritic branching patterns adapted to the space available and the afferent inputs of each brain area. Dendritic spines vary in their distribution, density, shapes, and sizes (classified as stubby/wide, thin, mushroom-like, ramified, transitional forms, “atypical” or complex forms, such as thorny excrescences in the MeA and CA3 hippocampal region). Spines were found isolated or intermingled, with evident particularities (e.g., an extraordinary density in long, deep CA1 pyramidal neurons), and some showing a spinule. We describe spiny pyramidal neurons considerably improving the connectional and processing complexity of the brain circuits. On the other hand, these cells have some vulnerabilities, as found in neurodegenerative Alzheimer’s disease and in temporal lobe epilepsy.

Visualizing nerve cells has been fundamental for the systematic description of brain structure and function in humans and other species. Different approaches aimed to unravel the morphological features of neuron types and diversity. The inherent complexity of the human nervous tissue and the need for proper histological processing have made studying human dendrites and spines challenging in postmortem samples. In this study, we used Golgi data and open-source software for 3D image reconstruction of human neurons from the cortical amygdaloid nucleus to show different dendrites and pleomorphic spines at different angles. Procedures required minimal equipment and generated high-quality images for differently shaped cells. We used the "singlesection" Golgi method adapted for the human brain to engender 3D reconstructed images of the neuronal cell body and the dendritic ramification by adopting a neuronal tracing procedure. In addition, we elaborated 3D reconstructions to visualize heterogeneous dendritic spines using a supervised machine learning-based algorithm for image segmentation. These tools provided an additional upgrade and enhanced visual display of information related to the spatial orientation of dendritic branches and for dendritic spines of varied sizes and shapes in these human subcortical neurons. This same approach can be adapted for other techniques, areas of the central or peripheral nervous system, and comparative analysis between species.

RESUMO M10(R1 = 1,6; R0,75 = 3,8) e M15(R1 = 1,04; R0,75 = 2,8 U N I T E R M O S : A N E S T É S I C O S , L o c a l : r o p i v a c a í n a R1: 9.72 ± 2.38 ml and 6.96 ± 0.97 ml; and for R0.75: 12.64 ± 5.10 ml and 7.36 ± 1.07

The aim of this randomized, double-blind clinical trial was to determine the effectiveness of systemic antibiotic application followed by either topical ionized solution (IS) or topical saline solution (placebo) as surgical site infection (SSI) prophylaxis in appendectomy for non-perforated appendicitis. Prophylactic antibiotic was administered pre-incision and either topical IS or placebo was applied pre-suturing to 529 patients, who were then monitored for 30 days. When topical IS was used, SSI relative risk was 0.739 (95% CI 0.537, 1.019) and the SSI prevention rate was 26.06% (CI -1.8%, 46.3%). The number needed to treat was 14.80 patients and the number needed to harm was 209 in order for SSI to be avoided. In conclusion, there was a trend for topical IS prophylaxis to reduce SSI frequency in patients undergoing appendectomy for non-perforated appendicitis, but the result was not statistically significant.

RESUMO r o c e d i m e n t o c i r ú r g i c o d e f i x a ç ã o d e f r a t u r a

Combined labor spinal-epidural analgesia is very close to being the ideal technique. Care must be taken with the sterile technique to induce spinal blockade. The reported complication has occurred without an apparent technique failure and is inherent to techniques risk-benefit ratio.

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