Dominant Branch Research Articles

N-linked glycosylation at site 158 of the HA protein of H5N6 highly pathogenic avian influenza virus is important for viral biological properties and host immune responses

Since 2014, clade 2.3.4.4 has become the dominant epidemic branch of the Asian lineage H5 subtype highly pathogenic avian influenza virus (HPAIV) in southern and eastern China, while the H5N6 subtype is the most prevalent. We have shown earlier that lack of glycosylation at position 158 of the hemagglutinin (HA) glycoprotein due to the T160A mutation is a key determinant of the dual receptor binding property of clade 2.3.4.4 H5NX subtypes. Our present study aims to explore other effects of this site among H5N6 viruses. Here we report that N-linked glycosylation at site 158 facilitated the assembly of virus-like particles and enhanced virus replication in A549, MDCK, and chicken embryonic fibroblast (CEF) cells. Consistently, the HA-glycosylated H5N6 virus induced higher levels of inflammatory factors and resulted in stronger pathogenicity in mice than the virus without glycosylation at site 158. However, H5N6 viruses without glycosylation at site 158 were more resistant to heat and bound host cells better than the HA-glycosylated viruses. H5N6 virus without glycosylation at this site triggered the host immune response mechanism to antagonize the viral infection, making viral pathogenicity milder and favoring virus spread. These findings highlight the importance of glycosylation at site 158 of HA for the pathogenicity of the H5N6 viruses.

Role of bar‐channel interactions in a dominant branch shift: The Taipingkou waterway, Yangtze River, China

AbstractPrevious investigations regarding river bifurcation mainly focus on the conditions of a stable bifurcation and how key factors affect the asymmetrical features of a bifurcation. In this paper, a numerical case study is presented of the 2012–2014 north to south shift in the Sanba mid‐channel bar of the Taipingkou waterway's dominant branch in the Yangtze River, China. Numerical reproduction of the bar‐channel system evolution process as well as the resultant shift in the dominant branch was conducted by a fully coupled hydro‐sediment‐morphodynamic model. The following aspects are shown to play important roles in the shift: the south bank flattening of the Lalinzhou point bar, which formed a straight and wide route for the south branch, and the downstream‐south movement of the north‐bank Yanglingji point bar, which narrowed the north branch entrance. The direct consequence of these bar evolutions is the north to south shift in the dominant branch. Prior to this shift, the south branch had a larger water diversion ratio during high water but a smaller ratio during low water. Subsequently, the south branch has a larger water diversion ratio when either high or low water levels occur. These findings suggest the important role of bar‐channel interactions in dominant branch shifts.

Forensic characteristics and phylogenetic analyses of one branch of Tai-Kadai language-speaking Hainan Hlai (Ha Hlai) via 23 autosomal STRs included in the Huaxia™ Platinum System.

BackgroundHainan Island, located in the South China Sea and separated from the Leizhou Peninsula by Qiongzhou Strait, is the second largest island after Taiwan in China. With the expansion of Han Chinese and the gradual formation of “South Hlai and North Han”, nowadays, Hainan Hlai is the second largest population after Han Chinese in Hainan Island. Ha Hlai, distributed in southwest and southern Hainan Island, is the dominant branch of Hlai and speaks Ha localism.MethodsWe utilized the Huaxia™ Platinum PCR Amplification System (including 23 autosomal STRs and 2 sex‐linked markers) to obtain the first STR profiling batch of 657 Ha Hlai individuals (497 males and 160 females). In order to explore the genetic relationships between the studied Ha Hlai and other reference populations with different language families, population genetic analyses, including PCA, MDS, STRUCTURE, and phylogenetic analysis, were conducted based upon the raw data and allelic frequencies of the polymorphic autosomal STR markers.ResultsIn total, 271 distinct alleles were observed at the 23 STR loci. The number of diverse alleles ranged from 7 at TPOX locus to 23 at FGA locus, and the allelic frequencies varied from 0.0008 to 0.5533. In addition, the CPE and CPD were 1‐7.39 × 10−10 and 1‐3.13 × 10−28, respectively. The phylogenetic analyses indicated that Ha Hlai is a Tai‐Kadai language‐speaking and relatively isolated population which has a close genetic and geographical relationship with Hainan Hlai, and M95 is the dominant haplogroup in Ha Hlai (56.18%).ConclusionThe 23 autosomal STR genetic markers were highly polymorphic as well as potentially useful for forensic applications in Hainan Ha Hlai population. The phylogenetic analyses demonstrated that small geographic scale gene flows could not be ignored and the shaping of the unique gene pool for each population was the combination effects of geographic, language, and cultural isolations.

Monitoring as a Tool for Improvement of Modern Regional Anti-Corruption Policy in Russia

Despite an extensive collection of specialized literature on anti-corruption field, including in the Russian segment of the study of these phenomena, issues of anti-corruption monitoring are not the dominant branch of modern special issues. However, it is this aspect that allows us to discover the real effect of managerial decisions of different anti-corruption agencies. Russia is the largest federal state in which the influence of regional anti-corruption strategies and programs is heterogeneous. Regions are rapidly gaining experience, identifying critical zones, corruption traps. In this sense, the generalization of this experience, the extrapolation of the results is a scientific task with a serious future perspective.

Lateral nasal wall flap for endoscopic reconstruction of the skull base: anatomical study and clinical series.

The lateral nasal wall (LNW) flap provides vascularized endonasal reconstruction primarily in revision surgery. Although the harvesting technique and reconstructive surface have been reported, the arterial supply to the LNW flap and its clinical implications is not well defined. This study presents anatomical dissections to clarify the vascular supply to this flap, and the associated clinical outcomes from this reconstructive technique. The course and branching pattern of the sphenopalatine artery (SPA) to the LNW were studied in 6 vascular latex-injected heads (11 LNW flaps total). Patients undergoing an LNW flap since 2008 were identified and the underlying pathology, indication, flap viability, and clinical outcomes were retrospectively analyzed. The inferior turbinate artery arises from the LNW artery and divides into 2 branches at the most posterior aspect of the inferior turbinate bone. A smaller-caliber superficial branch travels anteriorly and branches to the LNW. A larger dominant branch travels into the inferior meatus and tangentially supplies the nasal floor. Twenty-four patients with sellar or posterior cranial fossa (PCF) defects were reconstructed with an LNW flap. Postoperative contrast enhancement of the LWN flap was identified in 95.5% of cases. Postoperative cerebrospinal fluid (CSF) leaks were identified in 6 cases. Blood supply to the nasal floor by the dominant inferior meatus branch is more robust than the supply to the anterior LNW by the superficial arterial branch. The LNW flap is the preferred vascularized reconstructive option to the PCF and sella in the absence of a nasoseptal flap (NSF).

Numerical investigation of flow-induced vibrations of two cylinders in tandem arrangement with full wake interference

This paper presents a numerical investigation on flow-induced vibration (FIV) of two elastically mounted cylinders in a tandem arrangement at subcritical Reynolds numbers. The tandem spacing between the cylinder centers is set at four cylinder diameters, placing the FIV problem within the full wake interference regime. A fluid-structure interaction numerical methodology based on a two-dimensional discrete vortex method is developed and applied to the FIV simulation of two cylinders. To investigate the effect of the upstream wake frequency and Reynolds number on the FIV response of the downstream cylinder separately, two experimental cases are designed. In one case, the FIV response is investigated with the Reynolds number varying and the upstream wake frequency fixed. In another case, the Reynolds number is fixed and the upstream wake frequency varies. In both cases, the FIV response of the upstream cylinder roughly resembles the lower branch of the typical vortex-induced vibration response of the single cylinder with the upstream reduced velocity varying from 6 to 9. For the downstream cylinder, the FIV response is characterized by two frequency branches: a dominant frequency branch associated with the wake interference mechanism and a secondary frequency branch associated with the upstream vortex shedding mechanism. It is found that the variation of the vortex shedding frequency in the upstream wake has little effect on the amplitude and dominant frequency of the downstream FIV response but directly causes the variation of the secondary frequency as the secondary frequency strictly follows the upstream vortex shedding frequency. The FIV response amplitude and dominant frequency of the downstream cylinder shows a strong dependence on the Reynolds number. The wake pattern of FIV shows that the FIV vortex shedding of each cylinder is directly related to the motion of itself but slightly modified by the wake of other cylinders for the full wake interference regime. The upstream wake vortices interfering with the downstream motion induce a flow in favor of the downstream FIV response.

TEVAR- Thoracic Endovascular Stent Graft

Surgical care, respectively health care started with the first step in hospital us patient and client. All people who working in hospital where is surgical dominant medical branch, it will tell you that it is the only exact part of medicine, for this opinion have the simple explanation, medical team see problem and try to find the best solution for patient. Since many different levels surgical care: • preparation patient for diagnostic procedure, • preparation patient for surgical procedure, • surgical care in intensive care units, • surgical care in units of semi-intensive care, • department of surgical care

P5695Catheter ablation of ventricular tachycardia in patients with acute vs. previous myocarditis

Abstract Background Ventricular tachycardias (VT) may occur late after myocarditis, as well as in the acute inflammatory phase of the disease. However, the role of catheter ablation (CA) in preventing VT recurrences in patients with acute (AM) vs. previous myocarditis (PM) has never been investigated so far. Purpose To evaluate the results of CA performed in patients presenting with VA and biopsy-proved myocarditis at different inflammatory stages. Methods We enrolled 46 consecutive patients (74% males, mean age 43±12y, mean LVEF 46±9%) with myocarditis and VT at index hospitalization. Based on endomyocardial biopsy and cardiac magnetic resonance (CMR) results, the patients were divided into AM and PM groups: in AM group, myocarditis was biopsy-proved, according to the ESC criteria; PM patients had a history of biopsy-proved myocarditis more than 12 months before, with no current signs of active inflammation (negative biopsy according to the ESC criteria; nonischaemic LGE at CMR with negative Lake-Louise criteria; absence of unexplained troponin abnormalities). ICD were implanted upon clinical indications. All of the patients underwent electroanatomical mapping (EAM) and VT CA. During 3 (2.5–3.5)y FU, VT recurrences were evaluated by 2/y Holter ECG and ICD interrogation. Results At baseline, 23 patients (50%) had AM, and 23 PM. Overall, 16 AM and 21 PM patients underwent ICD implant (p=n.s.). The clinical VT was monomorphic in 22 AM and 23 PM patients, respectively (p=n.s.) with a dominant right-bundle branch block with superior axis (RS) morphology in both groups (16 AM vs. 17 PM cases, p=n.s.). However, RS morphology was associated with left ventricular inferoposterior LGE at CMR in 9/16 AM vs. 17/17 PM patients (p=0.003). Similarly, inferoposterior localization of low-voltage areas at EAM was found in 11/16 AM vs. 17/17 PM patients (p=0.018). Furthermore, CMR showed a greater LGE transmural extension in AM patients (65±19%) as compared to PM ones (40±25%, p<0.001). Epicardial EAM and CA were performed in 14 AM vs. 15 PM patients, with endocardial-only approach adopted in the remaining cases (p=n.s.). VT CA was defined as successful (class A) in all of the subjets. However, during FU VT recurrences were documented in 7/23 AM vs. 0/23 PM patients (p=0.009). Four AM cases underwent redo CA late after myocarditis (1.5±0.3y after index hospitalization), with no further VT recurrences in FU. Conclusion In myocarditis patients presenting with VT, CA results are significantly better in PM cases as compared to AM ones. These findings are consistent with the different underlying substrate, and suggest the best role for ablation strategy after myocarditis healing. Acknowledgement/Funding None

Testing of the narrow crowned Norway spruce ideotype (Picea abies f. pendula) and the hybrids with normal crown form (pyramidalis) in multisite comparative trials

The study aims to analyse the stability of the narrow crowned Norway spruce (pendula form) compared to the normal spruce form (pyramidalis form) and the hybrids of the two forms, in 5 field trials (Comandău, Lepşa 1&2, Ilva Mică and Voineasa) located in the Romanian Carpathians. Trees height (Th), breast height diameter (Dbh), height growth of the last year, crown diameter (Cd), number of branches per whorl (Nbw) and dominant branch diameter (Dbd) traits were measured and survival rate (Sr) was determined, at 20 years old. Also, branches finesse (Bf), trees volume (Tv) and trees slenderness (Ts) were calculated. In order to compare the wood density (Cwd) there were collected cores. In all trials ANOVA revealed significant (p < 0.05) differences between the two forms of spruce and the hybrids (mainly between those that have a different crown form mother), especially for the stability and quality traits. Factorial ANOVA revealed a high influence (p < 0.001) of the locality and also a significant influence (p < 0.05) of the locality × spruce form interaction. The factor “form” was significant for some traits involved in Norway spruce stability (Ts, Cd, Nbw). The pendula trees present higher values for Sr, Dbh and Tv, and lower values for Ts, Cd, Nbw, Dbd and Bf, compared to pyramidalis spruce form, which showed a higher stability. Heritability was in generally low (h2 < 0.4), with exceptions of Ts which presents a medium rate of heritage. For the same trait, different heritability was registered in different environmental conditions. The Cwd was higher only with 2% for the pendula form in Lepşa trial, while in Comandău trial the pyramidalis registered a higher value (7%). In the new breeding programme, the selection strategy may be pursued with the pendula trees selection based on Ts and branches traits.

Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature

Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.

Thrombectomy for M2 occlusions and the role of the dominant branch.

The benefits of thrombectomy for occlusion of M2 segments remain controversial. The aim of this study is to assess thrombectomy's efficacy and safety in patients with M2 segment occlusion and associations between occlusion sites and anatomic variations of M1 division. A prospective series of 30 patients with acute ischemic stroke (AIS) resulting from M2 segment occlusion of the middle cerebral artery (MCA) who underwent thrombectomy was analyzed. The primary endpoint was assessed by the Extended Treatment in Cerebral Infarction scale (eTICI). The secondary endpoints were the incidence of symptomatic hemorrhagic transformation (sICH), mortality and good functional outcome at three months. The mean patient age was 69.2 years. The mean National Institutes Health Stroke Scale score (NIHSS) upon hospital admission was 16. The recanalization rates were eTICI 2b/3 in 90% and 2c/3 in 60% of the patients. Total recanalization of the M2 branch was achieved in 53% of patients. sICH incidence was 6.6%, the mortality rate was 30%, and a good functional outcome (mRS ≤2) was observed in 50% of the patients. Twenty-seven patients (90%) had a dominant M2 branch and all were occluded. Regarding the site of M2 occlusions, 74% of patients had proximal M2 occlusions. Thrombectomy appears to be a safe and effective method for the treatment of acute M2 segment occlusions of the MCA. Most of the cases had a dominant M2 branch, and all of them were occluded. Larger studies are needed to verify the benefits of thrombectomy for different settings of M2 occlusions.

Adaptability of Narrow-Crowned Norway Spruce Ideotype (Picea abies (L.) Karst. pendula Form) in 25 Years Half-Sib Comparative Trials in the Eastern Carpathians

This study analysed the stability of the narrow-crowned Norway spruce (pendula form) compared with the classic form of spruce (pyramidalis form) in two half-sib field trials located in the Romanian Carpathians. From eight natural populations, representative of three of the four large spruce spread areas in Romania, open-pollinated seeds from 48 trees (24 pendula ideotype and 24 pyramidalis form) were collected to install the Maneciu and Soveja trials. In these trials, at age 25 years, measurements were performed for the following traits: tree height, breast height diameter, crown diameter, number of branches per whorl and dominant branch diameter. Some important traits were calculated: average volume per tree, trees’ slenderness, crown slenderness and branches’ finesse. Pearson’s simple correlations between the analysed traits were calculated and also the correlations between traits and geographic and climatic gradients of provenances’ origin. In addition, cores were collected to compare the wood density of the two forms of spruce. In both trials, but especially in the limitative environmental conditions of the Soveja trial, the narrow crowned form of Norway spruce (Picea abies f. pendula) presented more favourable average results than the normal crown spruce form for the most important stand stability traits: trees’ slenderness, wood density, branches’ diameter and branches’ finesse. Between spruce crown forms, in both trials, no significant differences were observed for the growth traits, but between trials, higher results resulted in optimal environmental conditions of the Măneciu test (+89% for the trees’ volume). The trees from different provenances and with specific forms of the crown reacted differently to the changing of the testing site, which required the adoption of maximum caution for decisions regarding the transfer of forest reproductive materials. The correlations between the analysed traits converge towards the adoption of a two-step breeding strategy, starting by selection of narrow crowned trees after stability traits.

Colanthelia longipetiolata (Poaceae: Bambusoideae), a new species of woody bamboo from the Brazilian Atlantic forest

Colanthelia is a woody bamboo genus belonging to the Arthrostylidiinae and currently includes nine species. It can be recognized by a suite of morphological characters including hollow and thick-walled culms, branch complement with a promontory in the base and a dominant divergent branch bearing few to many secondary small branchlets from its base, culm leaves with a relatively well developed girdle and a crest or skirt at the juncture of the sheath and girdle, racemose or weakly paniculate synflorescences, and relatively long and narrow spikelets with visible rachilla internodes. During recent fieldwork in Minas Gerais state, a new species, Colanthelia longipetiolata, from the Brazilian Atlantic forest was collected, which is here described and illustrated. So far as we know, the species is endemic to the Caparaó National Park, in Minas Gerais state. Comments on its habitat, distribution and conservation status, a morphological comparison between C. longipetiolata and C. sparsiflora, and a revised identification key to all species of the genus are provided.

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures.

The facial nerve is responsible for any facial expression channeling human emotions. Facial paralysis causes asymmetry, lagophthalmus, oral incontinence, and social limitations. Facial dynamics may be re-established with cross-face-nerve-grafts (CFNG). Our aim was to reappraise the zygomaticobuccal branch system relevant for facial reanimation surgery with respect to anastomoses and crossings. Dissection was performed on 106 facial halves of 53 fresh frozen cadavers. Study endpoints were quantity and relative thickness of branches, correlation to "Zuker's point", interconnection patterns and crossings. Level I and level II branches were classified as relevant for CFNG. Anastomoses and fusion patterns were assessed in both levels. The zygomatic branch showed 2.98 ± 0.86 (range 2-5) twigs at level II and the buccal branch 3.45 ± 0.96 (range 2-5), respectively. In the zygomatic system a single dominant branch was present in 50%, two co-dominant branches in 9% and three in 1%. In 66% of cases a single dominant buccal twig, two co-dominant in 12.6%, and three in 1% of cases were detected. The most inferior zygomatic branch was the most dominant branch (P = 0.003). Using Zuker's point, a facial nerve branch was found within 5 mm in all facial halves. Fusions were detected in 80% of specimens. Two different types of fusion patterns could be identified. Undercrossing of branches was found in 24% at levels I and II. Our study describes facial nerve branch systems relevant for facial reanimation surgery in a three-dimensional relationship of branches to each other. Clin. Anat. 32:480-488, 2019. © 2019 Wiley Periodicals, Inc.

Monitoring Metabolite Production of Aflatoxin Biosynthesis by Orbitrap Fusion Mass Spectrometry and a D-Optimal Mixture Design Method

Aflatoxins, highly toxic and carcinogenic to humans, are synthesized via multiple intermediates by a complex pathway in several Aspergilli, including Aspergillus flavus. Few analytical methods are available for monitoring the changes in metabolite profiles of the aflatoxin biosynthesis pathway under different growth and environmental conditions. In the present study, we developed by a D-optimal mixture design a solvent system, methanol/dichloromethane/ethyl acetate/formic acid (0.36/0.31/0.32/0.01), that was suitable for extracting the pathway metabolites. The matrix effect from dilution of cell extracts was negligible. To facilitate the identification of these metabolites, we constructed a fragmentation ion library. We further employed liquid chromatography coupled with high-resolution mass spectroscopy (UHPLC-HRMS) for simultaneous quantification of the metabolites. The limit of detection (LOD) and limit of quantitation (LOQ) were 0.002-0.016 and 0.008-0.05 μg/kg, respectively. The spiked recovery rates ranged from 81.3 to 100.3% with intraday and interday precision less than 7.6%. Using the method developed to investigate the time-course aflatoxin biosynthesis, we found that precursors, including several possible toxins (with a carcinogenic group similar to aflatoxin B1), occurred together with aflatoxin, and that production increased rapidly at the early growth stage, peaked on day four, and then decreased substantially. The maximum production of aflatoxin B1 and aflatoxin B2 occurred 1 day later. Moreover, the dominant branch pathway was the one for aflatoxin B1 formation. We revealed that the antiaflatoxigenicity mechanism of Leclercia adecarboxylata WT16 was associated with a factor upstream of the aflatoxin biosynthesis pathway. The design strategies can be applied to characterize or detect other secondary metabolites to provide a snapshot of the dynamic changes during their biosynthesis.

Dual origin of the right vertebral artery from the right common carotid and aberrant right subclavian arteries

This report describes a case of duplicated origin of the right vertebral artery incidentally found in a young patient. Computed tomographic angiography and digital subtraction angiography showed a dominant branch derived from the right common carotid artery and an accessory branch that derived from the right subclavian artery, which aberrantly originated from the far left aortic arch, and adjoined the dominant branch at the C5 level. We discuss angiographic findings, clinical implications and embryological basis for this rare anomaly.

Control of Delta Avulsion by Downstream Sediment Sinks

Understanding how fluxes are partitioned at delta bifurcations is critical for predicting patterns of land loss and gain in deltas worldwide. Although the dynamics of river deltas are influenced from both upstream and downstream, previous studies of bifurcations have focused on upstream controls. Using a quasi‐1‐D bifurcation model, we show that flow switching in bifurcations is strongly influenced by downstream sediment sinks. We find that coupling between upstream and downstream feedbacks can lead to oscillations in water and sediment flux partitioning. The frequency and initial rate of growth/decay of the oscillations depend on both upstream and downstream conditions, with dimensionless bifurcate length and bypass fraction emerging as key downstream parameters. With a strong offshore sink, causing bypass in the bifurcate branches, we find that bifurcation dynamics become “frozen”; that is, the bifurcation settles on a permanent discharge ratio. In contrast, under depositional conditions, we identify three dynamical regimes: symmetric; soft avulsion, where both branches remain open but the dominant branch switches; and full avulsion. Finally, we show that differential subsidence alters these regimes, with the difference in average sediment supply to each branch exactly compensating for the difference in accommodation generation. Additionally, the model predicts that bifurcations with shorter branches are less asymmetric than bifurcations with longer branches, all else equal, providing a possible explanation for the difference between backwater length distributaries, which tend to be avulsive, and relatively stable mouth‐bar‐scale networks. We conclude that bifurcations are sensitive both quantitatively and qualitatively to downstream sinks.

Wooden architecture of sieve farmsteads in Biłgoraj on the example of the farmstead at Nadstawna 32 St.

At the turn of the 17th and 19th centuries, the sieving industry developed in the Biłgoraj region, which became the dominant branch of crafts and trade. In a special way it contributed to the development of the city - its construction, tradition, culture, and in present times to the identity of its current inhabitants. It was due to this industry that the local population of that time travelled to the city and recruited Biłgoraj sieve makers [1]. Unfortunately, as a result of wars, unstable situation in the country, declining profitability of sieves, as well as economic changes, this line of industry collapsed, leaving a small but valuable mark. The last preserved sieve house along with farm buildings is a "sieve farmstead” built in 1810 at Nadstawna 32 St. (formerly called Krasickiego 50 St.) [2] left in its original position, i.e. in situ. The object stood out against the background of wooden buildings due to its rich functional program, characteristic and representative form of the building together with regional architectural details.

A High Bifurcation of the Dorsal Branch with Dominant Superficial Palmar Branch of the Radial Artery: A Case Report of an Aberrant Radial Artery with Traumatic Aneurysm

Anatomical abnormalities such as unusual bifurcations or aberrant arteries of the radial artery are extremely rare and due to malformation or disruption of the vascular net. We present a case of a 64year old woman with a high bifurcated dorsal branch of the left radial artery, consulting us for a pulsatile mass in the anatomical snuffbox after a fall. The mass measured 3-4mm in diameter and was located on the dorsal aspect of the wrist over the anatomical snuffbox. Primary imaging studies using Duplex Ultrasound suggested an aneurysm of the radial artery, further imaging with arteriogram revealed a high bifurcation of the dorsal branch of the radial artery, presenting with an aneurysm. The deep palmar branch of the ulnar artery was the dominating vessel, allowing ligation and excision of the aneurysm. Histological evaluation revealed intimal wall hyperplasia within the aneurysm, suggesting an injury as initiating factor. A review of the literature showed that this abnormality of high bifurcation of the dorsal palmar branch of the radial artery has not been previously reported. Management of aneurysms at the wrist is discussed.

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint. Twenty-eight cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected. The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh. Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded. We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness. In 50% of the specimens, the LFCN divided into ≥2 branches superior to the inguinal ligament. Sixty-two percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS. The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue. Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue.