Lateral Nerve Research Articles

The value of magnetic resonance imaging of the mandibular nerve using a micro surface coil and three-dimensional double-echo steady-state with water excitation sequence

Objective To explore the value of small surface coil combined with three-dimensional double-echo steady-state with water excitation (3D-DESS-WE) sequence in displaying mandibular nerves and their branches. Methods The maxillofacial regions of 52 volunteers were scanned unilaterally by a small surface coil combined with 3D-DESS-WE sequence. According to the Gray's anatomy atlas, MPR and CPR was done according to the anatomic position of mandibular nerve and the branches, the signal characteristics of the nerves and neighboring structures were analyzed. The displaying rate of the mandibular nerves and their branches were evaluated.The image quality and display of the nerve were subjectively scored. The signal intensity(SI) of the nerve and adjacent lateral pterygoid muscle were measured. The signal intensity ratio(SIR) of mandibular nerve/lateral pterygoid muscle (SIRN/M) was calculated. Results Compared with the muscles, the nerve showed iso-signal intensity. The subjective scores for all small coil 3D-DESS-WE images were 3.02±0.82. The displaying rates of V3 trunk, anterior trunk, buccal nerve, posterior trunk, inferior alveolar nerve and lingual nerve were all 100%. V3 posterior trunk, inferior alveolar nerve and lingual nerve showed the best quality scores, which were all about 3 points, and the SIRN/M were about 1. The auricular temporal nerve and masseter muscle nerve were also basically satisfied. The displaying rate of mylohyoid muscle nerve, medial pterygoid nerve and lateral pterygoid nerve was low. Conclusion Small surface coil combine with 3D-DESS-WE sequence performed high-quality in mandibular nerves and their branches MR imaging using MPR, CPR post-processing technology, which are suitable for clinical application. Key words: Mandibular nerve; Magnetic resonance imaging; Small surface coil

From above or from below? That is the question. Comparison of the supraorbital approach with the endonasal approach. A cadaveric study

Background: Nowadays the endoscopic endonasal approach is increasingly being used to remove craniopharyngiomas, tuberculum sellae meningiomas and other presellar and parasellar lesions and its value in anterior skull base surgery is undisputed. Herein, we assess the relative advantages, disadvantages and feasibility of the keyhole eyebrow approach and the endonasal endoscopic approach in four cadaveric heads for the removal of presellar and parasellar lesions.Methods: We used four cadaveric heads for 12 surgical dissections. The specimens were embalmed with two different techniques. Two bilateral supraorbital endoscopic assisted approaches and one transnasal expanded endonasal approach were performed for each head. We evaluated the feasibility, maneuverability and safety of each approach. We measured the operating room obtained with each approach and the distance from the main structures we reached.Results: The technical feasibility of the endoscopic endonasal transphenoidal approach and the supraorbital eyebrow approach was reproduced in all four cadaveric heads. The transnasal approach gave us a good operating field medial to the two optic nerves and the two carotid arteries anteriorly until the frontal sinus and, posteriorly, the basilar artery, the emergence of the superior cerebellar arteries and posterior cerebral arteries. After performing the supraorbital approach, we viewed a wider field of the anterior skull base and we were able to reach the ipsilateral carotid artery, the optico-carotid recess, the pituitary stalk, the lamina terminalis until the contra lateral optic nerve and carotid artery, keeping a wider angle of maneuverability.Conclusions: Although the endoscopic transnasal approach has developed in leaps and bounds in the last decade, other transcranial approaches maintain their value. The supraorbital endoscopic approach is a minimally invasive approach and seems to be optimal for those lesions wider than 2 cm in the lateral extension and for all the paramedian lesions.

Does endoscopic piriformis tenotomy provide safe and complete tendon release? A cadaver study

BackgroundEndoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. HypothesisEPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. Material and methodsEPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. ResultsComplete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5–6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4–8.5cm) for the inferior gluteal artery. DiscussionEPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. Level of evidenceIII, prospective cadaver case-control study.

Comparison of lameness scores after a low 4‐point nerve block to lameness scores after additional desensitisation of the dorsal metatarsal nerves in horses with experimentally induced pain in the metatarsophalangeal joint

SummaryThis study evaluated whether anaesthesia of the dorsal metatarsal nerves in addition to a low 4‐point nerve block provides significantly more analgesia to the metatarsophalangeal joint than to a low 4‐point nerve block alone. A wireless, inertial, sensor‐based, motion analysis system was used to evaluate gaits of six horses before induction of lameness, after administration of interleukin‐1β into a metatarsophalangeal joint, after anaesthesia of the medial and lateral plantar nerves and the medial and lateral plantar metatarsal nerves, and after additional anaesthesia of the lateral and medial dorsal metatarsal nerves. The magnitude of hindlimb lameness was analysed considering both the push‐off component (diffmaxpelvis) and the impact component (diffminpelvis) of the lame limb for all trials. There was no significant difference in the sum of diffmaxpelvis and diffminpelvis (SDMPs) when comparing the horse's gait after the low 4‐point nerve block to the gait after additional anaesthesia of the dorsal metatarsal nerves, indicating that there is likely no benefit of medial and lateral dorsal metatarsal nerve anaesthesia when using regional anaesthesia to localise pain to the metatarsophalangeal joint during a lameness examination.

Pulsed Radiofrequency Ablation after One Block for the Treatment of Meralgia Paresthetica

Meralgia paresthetica describes a condition in which impingement of the lateral femoral cutaneous nerve (LFCN) causes anterolateral thigh numbness, and often pain. Treatment options include conservative care with nonsteroidal anti-inflammatories, local anesthetic nerve blocks with corticosteroids, radiofrequency ablation of the LFCN, and surgical interventions, such as neurolysis and neurectomy. When a left femoral cutaneous nerve block is used to treat meralgia paresthetica, it is typically repeated before advancing to pulsed radiofrequency ablation (pRFA). We hypothesized that a single trial of a LFCN block, which relieved pain, but for only a short duration was sufficient to advance to pRFA . Our patient was a 55-year-old woman with right anterior lateral thigh pain for 1 year, which made activities of daily living difficult and was resistant to conservative treatment which included nonsteroidal anti-inflammatories, an antidepressant, and an anticonvulsant. Diagnosis of meralgia paresthetica was established by physical exam, nerve conduction study, and electromyography. A LFCN block under ultrasound guidance was successful in resolving 100 percent of the pain for approximately 2 weeks duration, at which time the pain and paresthesia returned to original intensity. The patient was deemed an appropriate candidate for pRFA of the LFCN, which resulted in complete resolution of symptoms as of her 9 month follow-up visit. To our knowledge, this is the first report of the use of pRFA after a single LFCN block providing faster resolution of symptoms and return to activities of daily living. Key words: Pulsed radiofrequency ablation, RFA, pRFA, meralgia paresthetica, lateral femoral cutaneous nerve, LFCN

Do chitons have a brain? New evidence for diversity and complexity in the polyplacophoran central nervous system.

Molluscs demonstrate astonishing morphological diversity, and the relationships among clades have been debated for more than a century. Molluscan nervous systems range from simple 'ladder-like' cords to the complex brains of cephalopods. Chitons (Polyplacophora) are assumed to retain many molluscan plesiomorphies, lacking neural condensation and ganglionic structure, and therefore a brain. We reconstructed three-dimensional anatomical models of the nervous system in eight species of chitons in an attempt to clarify chiton neuroarchitecture and its variability. We combined new data with digitised historic slide material originally used by malacologist Johannes Thiele (1860-1935). Reconstructions of whole nervous systems in Acanthochitona fascicularis, Callochiton septemvalvis, Chiton olivaceus, Hemiarthrum setulosum, Lepidochitona cinerea, Lepidopleurus cajetanus and Leptochiton asellus, and the anterior nervous system of Schizoplax brandtii, demonstrated consistent and substantial anterior neural concentration in the circumoesophageal nerve ring. This is further organised into three concentric tracts, corresponding to the lateral, ventral and cerebral nerve cords. These represent homologues to the three main pairs of ganglia in other molluscs. Their relative size, shape and organisation are highly variable among the examined taxa, but consistent with previous studies of select species, and we formulated a set of neuroanatomical characters for chitons. These support anatomical transitions at the ordinal and subordinal levels; the identification of robust homologies in neural architecture will be central to future comparisons across Mollusca and, more broadly, Lophotrochozoa. Contrary to almost all previous descriptions, the size and structure of the chiton anterior nerve ring unambiguously qualify it as a true brain with cordal substructure.

Neuroanatomy of a Dactylogyrid monogenean, from gold fish Carassius auratus, Nilsson, from Meerut (U. P.), India

Chemical named 5-bromo indoxyl acetate has been used to describe the nervous system of anoviparous Dactylogyridmonogenean PellucidhaptorPrice and Mizelle (1964), a gill parasite of Carassius auratus. Central nervous system consists of paired cerebral ganglia from which anterior and posterior neuronal pathways arise. These neuronal pathways are interlinked by cross connectives and commissures. Paired dorsal, ventral and lateral nerve cords emanate from the cerebral ganglia, connected at intervals by transverse connectives. Huge arrangement of dorsal, ventral and lateral nerve cords and their innervations have been examined. Peripheral nervous system (PNS) includes innervations of the alimentary tract, reproductive organs and attachment organs (anterior adhesive areas and haptor). Both the CNS and PNS are bilaterally symmetrical, and better developed ventrally than laterally and dorsally.

New information on the distribution pattern of Acanthobdella peledina(Annelida, Acanthobdellida) in Eastern Siberia.

The Acanthobdellida is a group of annelid parasites of fish, which are restricted to subarctic parts of the Northern Hemisphere. These ancient worms arouse the interest of the scientific world due to their mosaic combination of (1) primitive oligochaetous characters (e.g. the presence of setae on the very anterior segments, a lateral nerve system and a metameric coelomic cavity around the intestinal canal) and (2) evolutionarily advanced hirudinean ecological and morphological features (e.g. suckers and parasitic lifestyle), attesting to their intermediate role between Oligochaeta and Euhirudinea (i.e. leeches with setae).

The Relationship amongst Intervertebral Disc Vertical Diameter, Lateral Foramen Diameter and Nerve Root Impingement in Lumbar Vertebra

Introduction: The vertical diameter of the foramen is dependent upon the vertical diameter of the corresponding intervertebral disc. A decrease in disc vertical diameter has direct anatomic consequences to the foraminal diameter and area available for the nerve root passing through it. This study is to establish the relationship amongst the intervertebral disc vertical diameter, lateral foramen diameters and nerve root compression in the lumbar vertebra.Materials and Methods: Measurements of the study parameters were performed using sagittal MRI images. The parameters studied were: intervertebral disc vertical diameter (DVD), foraminal vertical diameter (FVD), foraminal transverse diameter (FTD) and nerve root diameter (NRD) of both sides. The relationship between the measured parameters were then analyzed.Results: A total of 62 MRI images were available for this study. Statistical analysis showed moderate to strong correlation between DVD and FVD at all the lumbar levels except at left L23 and L5S1 and right L3L4 and L4L5. Correlation between DVD and FTD were not significant at all lumbar levels. Regression analysis showed that a decrease of 1mm of DVD was associated with 1.3, 1.7, 3.3, 3.3 and 1.3mm reduction of FVD at L1L2, L2L3, L3L4, L4L5 and L5S1 respectively.Conclusion: Reduction of DVD was associated with reduction of FVD. However, FVD was relatively wide for the nerve root even with complete loss of DVD. FTD was much narrower than the FVD making it more likely to cause nerve root compression at the exit foramina. These anatomical details should be given consideration in treating patients with lateral canal stenosis.

Mechano- and thermosensitivity of injured muscle afferents 20 to 80 days after nerve injury.

Chronic injury of limb nerves leading to neuropathic pain affects deep somatic nerves. Here the functional properties of injured afferent fibers in the lateral gastrocnemius-soleus nerve were investigated 20 and 80 days after suturing the central stump of this muscle nerve to the distal stump of the sural nerve in anesthetized rats. Neurophysiological recordings were made from afferent axons identified in either the sciatic nerve (87 A-, 63 C-fibers) or the dorsal root L4/L5 (52 A-, 26 C-fibers) by electrical stimulation of the injured nerve. About 70% of the functionally identified A-fibers had regenerated into skin by 80 days after nerve suture; the remaining A-fibers could be activated only from the injured nerve. In contrast, 93% of the functionally identified C-fibers could only be activated from the injured sural nerve after 80 days. Nearly half of the injured A- (45%) and C-fibers (44%) exhibited ongoing and/or mechanically or thermally evoked activity. Because ~50% of the A- and C-fibers are somatomotor or sympathetic postganglionic axons, respectively, probably all injured muscle afferent A- and C-fibers developed ectopic activity. Ongoing activity was present in 17% of the A- and 46% of the C-fibers. Mechanosensitivity was present in most injured A- (99%) and C-fibers (85%), whereas thermosensitivity was more common in C-fibers (cold 46%, heat 47%) than in A-fibers (cold 18%, heat 12%). Practically all thermosensitive A-fibers and C-fibers were also mechanosensitive. Thus, unlike cutaneous axons, almost all A- and C-fibers afferents in injured muscle nerves demonstrate ectopic activity, even chronically after nerve injury. NEW & NOTEWORTHY After chronic injury of a muscle nerve, allowing the nerve fibers to regenerate to the target tissue, 1) most afferent A-fibers are mechanosensitive and regenerate to the target tissue; 2) ectopic ongoing activity, cold sensitivity, and heat sensitivity significantly decrease with time after injury in A-afferents; 3) most afferent C-fibers do not regenerate to the target tissue; and 4) injured C-afferents maintain the patterns of ectopic discharge properties they already show soon after nerve injury.

Reconstruction of the plantar toe with a distal reverse instep sensory island flap

Plantar toe ulcers are a challenging surgical problem. There are several methods for reconstruction, but no attention has been given to the preservation of sensation. This report proposes a method to provide protective sensation for the reconstructed area. The ulcers of seven patients ranged from 2 × 3 to 7 × 3 cm with defects of the plantar first toe and distal metatarsus, including four burns, a trauma, a diabetic ulcer, and a neuropathy injury reconstructed with a distal reverse instep sensory island (DRISI) flap. The patients were 21-38 years old. The second metatarsus medial nerve was co-opted using the end-to-side method to the adjacent lateral nerve, then its proximal stump provided the donor nerve for the sensation of the flap. Patients were assessed in terms of protective sensory functions, including touch, pain, dermatomeric somatosensory-evoked potentials (SEP), thermal sensation and Semmes-Weinstein monofilament (SWM) light touch. The flaps ranged from 2 × 3 to 7 × 3 cm. All transferred flaps to the plantar first toe survived. No complications were observed at the donor and flap sites. Patients were followed-up 8-24 months. Except for two cases, all nerves of the donor and flap sites exhibited protective sensation, including positive SEP responses between 44 and 50 ms and positive SWM responses ≤ 3.84. The DRISI flap can be used for the reconstruction of various plantar first toe defects with acceptable protective sensation. End-to-side neurorrhaphy provides a sensory nerve end to subsequent end to end co-optation to the flap nerve for protective sensation.

Pathophysiology and new treatment of itch

Many of the patients visit the doctors because of itching sensation. Itching is an unpleasant sensation. In the epidermal keratinocytes, various neurotransmitters and receptors are related itching. The itch signal is mainly transmitted through the lateral spinal ganglion-derived nerve fibers extending to the lower epidermis. Many mediators such as histamine are involved in the itching pathway. It can be helpful in the treatment of patients having itching sensation with a lot of new therapies from the basic medication such as antihistamines. Also, many drugs are currently under study.

Rheumatological manifestations of hansen's disease

Introduction: Hansen's disease (leprosy) most commonly presents with cutaneous and nerve involvement. Rheumatological manifestations occur commonly but are often under-recognized. Physicians and rheumatologists alike are often perplexed with the rheumatological manifestations, given that these may precede the diagnosis of leprosy or may suggest another disease, in addition to leprosy. We present our experience with patients of leprosy presenting with rheumatological manifestations. Methods: This was a retrospective study carried out in the Departments of Rheumatology and Medicine, King George's Medical University, Lucknow, a tertiary care hospital in North India. Those patients who had a confirmed diagnosis of leprosy were subsequently included. Demographic details and clinical presentations were documented. Results: Twenty-nine cases (19 males, mean age 38 ± 17.2 years) were included in the study. The mean duration of disease was 20.2 ± 18.4 months. Rheumatological manifestations seen included arthritis (n = 17), tenosynovitis (n = 5), swollen hands and feet syndrome (n = 6), painful swollen feet (n = 2), arthralgias (n = 3), and vasculitis (n = 1). The rheumatological diseases mimicked were rheumatoid arthritis (n = 10) and spondyloarthritis (n = 3), sarcoidosis (n = 2), relapsing polychondritis (n = 1), and vasculitis (n = 1). At some point in time, lepra reactions manifesting with arthritis, nodules, tenosynovitis and/or dactylitis were observed in 15 cases. Other classical clinical manifestations detected were paresthesia (n = 13) and anesthetic patches (n = 15). Thickened great auricular, ulnar and lateral popliteal nerve were seen in 20 cases. Five patients had pure neuritic leprosy with no cutaneous manifestations and had arthritis or tenosynovitis. Conclusion: Leprosy may mimic a number of common and uncommon rheumatological diseases, and these may be the presenting manifestation. Awareness and a high index of suspicion are required to arrive at a timely and accurate diagnosis.

Peripheral nerve stimulator guided pectoralis (PEC-I) block: A novel approach to the chest wall block

Introduction: Thoracic epidural and paravertebral blocks, the gold standard for post-operative analgesia for chest wall surgeries have a high incidence of complications and adverse effects. The pectoralis (PEC) blocks, first described by Blanco et al., have been proven to provide good analgesia postoperatively for breast surgeries, wide pectoral dissections, upper chest injuries, pacemaker insertions, port-a-cath placements, and intercostal chest drains. To widen the scope of this simple and useful analgesia technique, which mandates the availability of ultrasound machine and indepth knowledge of the sonoanatomy of the area, we are describing the conduct of PEC-I block using peripheral nerve stimulator, which is easily available to most anesthetists. Description of the Technique: Medial and lateral pectoral nerves (LPNs) are motor nerves originating in the brachial plexus innervate the pectoral muscles. The LPN runs in between pectoralis major and pectoralis minor muscle alongside the pectoral branch of thoracoacromial artery and supplies the pectoralis major muscle. The LPN communicates with the medial pectoral nerve and is known to carry nociceptive and proprioceptive fibers. The patient lies in a supine position with ipsilateral arm slightly abducted. The injection point is the intersection of a line drawn from the angle of Louis (2nd rib) and the anterior axillary line. After local infiltration of the skin with 1% lignocaine, a 50 mm insulated nerve stimulator needle with syringe filled with local anesthetic attached to the extension tubing is inserted perpendicular to the skin. The peripheral nerve stimulators (PNS)are initially set at 1.0–1.5 mA current, 0.1ms duration, and frequency of 1Hz. The needle is slowly advanced till the pectoralis muscle contractions is noted, with a current threshold of 0.3–0.5 mA. Persistence of contraction of pectoralis muscle at this level confirms the needle placement at the target site. The LA is then slowly injected in increments with frequent negative aspirations. Discussion: An increasing numbers of breast surgeries warrant better post-operative analgesia techniques, with fewer complications.Thoracic epidural analgesia, thoracic paravertebral blocks (TPVB), and intercostal nerve blocks have all been very effective for such surgeries but, are associated with complications such as epidural hemat omas, nerve injuries, pneumothorax,and hypotension. Analgesia technique like TPVB was unreliable with a single injection, and pectoral nerves were still spared producing inadequate analgesia of the chest wall and needed post-operative monitoring. The pectoralis block (PEC block), a novel technique, was described by Blanco et al. in 2011 using ultrasound and was easy, reliable, and associated with fewer complications. Peripheral nerve stimulator for such an easy and superficial block increases the utilization and benefits wider population. We have described the use of PNS for PEC-I block that can be used as a sole analgesia technique for breast implant insertion, pacemaker implantation, porta-cath insertion, ICD insertions or removals, and pectoralis muscle flaps. The PEC-I block can be further combined with PNS guided serratus anterior plane block to achieve excellent analgesia of the chest wall for surgeries. Conclusion: The PEC-I block along with PEC-II or SA plane block has a high success rate and minimal incidence of complications and provides a consistent and reliable block for hemithorax analgesia. In this article, we describe PEC-I block using PNS which is easily available to most anesthetist,unlike US machines which are available only to very few. PNS guided PEC-I block will increase the scope of this superficial, easy, and reliable block. Keywords: Pectoralis blocks, chest wall blocks, pectoralis-I, pectoralis-II, peripheral nervous system, peripheral nervous system guided chest wall block.

The PECS II block as a major analgesic component for clavicle operations: A description of 7 case reports

Clavicle fractures correspond to 35% of traumatic fractures of the shoulder girdle. Regional anaesthesia has shown better analgesic results than systemic treatment for perioperative management. Innervation of the clavicle is complex, at present its knowledge raises controversy. The lateral pectoral nerve through the innervating musculature predominantly participates in the lateral and anterior part of the clavicle. The following report of 7 cases describes the effective postoperative analgesia of modified PEC II block in patients with middle third clavicle fracture or acromioclavicular dislocation who underwent a modified PEC II block for postoperative pain management, in the context of a multimodal analgesia. The potential advantage of this management over other analgesic procedures should be evaluated in specific clinical trials.

A Case of a Chest Wall Schwannoma Probably Derived from the Lateral Pectoral Nerve which was Detected by Palpation

A Case of a Chest Wall Schwannoma Probably Derived from the Lateral Pectoral Nerve which was Detected by Palpation

Yet another PECS usage: A continuous PECS block for anterior shoulder surgery.

Yet another PECS usage: A continuous PECS block for anterior shoulder surgery.

Long-term intermittent high-amplitude subcutaneous nerve stimulation reduces sympathetic tone in ambulatory dogs

Reducing sympathetic efferent outflow from the stellate ganglia (SG) may be antiarrhythmic. The purpose of this study was to test the hypothesis that chronic thoracic subcutaneous nerve stimulation (ScNS) could reduce SG nerve activity (SGNA) and control paroxysmal atrial tachycardia (PAT). Thoracic ScNS was performed in 8 dogs while SGNA, vagal nerve activity (VNA), and subcutaneous nerve activity (ScNA) were monitored. An additional 3 dogs were used for sham stimulation as controls. Xinshu ScNS and left lateral thoracic nerve ScNS reduced heart rate (HR). Xinshu ScNS at 3.5 mA for 2 weeks reduced mean average SGNA from 5.32 μV (95% confidence interval [CI] 3.89-6.75) at baseline to 3.24 μV (95% CI 2.16-4.31; P = .015) and mean HR from 89 bpm (95% CI 80-98) at baseline to 83 bpm (95% CI 76-90; P = .007). Bilateral SG showed regions of decreased tyrosine hydroxylase staining with increased terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive nuclei in 18.47% (95% CI 9.68-46.62) of all ganglion cells, indicating cell death. Spontaneous PAT episodes were reduced from 9.83 per day (95% CI 5.77-13.89) in controls to 3.00 per day (95% CI 0.11-5.89) after ScNS (P = .027). Left lateral thoracic nerve ScNS also led to significant bilateral SG neuronal death and significantly reduced average SGNA and HR in dogs. ScNS at 2 different sites in the thorax led to SG cell death, reduced SGNA, and suppressed PAT in ambulatory dogs.

Classification of confectionary sunflower genotypes based on morphological characters

SUMMARYKnowledge of genetic diversity of confectionary sunflower can have a large impact on its use in breeding programmes. However, levels and distribution of genetic variation within the confectionary sunflower gene pool are still not adequately explored. The aim of the present paper was to describe the diversity of 68 confectionary sunflower genotypes: open-pollinated varieties, lines and hybrids. A total of 32 morphological traits were used for characterization. The Shannon & Weaver diversity index (H) was estimated as a measure of morphological diversity. The mean value of the Shannon index was 0·71, which indicates a high morphological diversity. The lowest diversity was found for leaf descriptors, moderately high to high for seed traits, while the highest values were found for disc flowers and ray florets. The highest individual descriptor diversity was found for: head attitude, the angle of leaf lateral nerves and ray floret disposition. The homogeneity analysis (HOMALS) multivariate reduction technique for nominal categorical data proved to be an efficient method for a comprehensive overview of genotype diversity and group homogeneity. Besides diversity, the number of categories and uniformity of genotype distribution determines discriminative power of descriptors. Traits that contributed the most to the distinction of genotypes were identified, enabling differentiation of genotypes with similar phenotypic attributes. The highest discriminative power was observed in traits such as anthocyanin colouration of stigma (DFIA), seed colour of stripes and seed main colour. The genotypes tested formed two distinctive major groups of varieties and hybrids with inbred lines widely dispersed along both axes. A separate grouping was obtained per the most discriminative traits based on HOMALS analysis, while the best separation was obtained using DFIA. Isolated genotypes that may not be representative by yield or seed-specific traits can be useful sources of traits for breeding. Morphological characterization can be used to improve description and classification of confectionary sunflower germplasm when evaluating diversity.

Minimally invasive esophagectomy in the lateral-prone position: Experience of 124 cases in a single center.

BackgroundMinimally invasive esophagectomy was first introduced as a new technique for esophageal cancer treatment 20 years ago. Performing this procedure in the lateral‐prone position is the most appropriate method. Since May 2013, our center has performed 124 esophageal cancer operations using this procedure. Herein, we share our experience.MethodsWe retrospectively reviewed 124 consecutive patients who had received minimally invasive esophagectomy in the lateral‐prone position from May 2013 to June 2017. The procedure, operative variables, postoperative complications, and oncology outcomes were assessed.ResultsThe surgery was successful in all 124 patients; three cases converted to an abdominal opening procedure during surgery. The mean total lymph node harvest was 19.2: 12.9 in the thoracic cavity and 6.0 in the abdominal cavity. The average total operation duration was 376 minutes and blood loss was 156 mL. No mortality occurred within 30 postoperative days. Forty‐three cases of postoperative morbidity occurred in 38 patients (30.6%), including 11 anastomotic leakages (8.9%), 1 chyle leak (0.8%), 12 lateral recurrent nerve palsies (9.7%), 11 pulmonary complications (8.9%), and 8 other complications (6.5%). A learning curve indicated that blood loss, operation duration, and the number of lymph nodes harvested would improve with time.ConclusionsSurgical and oncological outcomes following minimally invasive esophagectomy for esophageal cancer were acceptable. There are some advantages to this technique compared to previous reports of opening procedures.