Neuronal injury and neurodegeneration are the hallmark pathologies in a variety of neurological conditions such as epilepsy, stroke, traumatic brain injury, Parkinson’s disease and Alzheimer’s disease. Quantification of absolute neuron and interneuron counts in various brain regions is essential to understand the impact of neurological insults or neurodegenerative disease progression in animal models. However, conventional qualitative scoring-based protocols are superficial and less reliable for use in studies of neuroprotection evaluations. Here, we describe an optimized stereology protocol for quantification of neuronal injury and neurodegeneration by unbiased counting of neurons and interneurons. Every 20th section in each series of 20 sections was processed for NeuN(+) total neuron and parvalbumin(+) interneuron immunostaining. The sections that contain the hippocampus were then delineated into five reliably predefined subregions. Each region was separately analyzed with a microscope driven by the stereology software. Regional tissue volume was determined by using the Cavalieri estimator, as well as cell density and cell number were determined by using the optical disector and optical fractionator. This protocol yielded an estimate of 1.5 million total neurons and 0.05 million PV(+) interneurons within the rat hippocampus. The protocol has greater predictive power for absolute counts as it is based on 3D features rather than 2D images. The total neuron counts were consistent with literature values from sophisticated systems, which are more expensive than our stereology system. This unbiased stereology protocol allows for sensitive, medium-throughput counting of total neurons in any brain region, and thus provides a quantitative tool for studies of neuronal injury and neurodegeneration in a variety of acute brain injury and chronic neurological models.

Point of care ultrasound (POCUS) allows for rapid, real-time evaluation of cardiovascular and respiratory pathology. The advent of portable, handheld devices and increased recognition by accrediting bodies of the importance of POCUS in guiding clinical decision making has expanded its use across the hospital setting and within medical training programs. POCUS allows clinicians to begin immediate investigation into their differential diagnoses without waiting for a formal imaging study, enhancing the speed of clinical interpretation. In addition to its diagnostic utility, POCUS can also inform clinicians of patients’ response to interventions when serial exams are obtained. This review examines the role of POCUS in the context of frequently encountered patients and highlights the key clinical questions that can be readily answered by POCUS.

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Background Acute abdominal pain is one of the most common complaints that patients present with in the emergency room and has long been a challenge to effectively manage without relying on opioid analgesia. The use of ultrasound-guided peripheral nerve blocks (UGRA) represents a new frontier in multimodal pain control regimens in the acute setting. An erector spinae plane (ESP) block is believed to mediate pain relief in multiple dermatomes through blockage of both visceral and somatic nerves. Analgesia provided by a single injection can help keep a patient comfortable for hours without breakthrough pain and the subsequent need for frequent redosing of opioid pain medication. To this date, there is very limited evidence of an ESP block in the utilization of acute appendicitis in the emergency department. Case report This case report presents a 26-year-old female with a past medical history of polycystic ovarian syndrome (PCOS) and a tubal ligation that presented with 7/10 right lower quadrant abdominal pain that began 1 h prior to arrival. She stated that she felt like this was similar to her PCOS exacerbations in the past. During her evaluation, she underwent a computed tomography (CT) scan of her abdomen and pelvis that was remarkable for acute, uncomplicated appendicitis. She was given 4 mg of morphine for her pain with little response, so the offer was made for an erector spinae block that the patient elected to receive. After being consented both for the procedure and for research, she received a right-sided erector spinae block with 20 mL’s of 0.2% ropivacaine (2 mg/mL) at the L1 vertebral level. After approximately 15 min, she stated that she had a reduction in her pain from a 6/10 to a 1/10 that persisted throughout the rest of her stay in the emergency department.