Anatomical Approach Research Articles

Sulfuric acid effects in seed dormancy break of Ipomoea batatas evaluated by enzymatic, anatomic and physiological approaches

ABSTRACT The recommended method to overcome seed coat dormancy in sweet potato seeds is exposure to sulfuric acid, which can damage the embryo and affect seedling development depending on exposure time. This study aimed to determine the ideal immersion period using physiological, anatomical, and enzymatic analyses. Seeds were scarified with concentrated sulfuric acid for nine immersion periods. Physiological analyses included germination tests, germination speed index, first germination count, emergence test, and emergence speed index. Image analysis quantified the primary root length, root-to-hypocotyl ratio, and seedling length. Catalase and superoxide dismutase enzyme activities were analysed. Seed coat anatomy, including thickness, wear, and colour, was also assessed. Exposure to sulfuric acid for 30 min effectively broke dormancy without impacting the antioxidant system or seedling development. Thermal chambers confirmed that chemically scarified seeds absorb water and activate metabolism faster. Plant anatomy helped illustrate how sulfuric acid breaks dormancy by eroding physical barriers.

Functional characterization of optic photoreception in Lymnaea stagnalis.

Optic photoreception is a critical function for animal survival. Across the evolutionary spectrum, diverse animal models have been used to investigate visual system function and potential mechanisms under physiological or pathophysiological states. However less is known on photoreceptive behaviors and retinal processing in invertebrates, especially molluscs. This study focuses on the freshwater pond snail, Lymnaea stagnalis (L. stagnalis), to explore its visual function and underlying mechanisms. Using anatomical and histological approaches we characterized the L. stagnalis eye structure and demonstrated structural connections and retinal rhodopsin-positive sensory cells potentially critical for phototransduction. To assess the snail phototactic responses, we developed a new neurobehavioral protocol and employed DeepLabCut to track and quantify animal locomotion. We demonstrated that L. stagnalis exhibits a positive locomotory response to intense focal light and has diverse photo-locomotory responses. Further, we conducted phylogenetic and protein structure analyses and demonstrated that L. stagnalis has a unique repertoire of both vertebrate and invertebrate phototransduction genes. Further characterization of a rhodopsin-like gene identified unique characteristics compared to other mollusks and vertebrates, suggesting different mechanisms of phototransduction. Taken together, our work establishes L. stagnalis as a model organism for studying optic photoreception, offering new insights into the evolution and diversity of visual function across animal species.

Anatomical Approach for the Evaluation of the Nipple-Areolar Complex.

The nipple-areolar complex (NAC) is an anatomically unique region from which several normal variants and pathologies arise. Understanding its anatomy is crucial for accurate clinical and imaging assessments, aiding with differential diagnosis, and ensuring radiologic-pathologic concordance. Mammography and US are commonly used for NAC evaluation; however, these are susceptible to technical limitations such as tissue superimposition and artifacts, compromising visualization of abnormalities in this area. Although MRI offers higher sensitivity, it is not the initial evaluation modality. A comprehensive clinical inspection is necessary because it may reveal abnormalities not apparent on imaging. This article offers an anatomical approach to the NAC evaluation, simplifying differential diagnoses by reviewing imaging techniques and clinical features of common NAC abnormalities.

Anatomical versus Electrophysiological Approach for Ablation of Premature Ventricular Contractions Originating from the Left Ventricular Summit (ISESHIMA-SUMMIT Study).

Catheter ablation (CA) of idiopathic ventricular arrhythmias (VAs) from the epicardial left ventricular summit is challenging. The endocardial approach targets two sites: the endocardial closest site (ECS) to the epicardial earliest activation site (epi-EAS) and the endocardial EAS (endo-EAS). We aimed to differentiate between cases where CA at the ECS was effective and where CA at the endocardial EAS yielded success. Fifty-eight patients (47 men, 60±13 years) were analyzed with VAs in which the EAS was observed in the coronary venous system (CVS). Overall, VAs were successfully eliminated in 42 (72%) patients; 8 in the CVS, 8 where the ECS matched with the endo-EAS, 11 at the ECS, and 15 at the endo-EAS. Successful ECS ablation was associated with a shorter epi-EAS-ECS distance (10.2±4.7 vs. 18.8±5.3 mm; P<0.001) and shorter epi-EAS-left main coronary trunk (LMT) ostial distance (20.3±7.6 vs. 30.3±8.4 mm; P=0.005), with optimal cut-off values of ≤12.6 mm and ≤24.0 mm, respectively. Successful endo-EAS ablation was associated with an earlier electrogram at the endo-EAS (23 [18, 36] vs. 15 [0, 19] ms preceding the QRS; P<0.001) and shorter epi-EAS-endo-EAS interval (6 [1, 8] vs. 22 [12, 25] ms; P<0.001), with optimal cut-off values of ≥18 ms and ≤9 ms, respectively. Shorter anatomical distances between the epi-EAS and ECS, and between the epi-EAS and LMT ostium, predict a successful ECS ablation. The prematurity of the endo-EAS electrogram and a shorter interval between the epi-EAS and endo-EAS predicted a successful endo-EAS ablation.

Novel approach of slow pathway ablation in common atrioventricular nodal reentrant tachycardia by peak frequency map

Abstract Background It is difficult to visualize slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) even with recent high-density mapping. This could be because the slow pathway potential is buried by the potential of atrial working cells during sinus rhythm and tachycardia. In other words, it is extremely difficult for conventional 3D mapping systems to annotate slow pathway potential even though the histological run of slow pathway is known .[1], [2] Purpose The purpose of this study is to visualize the atrial myocardial junction of rightward inferior extension by the peak frequency map of Ensite X in common AVNRT and to evaluate whether relative high frequency (HF) sites in low voltage area extending from Koch's triangle to tricuspid annulus (TA) is effective targets of slow pathway ablation and the characteristics of junctional rhythm (JR) after radiofrequency application. Methods This study is single-center prospective cohort study. In 37 consecutive common AVNRT patients, novel approach and conventional approach of slow pathway ablation were performed in 17 and 20 patients, respectively. The conventional approach is anatomical and electrophysiological approach. Peak frequency map was performed during sinus rhythm with HD-grid catheter in novel approach patients. A frequency scanning is performed to locate relative HF sites on the tricuspid annulus. Radiofrequencey application is 30 W, 30-60 sec, and the end point was no inducibility or until one echo under load of isoproterenol. Results The success rate was 100 % with two approaches. The relative HF sites in low voltage area were distributed at the TA side from 4 to 5 o'clock in all novel approach patients, mean peak frequency in success site was 419 ± 87 Hz. The distance to His bundle from success site was farther (24.8 ± 4.9 vs. 12.8 ± 4.4 mm, p&amp;lt;0.001), JR was slower (93 ± 14 vs. 118 ± 10 bpm, p=0.013), time to JR occurrence was shorter (3.0 ± 1.3 vs. 7.6 ± 4.6 sec, p=0.003), and elimination rate of jump up (78 % vs. 40 %, p=0.06) was higher in novel approach. Conclusions The relative HF sites in low voltage area at TA side from 4 to 5 o'clock by peak frequency map could be novel target of slow pathway ablation with high success rate and sufficient safety and efficiency.peak frequency map

A practical approach to the post esophagectomy CT: expected postoperative anatomy and anatomical approach to associated complication.

This pictorial review aims to provide a structured approach to the interpretation of post esophagectomy CT by reviewing the major esophagectomy surgeries and conduit reconstructions, along with their associated complications at key anatomical landmarks. This paper combines an image rich experience and evidence-based approach to common and rare complications. The paper begins with an overview of the conventional Ivor Lewis esophagectomy and the expected postoperative imaging appearance (with separate detailed tables on additional surgical reconstructions), followed by a focused review of various complications at specific anatomical sites in a systematic fashion. By the conclusion of this review, radiologists will be equipped to employ a systematic approach to post-esophagectomy CT interpretation, confidently identifying both common and uncommon complications.

An in-silico comparison of anatomical and substrate based AF ablation using electro and optical flow mapping

Abstract Background The pursuit of improved outcomes for persistent AF may necessitate the utilization of innovative technologies and ablation methods. We hypothesize that combining electrophysiologic phase and optical flow mapping could offer a novel approach to identify ablation sites in persistent AF while minimizing ablation area, thereby enhancing the effectiveness of substrate-based ablation compared to a purely empiric strategy. Objective To compare the efficacy of a novel electro-optic flow-based ablation strategy (EOF) with empiric ablation for persistent AF patients using a virtual cohort of bi-atrial models. Methods An exploratory cohort (n=20) from a CT-derived bi-atrial in silico population was utilized to simulate AF. A pipeline was developed to assess ablation targets based on simulated AF and to automatically connect targets to closest inert boundaries. As part of target assessment, phase singularities (PS) and Horn-Schunck average optical flow maps were computed. An intersection of information assessed through PS and curl of average optical flow was utilized to generate EOF maps. 5 x strategies comprising purely anatomical, PS based and EOF guided ablations were simulated (1. PVI; 2. PVI+mitral/roof lines; 3. PVI+mitral/box line; 4. PS+anatomical; 5. EOF+anatomical). Ablation efficacy was determined by first examining change of rhythm via ablation and second by calculating the amount of tissue area ablated. Results Ablating PVI alone (Method 1) did not result in AF termination in any case. Ablating PVI with mitral or roof lines (Method 2) resulted in moderate outcomes (6 AF term. / 3 conv. to AT) whereas ablating PVI with mitral and box lines (Method 3) resulted in improved outcomes (9 AF term. / 4 conv. to AT). Compared to purely anatomical approaches, ablating PS or EOF targets and combining them with roof, mitral lines (Method 4 and Method 5 respectively) saw marked improvement (16 AF term. / 2 conv. to AT). Mapping based on EOF (Method 5) resulted in smaller ablation targets compared to a PS guided strategy (Method 4) with the same outcome. Conclusion AF termination to ablated tissue area ratio was higher for EOF based ablation targets compared to PS based or empiric ablations. Algorithmic generation of ablation lesion masks based on predicted targets can provide novel insights into ablation outcomes. Combining EOF targets with empiric lesions represents a potential ablation strategy of individualized substrate modification for persistent AF.Study Pipeline

Cervical osteomyelitis in the setting of multiple comorbidities: a complex anatomical approach. Illustrative case.

Vertebral osteomyelitis (VO), also known as spinal osteomyelitis or spondylodiscitis, is a rather rare yet serious disease comprising 3%-5% of all osteomyelitis cases, with only 3%-6% of this subset affecting the cervical spine. Risk factors include an advanced age, diabetes, immunosuppression, and intravenous (IV) drug use. The incidence of VO has increased over recent decades, with high-risk patients experiencing higher mortality rates. Treatment guidelines for VO are not standardized and rely on physician preference, often starting with IV antibiotics and progressing to surgery, if necessary. A 54-year-old female with tracheostomy-dependent obesity hypoventilation syndrome, hypertension, and morbid obesity presented with upper back pain after a fall. Imaging revealed early C6-7 discitis osteomyelitis, which was initially managed conservatively with IV antibiotics. Her condition worsened, leading to anterior corpectomy of C6-7, followed by posterior cervical fusion from C5 to T2 in the sitting position. This approach was chosen due to the patient's complex anatomy and tracheostomy. This case underscores the need for unique surgical approaches in high-risk patients with complex anatomy. It highlights the importance of interdisciplinary care when managing VO, especially in patients with multiple comorbidities. Given the increasing rates of morbid obesity, this case provides valuable insights for neurosurgical decision-making in similar future cases. https://thejns.org/doi/10.3171/CASE24448.

SpinalTRAQ: A novel volumetric cervical spinal cord atlas identifies the corticospinal tract synaptic projectome in healthy and post-stroke mice.

Descending corticospinal tract (CST) connections to the neurons of the cervical spinal cord are vital for performance of forelimb-specific fine motor skills. In rodents, CST axons are almost entirely crossed at the level of the medullary decussation. While specific contralateral axon projections have been well-characterized using anatomic and molecular approaches, the field currently lacks a cohesive imaging modality allowing rapid quantitative assessment of the entire, bilateral cervical cord projectome at the level of individual laminae and cervical levels. This is potentially important as the CST is known to undergo marked structural remodeling in development, injury, and disease. We developed SpinalTRAQ (Spinal cord Tomographic Registration and Automated Quantification), a novel volumetric cervical spinal cord atlas and machine learning-driven microscopy acquisition and analysis pipeline that uses serial two-photon tomography- images to generate unbiased, region-specific quantification of the fluorescent pixels of anterograde AAV-labeled CST pre-synaptic terminals. In adult mice, the CST synaptic projectome densely innervates the contralateral hemicord, particularly in laminae 5 and 7, with sparse, monosynaptic input to motoneurons in lamina 9. Motor pools supplying axial musculature in the upper cervical cord are bilaterally innervated. The remainder of the ipsilateral cord has sparse labeling in a distinct distribution compared to the contralateral side. Following a focal stroke of the motor cortex, there is a complete loss of descending corticospinal axons from the injured side. Consistent with prior reports of axon collateralization, the CST spinal projectome increases at four weeks post-stroke and continues to elevate by six weeks post stroke. At six weeks post-stroke, we observed striking synapse formation in the denervated hemicord from the uninjured CST in a homotopic distribution. Additionally, CST synaptic reinnervation increases in the denervated lamina 9 in nearly all motoneuron pools, exhibiting novel patterns of connectivity. Detailed level- and lamina-specific quantification of the bilateral cervical spinal cord synaptic projectome reveals previously undescribed patterns of CST connectivity in health and injury-related plasticity.

Anatomical Treatment Strategies for Persistent Atrial Fibrillation with Ethanol Infusion within the Vein of Marshall—Current Challenges and Future Directions

Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach—improving both its success rate and lesion durability may lead to improved treatment outcomes. An additional approach complementary to the anatomical one is also attracting attention, one that focuses on epicardial conduction. This involves ethanol ablation of the vein of Marshall (VOM) and can be very effective in blocking epicardial conduction related to Marshall structure; it is becoming incorporated into standard treatment. However, the pitfall of this “Marshall-PLAN”, a method that combines an anatomical approach with ethanol infusion within the VOM (Et-VOM), is that Et-VOM and other line creations are not always successfully completed. This has led to cases of AF and/or atrial tachycardia (AT) recurrence even after completing this lesion set. Investigating effective adjunctive methods will enable us to complete the lesion set with the aim to lower the rates of recurrence of AF and/or AT in the future.

Practical Approach to Orbital Lesions by Anatomic Compartments.

A wide range of pathologic conditions can originate in the orbit. While it is common to approach the differential diagnosis based on disease categories, such as neoplastic and inflammatory, segmenting the orbit into anatomic compartments can direct the radiologist toward the most common pathologic conditions for each manifestation and space. The orbit can be divided into intraconal, conal, and extraconal compartments. Additionally, the optic nerve sheath complex and lacrimal apparatus can be partitioned into separate compartments due to their unique functions and pathologic features. By using this anatomic approach, the authors review the most common pathologic conditions affecting the orbit and discuss clinical and imaging findings that can guide the differential diagnosis for lesions with similar appearances. Published under a CC BY 4.0 license. Supplemental material is available for this article.

Modular anatomic approach to oral tongue carcinoma: functional outcomes and quality of life.

The purpose of this study is to present the long-term functional swallowing outcomes of various surgical approaches to oral tongue/floor of mouth squamous cell carcinoma (OTFOMSCC) according to a modular and compartment-based concept previously described elsewhere. A retrospective study was conducted on patients undergoing surgery for OTFOMSCC from January 2017 to April 2023 in the Department of Otorhinolaryngology at the Hospital of Bolzano. Functional swallowing outcomes and quality of life (QoL) were assessed through the administration of a scale and questionnaires between 6 months and 1 year postoperatively or after the end of adjuvant therapy, stratifying the results according to the surgical technique used. A total of 92 patients with OTFOMSCC were enrolled: 44 patients underwent transoral anatomically guided surgery (TAGS) for early-stage tumours, and 48 underwent major surgery for advanced stages. Among the latter 48 patients: 35 underwent compartment tongue surgery (CTS), 3 underwent extended glossectomies (EG) Type A, 6 underwent EG Type B, and 4 underwent EG Type C. After TAGS, all patients resumed oral feeding for all consistencies. In the CTS group, only one patient faced challenges with pure liquids, yet all achieved the target of consuming a semisolid and semiliquid diet. EG exhibited a noticeable decline in performance from Type A to total glossectomy (Type C). Following an anatomically-guided approach to the resection of OTFOMSCC allows the surgery to be modulated on the structures involved by the tumour, thus achieving optimal oncological results, while maintaining the possibility to predict functional outcomes and postoperative QoL.

Subvastus approach improves intraoperative patellofemoral tracking in total knee arthroplasty for varus deformities – An in vivo study

Objectives: The subvastus approach has the theoretical advantages of protecting the extensor mechanism while securing the patellar blood supply, enhanced patellofemoral tracking, faster recovery, decreased post-operative pain, and shortened length of hospital stay at the expense of longer operative and tourniquet times. This study aimed to evaluate the effect of the subvastus approach on patellofemoral tracking. We hypothesize that being a more anatomical approach, the subvastus approach may improve patellofemoral tracking intraoperatively and decrease the necessity to release the lateral retinaculum during total knee replacement (TKR). Methods: In 54 consecutive cases presented with advanced varus osteoarthritis knee in a high-volume arthroplasty hospital from January 2022 to April 2022 and scheduled for cemented posterior stabilized TKR, patellofemoral tracking and the tightness of lateral retinaculum were evaluated intra-operatively all through the whole range of motion (ROM) of the knee by “No thumb test” and “Vertical patella test” subsequent doing the whole tibial and femoral bony cuts, proper sizing, completing soft-tissue release and gap balancing, and reaching the full ROM. Results: The “No thumb test” and “Vertical patella test” were negative in all the patients, and there was no intra-operative dislocation or subluxation. In addition, there was no need to release the lateral retinaculum in any of them. Conclusion: Implementing the subvastus approach during TKR surgeries, with subsequent preservation of the patellar attachment of the vastus medialis oblique muscle, allows for better tracking of the patella over the femur during surgery, resulting in a reduction in the necessity of performing lateral retinaculum release intraoperatively.

The onset of coarctation of the aorta before birth: Mechanistic insights from fetal arch anatomy and haemodynamics

Accurate prenatal diagnosis of coarctation of the aorta (CoA) is challenging due to high false positive rate burden and poorly understood aetiology. Despite associations with abnormal blood flow dynamics, fetal arch anatomy changes and alterations in tissue properties, its underlying mechanisms remain a longstanding subject of debate hindering diagnosis in utero. This study leverages computational fluid dynamics (CFD) simulations and statistical shape modelling to investigate the interplay between fetal arch anatomy and blood flow alterations in CoA. Using cardiac magnetic resonance imaging data from 188 fetuses, including normal controls and suspected CoA cases, a statistical shape model of the fetal arch anatomy was built. From this analysis, digital twin models of false and true positive CoA cases were generated. These models were then used to perform CFD simulations of the three-dimensional fetal arch haemodynamics, considering physiological variations in arch shape and blood flow conditions across the disease spectrum. This analysis revealed that independent changes in the shape of.the arch and the balance of left-to-right ventricular output led to qualitatively similar haemodynamic alterations. Transitioning from a false to a true positive phenotype increased retrograde flow through the aortic isthmus. This resulted in the appearance of an area of low wall shear stress surrounded by high wall shear stress values at the flow split apex on the aortic posterior wall opposite the ductal insertion point.Our results suggest a distinctive haemodynamic signature in CoA characterised by the appearance of retrograde flow through the aortic isthmus and altered wall shear stress at its posterior side. The consistent link between alterations in shape and blood flow in CoA suggests the need for comprehensive anatomical and functional diagnostic approaches in CoA. This study presents an application of the digital twin approach to support the understanding of CoA mechanisms in utero and its potential for improved diagnosis before birth.

Multi-scale anatomical regularization for domain-adaptive segmentation of pelvic CBCT images.

Cone beam computed tomography (CBCT) image segmentation is crucial in prostate cancer radiotherapy, enabling precise delineation of the prostate gland for accurate treatment planning and delivery. However, the poor quality of CBCT images poses challenges in clinical practice, making annotation difficult due to factors such as image noise, low contrast, and organdeformation. The objective of this study is to create a segmentation model for the label-free target domain (CBCT), leveraging valuable insights derived from the label-rich source domain (CT). This goal is achieved by addressing the domain gap across diverse domains through the implementation of a cross-modality medical image segmentationframework. Our approach introduces a multi-scale domain adaptive segmentation method, performing domain adaptation simultaneously at both the image and feature levels. The primary innovation lies in a novel multi-scale anatomical regularization approach, which (i) aligns the target domain feature space with the source domain feature space at multiple spatial scales simultaneously, and (ii) exchanges information across different scales to fuse knowledge from multi-scaleperspectives. Quantitative and qualitative experiments were conducted on pelvic CBCT segmentation tasks. The training dataset comprises 40 unpaired CBCT-CT images with only CT images annotated. The validation and testing datasets consist of 5 and 10 CT images, respectively, all with annotations. The experimental results demonstrate the superior performance of our method compared to other state-of-the-art cross-modality medical image segmentation methods. The Dice similarity coefficients (DSC) for CBCT image segmentation results is %, and the average symmetric surface distance (ASSD) is . Statistical analysis confirms the statistical significance of the improvements achieved by ourmethod. Our method exhibits superiority in pelvic CBCT image segmentation compared to its counterparts.

Topography-guided Anatomical Reassembly for Distal Penile Hypospadias Without Chordee: A Comprehensive Illustration and Midterm Results of a Novel Approach

ObjectivesTo provide a comprehensive illustration of the newly introduced ‘topography-guided anatomical reassembly’ approach, which has shown promising early results, and to report the mid-term outcomes of an extended series. MethodsThis is a prospective cohort study of all patients presenting to the author’s facility with distal penile hypospadias without chordee between June 2018 and January 2023. Redo cases, circumcised cases, and cases with non-preservable plates are excluded. The procedure follows the most recently introduced principle of the topography-guided anatomical reassembly approach for distal penile hypospadias, that is, the exclusive zipping-up of the unfolded spongiosal plate. ResultsA subset of 97 boys met the enrolment criteria. The hypospadias meatus was coronal or sub-coronal in 35 boys, distal penile in 45 boys, and mid-penile in 17 boys. The mean age at the time of surgical correction was 8.11 months. The mean operative time was 66.7 min. After a mean follow-up of 27 months, five urethrocutaneous fistulae were reported: three glanular and two sub-coronal. Meatal disfigurement with downward stream deviation was reported in two more patients. Two more occurrences of meatal recession were identified, yet surgical correction was not necessary. The overall reoperation rate settled at 7%. ConclusionsThe proposed topography-guided anatomical reassembly technique for distal hypospadias is simple, effective, and highly feasible at mid-term follow-up of the given series. Maintaining the integrity of well-developed penile tissues eliminates the possibility of unforgivable tissue damage and avoids the need for challenging revision procedures.

572. TECHNICAL DETAIL AND SHORT-TERM OUTCOMES OF ROBOT-ASSISTED CERVICAL ESOPHAGECTOMY (RACE) WITH BILATERAL CERVICAL APPROACH FOR ESOPHAGEAL CANCER

Abstract Background The transcervical mediastinoscopic esophagectomy is a relative new technique that has gradually demonstrated because of its ease of dissection along the organ sheath and its less invasive nature. However, the conventional cervical approach to mediastinoscopy has been reported to have a relatively high rate of recurrent nerve palsy due to interference in the mediastinum caused by the straight forceps. The robot-assisted transcervical esophagectomy (RACE) approach is novel procedure expected to reduce these interferences and improve maneuverability around the recurrent nerve. In this report, we describe a surgical technique and short-term outcome of RACE. Methods In this study, we included 26 RACE cases performed between Feb 2023 to Feb 2024. Principally, our hospital performs transcervical esophagectomy mainly on patients who are difficult to approach by transthoracic approach due to history of thoracic diseases, etc. In our department, transcervical esophagectomy is usually performed via a bilateral cervical approach, starting from the right neck and continuing to the left neck, and RACE is performed using the da Vinci Xi via a bilateral cervical approach as well. Recently, we have been shortening the operation time by performing simultaneous cervical and abdominal operations without muscle relaxation using NIM. Results Patient background: mean age 74.5, male to female ratio 22:4, cStage I/II/III/IV: 13/3/9/1, NAC: 46.1%, more than 80% had some history of pulmonary disease/systemic history. All patients underwent RACE via bilateral cervical approach, and no intraoperative complications or thoracoscopic conversion were observed. Postoperative complications (CD Grade≥1) included recurrent nerve palsy in 15.6% and respiratory complications in 7.6%. In addition, the recent operation with simultaneous cervical/abdominal NIM and no muscle relaxant has significantly shortened the average total operative time to 4 hours and 40 minutes. Conclusion Robot-assisted Cervical Esophagectomy (RACE) is a relatively safe procedure that offers a natural anatomic approach, fewer respiratory complications, and a significant reduction in operative time due to simultaneous neck and abdominal manipulation. With the advancement of robotics and devices, RACE is expected to become more effective and more widely used in the future.

High Resolution Ultrasound of the Lower Extremity Nerves

High resolution ultrasound is a powerful diagnostic tool to evaluate the lower extremity peripheral nerves. It offers a complementary evaluation to MR neurography and has distinct advantages. Requests for ultrasound imaging of lower extremity nerves are becoming more commonplace as a first line evaluation of neurologic deficits given its accessibility, lower cost, and non-invasive approach. Radiologists can provide a higher value to their referring providers with a thorough understanding of lower extremity nerve anatomy and common pathologies. This article discusses the ultrasound appearance of lower extremity nerves with an anatomic approach as well as commonly seen pathologies.

Developmental Cajal-Retzius cell death contributes to the maturation of layer 1 cortical inhibition and somatosensory processing

The role of developmental cell death in the formation of brain circuits is not well understood. Cajal-Retzius cells constitute a major transient neuronal population in the mammalian neocortex, which largely disappears at the time of postnatal somatosensory maturation. In this study, we used mouse genetics, anatomical, functional, and behavioral approaches to explore the impact of the early postnatal death of Cajal-Retzius cells in the maturation of the cortical circuit. We find that before their death, Cajal-Retzius cells mainly receive inputs from layer 1 neurons, which can only develop their mature connectivity onto layer 2/3 pyramidal cells after Cajal-Retzius cells disappear. This developmental connectivity progression from layer 1 GABAergic to layer 2/3 pyramidal cells regulates sensory-driven inhibition within, and more so, across cortical columns. Here we show that Cajal-Retzius cell death prevention leads to layer 2/3 hyper-excitability, delayed learning and reduced performance in a multi-whisker-dependent texture discrimination task.

Application of the Length of Index and Ring Fingers to Estimate the Stature.

Stature contributes as a crucial element of an individual's physical appearance and can be instrumental in establishing their identity.In cases where the body is extensively mutilated, decomposed, or reduced to skeletal remains, stature becomes an essential component in identifying the unknown by means of measuring the skeletal remains. Its estimation relies on the principle that an individual's height has a definite and linear relationship with specific body parts and long bones. This process, together with assessing age, sex, and race constitutes the essential components of the anthropological protocol. Stature estimation can be accomplished through both anatomical and mathematical approaches. The present study clearly defines regression models for height estimation from finger lengths. The formula derived can proveparticularly valuable in Medico-legal scenarios, as it can be applied effectively even when only a portion of the body is accessible. The purpose of the present study is to estimate the stature of individuals by measuring the length of the index and ring fingers. The current study acquired three measurements, such as stature, right/left index finger length (RIFL/LIFL), and ring finger length (RFL), from 220 samples, including 110 males and 110 females, respectively, between the age groups of 20 and 60 years. The application of the length of the index and ring finger in forensic investigations holds significance due to their potential as reliable predictors of an individual's height. According to the findings of the study, males showed significantly higher stature than females. A statistically significant correlation was also observed (p-value = 0) between stature and finger lengths (IFL, RFL) in both hands. The highest correlation coefficients were found for the left RFL (r = 0.688) in females and the LIFL (r = 0.552) in males. Additionally, males showed significantly longer index and RFL than females. Linear regression models for the estimation of stature from ring and index finger length were also derived successfully. The results obtained from the present study exhibit potential use to evaluate the utility of measuring index and RFLs for determining stature and predicting the precision of regression models by employing those parameters. The models derived from this study can serve as corroborative evidence for identifying mutilated body parts or unknown remains.