Level Of Bifurcation Research Articles

Efficacy and Safety of Distal Radial Artery Access versus Proximal Radial Artery Access for Cardiac Procedures: A Systematic Review and Meta-analysis.

Cardiac catheterization using the distal radial artery access (DRA), at the level of the anatomical snuff box post radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery access (PRA) in cardiac catheterization or angiography. A detailed literature search was performed on PubMed, Cochrane, Embase and Clinicaltrials.gov from inception till June 2024. Risk ratios (RR) and mean differences (MD) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on Revman. Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-hour radial artery occlusion (RAO) rates (RR 0.30, 95% CI 0.23 to 0.40, p ≤ 0.00001), and time to hemostasis (minutes) (MD -44.46, 95% CI -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI 2.02 to 4.15, p < 0.00001, and puncture attempts (MD 0.69, 95% CI 0.37 to 1.00, p = 0.00001). DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.

Patient body fat and AI ensemble technique and the influence on false-positive rate in AI second observer for colorectal cancer detection.

216 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths. We previously found that delayed diagnosis due to lack of radiological identification results in significantly worse outcome for patients. We had developed a rudimentary, AI second observer which demonstrated potential for detecting CRC on routine CT abdomen/pelvis (CTAP). However, the AI algorithm detected many false positives. In this study, we analyzed the data using TCIA as test cases and evaluated whether patient peritoneal fat content influenced the false positive rate. This could serve as a guide for future training of AI second observer to minimize false positive detection. Methods: 2D U-Net convolutional neural network (CNN) containing 31 million trainable parameters was trained with 58 CRC CT images from Banner MD Anderson (AZ) and MD Anderson Cancer Center (TX) (51 used for training and 7 for validation) and 59 normal CT scans from Banner MD Anderson Cancer Center. 18 of the 25 CRC cases from public domain data (The Cancer Genome Atlas) were used to evaluate the performance of the models (5 had no identifiable cancer and 2 were rejected for having no contrast). The CRC was segmented using ITK-SNAP open-source software (v. 3.8). To apply the deep ensemble approach, five CNN models were trained independently with random initialization using the same U-Net architect and the same training data. Given a testing CT scan, each of the five trained CNN models was applied to produce tumor segmentation for the testing CT scan. The tumor segmentation results produced by the trained CNN models were then fused using a simple majority voting rule (up to 2 voters) to produce consensus tumor segmentation results. The segmentation was analyzed for the number and location of false positives per case. The peritoneal fat content was classified at the level of aortic bifurcation by the distance of fat between adjacent small bowel loops (≤ or &gt; 1 cm). Chi-square test was performed testing fat volume and number of voters as the intervention. Results: Our results showed that the higher volume of peritoneal fat (&gt; 1 cm, N=6) decreases the rate of false positive compared with low volume (≤ 1 cm, N=12, p=0.013). When comparing between having one voter and two voter ensemble using low fat volume data, two voter ensemble also decreased the number of false positives but not statistically significant (p=0.286). Conclusions: Our results show that AI-based second observer generates more false positives when patients have lower peritoneal fat volume; this implies that future training may require higher percentage of cases with low peritoneal fat to improve second observer precision. Our analysis also showed that increasing the number of voter in the ensemble also decrease the number of false positives per case.

Lateral Polydactyly of the Foot: Surgical Outcomes Based on a New Classification.

The objective of this study was to propose a novel classification for lateral polydactyly of the foot that integrates both visual appearance and radiographic findings and to delineate surgical techniques and their outcomes based on this classification. This study enrolled 148 feet from 126 patients who underwent initial surgery at our hospital between January 2009 and July 2021. The new classification system was derived from visual appearance according to the Hirase classification and radiological bifurcation level (D: distal or middle phalanx, P: proximal phalanx, and M: metatarsal). Incidence rates, surgical procedures, and surgical outcomes were compared across each type. Morphologically, 25 cases were classified as type A, 43 cases as type B1, and 80 cases as type B2. The branching level was categorized as D in 81 feet, P in 41 feet, and M in 26 feet, with 68 feet (46%) classified as B2-D type. Excision of the sixth toes was performed in all type A cases, whereas the majority of type B cases required excision of the fifth toes. Revision procedures were conducted on 8 feet. Three patients with type A-P classification developed painful hammer toe deformities as a late sequela that necessitated extensor tenolysis and metatarsophalangeal joint contracture release during their school-age years. The classification system based on the combination of visual appearance and radiological branching level was both straightforward and beneficial for surgical planning and for predicting surgical outcomes and late sequelae.

FLUID FLOW AND THERMAL ANALYSIS OF BLOOD FLOW IN AN AUTOMATICALLY GENERATED 2D VASCULAR NETWORK FEATURING THE POROUS MEDIA-BASED OUTFLOW BOUNDARY CONDITIONS

Blood flow and thermal analyses in biological tissues are utterly important to better understand the transport phenomena in human tissues with reference to cardiovascular diseases, drug delivery, and thermal ablation. In the existing literature, there is room for new computationally lighter numerical analyses, including both fluid flow and heat transfer. This paper presents an analysis of blood thermo-fluid dynamics within an automatically generated two-dimensional (2D) vascular network, employing the constrained constructive optimization algorithm for structure generation, the porous media assumption for outflow boundary conditions, and heat transfer coefficient analysis for terminal vessels. Through comparisons with theoretical results, the model demonstrates mathematical robustness. Results of the simulations show that blood velocity decreases with increasing number of bifurcations, offering quantitative insights into its decay in magnitude and on its impact on heat transfer. Blood temperature rises in vessels with low velocity, hindering its cooling effects in the surrounding tissues. The study highlights the influence of bifurcation levels on heat transfer coefficient reduction, suggesting longer pathways and time periods to reach high temperature within the blood vessels, due to the cooling effect of pulsating blood flow in larger vessels. The quantitative analysis of the heat transfer coefficient and Nusselt number provides insights into heat transfer between blood and the surrounding tissue, offering also valuable information for numerical bioheat models in thermal therapy simulations.

Use of Three-Dimensional (3D) Airway Modeling and Virtual Reality for Diagnosis, Communication, and Surgical Planning of Complex Airway Stenosis.

We hypothesized that a method to segment human airways from clinical cases and import them into a case presentation environment in Virtual Reality (VR)could be developed to model and visualize complex airway stenosis for efficient surgical planning. One normal and two pathological airways modeled from CT scans at a slice thickness of 0.625 mm were processed. A multidisciplinary team composed of airway surgeons, VR engineers, educators, and radiologists collaborated to create a clinically relevant VR rendering and explanatory Narrations of the three clinical cases. Segmentation and postprocessing were completed in the Mimics Innovation Suite v24 from Materialize. Structures were segmented from the level of bifurcation of common carotid arteries to the level of bifurcation of the main bronchi, including cartilaginous and bony airway structures, vessels, and soft tissues. They were then postprocessed into 3D image volumes and imported into syGlass (IstoVisio Inc.), a VR software. Direct visualization and free manipulation of these 3D airway models within the VR environment provided improved geometrical and anatomical details compared to traditional two-dimensional (2D) CT. Then, specialized presentation and active learning tools developed for scientific communication using the VR environment permitted the creation of VR Narrations to explain pathological cases. The method to segment human airways from clinical cases used in this paper, combined with intuitive VR tools to overlay segmentation and image data in an active learning environment, shows potential in the use of 3D airway modeling and VR in clinical practice for the description and surgical planning of complex airways. Further work is needed to validate the use of these models in clinical practice and patient education. Level 4.

Cervical Vagal Schwannoma: A Case Report

Nerve sheath tumors arising from the cervical vagus nerve are rare. These tumors mostly present as asymptomatic, slowly growing masses in the lateral neck. The authors reported a case of vagal schwannoma in a healthy male patient with a small lump in his neck. The neck examination revealed a firm, non-tender, non-pulsatile mass measuring 3×3 cm in the upper part of the right neck at the level of the carotid bifurcation. No neurologic deficit was detected. Fine needle aspiration showed inconclusive results. The MRI findings were distinctive, enabling a diagnosis before surgery. The preferred treatment option was gross total resection while preserving the vagus nerve. Although the authors meticulously dissected the tumor from the nerve and the nerve trunk was preserved, postoperative complications of this case were ipsilateral vocal cord paralysis and hypoglossal nerve palsy. Complete surgical removal is crucial to prevent recurrence. The prognosis of the complete cure for benign neurogenic tumors in the neck is excellent.

Epithelioid Hemangioendothelioma of the Azygos Vein

Background. Epithelioid hemangioendothelioma (EHE) is a malignant vascular tumor of mesenchymal origin. In the mediastinum, EHE originates from the large venous vessels of the superior vena cava.The purpose of the study was to describe a rare clinical case of EHE of the unpaired vein and analyze literature data to improve diagnosis and treatment of this disease.Case presentation. We present a rare case of EHE of the unpaired vein in a 23-year-old male patient who admitted to the Herzen Moscow Oncology Research Institute with a posterior mediastinal tumor detected in August 2022. It was known from the medical history that the patient had undergone diagnostic right-sided thoracotomy and tumor biopsy at the place of residence. Morphologically, the tumor was an epithelioid hemangioendothelioma. The histological re-assessment of biopsy specimens at the Herzen Moscow Oncology Research Institute confrmed the diagnosis of EHE. Computed tomography of the chest organs revealed a mass in the posterior mediastinum (in the projection of the lumen of the unpaired vein), measuring 16×14×41 mm, with relatively clear even contours, close to the posterior wall of the trachea at the bifurcation level, the posterior wall of the right main bronchus, the left semicircle of the esophagus (without signs of invasion). Based on the data on the presence of a vascular tumor in the posterior mediastinum on the right, a multidisciplinary medical consilium recommended surgical treatment: right thoracotomy, removal of a posterior mediastinal tumor with resection of the azygos vein, marginal resection of the superior vena cava, and thrombectomy from its lumen. The duration of surgery was 180 minutes, blood loss was 200 ml. Morphological examination confrmed EHE of the unpaired vein. No complications were observed in the postoperative period. The patient was discharged from the hospital on the 8th day after surgery in a satisfactory condition.Conclusion. EHE of the unpaired vein is an extremely rare vascular tumor. The clinical feature of EHE of the unpaired vein is the absence of any pathognomonic signs, which complicates differential diagnosis of mediastinal tumors. Surgery is currently the optimal treatment approach.

The anatomy of the common iliac artery: a meta-analysis based on 5785 cases.

The common iliac arteries (CIA) are the main finals branches of the abdominal aorta. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the CIAs, including their length, take-off angles, and diameters. PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to find all studies considering the anatomy of the CIA. Eligibility assessment and data extraction stages were performed. The results of the measurements in a total of 5785 patients were evaluated and included in the statistical analysis. The prevalence of the origin variations of the CIA has been evaluated. CIA was found to most commonly originate at the level of L4 vertebrae with a pooled prevalence of 59.49% (95% CI 48.00-70.50%). The overall mean length of the CIA was 5.59mm (SE: 0.13), and the mean diameter of the CIA was 10.52mm (SE: 0.85). The knowledge of the anatomy and variations of the CIA is crucial in lumbar spine surgery, especially when performing the anterolateral approach to L4 and L5 vertebrae. Furthermore, the level of the aortic bifurcation has significant implications related to vascular surgery in this region. We performed the present meta-analysis to standardize the extensive information on the anatomy of the CIAs.

Radicular Dentin Thickness and Root Canal Morphology of Mandibular Incisors in Indian Subpopulation Using Cone Beam Computed Tomography.

Aim Using two classifications, this study assessed root morphology and canal configuration and measured the Dentin thickness (DT) and canal shapes. Methods Cone beam computed tomography (CBCT) with 400 Mandibular Incisors was collected and assessed for the number, length, curvature of roots, number of canals, bifurcation level, configurations based on Vertucci's and Ahmed's classification, DT and canal shape at 3, 6, 9 mm from the apex. The collected data was subjected to statistical analysis with a level of significance at p<0.05. Results All samples had one root, averaging 12.769 ± 1.128 mm in central incisor (CI) and 13.044 ± 1.235 mm in lateral incisor (LI), with most roots being straight. Most samples had one canal in both teeth, with bifurcations most frequent in the middle third. The most frequent configuration was type 1 Vertucci or1CI1/1LI1 by Ahmed, followed by type 3 or 1CI1-2-1/1LI1-2-1. One sample, not classifiable under Vertucci, was classified as 1CI1-3-1 by Ahmed. The mean DT for CI was 3.18 ± 0.639 mm, 3.72 ± 0.671 mm and 4.43 ± 0.754 mm labiolingually and 1.578 ± 0.342 mm, 1.881 ± 0.374 mm, 2.283 ± 0.465 mm mesioditally at 3, 6, 9 mm from the apex, respectively. For LI, mean DT was 3.41 ± 0.916 mm, 3.90 ± 0.702 mm and 4.55 ± 0.746 mm labiolingually and 1.63 ± 0.322 mm, 1.981 ± 0.485 mm, 2.55 ± 0.470 mm mesioditally at 3, 6, 9 mm from the apex respectively, canal shape changed from oval to round, from apical to coronal. Conclusion Single canals were the most common, followed by two canals. The middle third of the canal had the most bifurcations. Vertucci type 1 or Ahmed's 1CI1/1LI1 was the most commonly reported canal configuration, with one sample that could not be classified under Vertucci but could beclassified using Ahmed classification. DT increased apical to coronal. The canal shape changed from oval to rounded, from apical to coronal.

Sciatic nerve variations around the piriformis muscle and bifurcation level: An anatomical study

Sciatic nerve variations around the piriformis muscle and bifurcation level: An anatomical study

Influence of Aortic Deviation on Abdominal Aorta Bifurcation Level Relative to Vertebral Position.

Introduction Research on abdominal aortic deviation (AAD) and its impact on the vertebral level of abdominal aortic bifurcation (AAB) has been limited. We aimed to determine the level of AAB with respect to vertebral levels and assess the proportion of AAD and its impact on AAB. Materials and methods This single-arm, cross-sectional, retrospective study involved contrast-enhanced computed tomography (CECT) scans of the abdomen and pelvis of 208 subjects aged 18 years or older. AAD and AAB in terms of vertebral levels were noted using the digital imaging and communication in medicine (DICOM) viewing software RadiAnt (Medixant, Poznań, Poland). Results The rate of AAD was found to be 44 out of 208 (21.2%), 16 out of 98 (16.3%) in men and 28 out of 110 (25.45%) in women (p=0.10). The AAD rates in the 31-40-, 51-60-, and 71-80-year age groups were 11 out of 37 (29.7%), 17 out of 61 (27.8%), and three out of seven (42.8%) with p=0.03, respectively. AAB was seen in the middle of the L4 vertebrae in 65 cases (31.2%), followed by 49 cases (23.6%) in the L4 lower vertebrae. Twenty-three (20.9%) women had AAB above the L4, compared to 13 (13.2%) men (p=0.34). AAB was located below the L4 vertebral level in eight out of 44 (18.18%)subjects with AAD versus 41 out of 164 (25%) subjects without AAD (p=0.55). Conclusion AAD was observed in approximately one-fifth of the subjects in our study cohort, with a higher proportion among women and in elderly age groups. AAB was most commonly observed in the middle of the L4 vertebrae and AAD did not impact AAB levels.

Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery.

Variations in the carotid arterial system significantly impact atherosclerosis's clinical and surgical management, which predominantly occurs at arterial bifurcations. This study aimed at evaluating anatomical variations in the bifurcation levels of the common carotid artery (CCA) and the superior thyroidartery (STA), emphasizing clinical relevance. This was an observational cross-sectional study conducted in June 2021 using 32 embalmed cadavers of adult age from medical schools in Khartoum, Sudan. Sixty-four carotids were examined, noting the levels of CCA bifurcation and STA origin, and their symmetry across both sides of the body. Results: Among the cadavers studied, CCA bifurcation most commonly occurred at the superior border of the thyroid cartilage (46.9%), followed by the body of the hyoid bone (40.1%). The STA predominantly originated from the external carotid artery (ECA) (65.6%). Conclusion: No significant correlation was found between the bifurcation levels of the CCA and the origins of the STA. Bilateral symmetry in the bifurcation of the CCA and the origin of the STA was observed in most cases. The study highlights notable variations in the anatomy of the carotid arteries. These findings suggest that pre-surgical imaging and careful planning are crucial to accommodate anatomical diversities.

Carina: A major determinant in the pathophysiology and treatment of coronary bifurcation lesions.

Over the last decade, several in vivo and computational investigations have significantly advanced our understanding of the pathophysiology of coronary bifurcations, contributing to the enhancement of their percutaneous revascularization. The carina of the coronary bifurcations plays a substantial role in generating their main hemodynamic features, including distinctive flow patterns with secondary flows and specific shear stress patterns. These factors play a pivotal role in determining the susceptibility, development, and progression of atherosclerosis. The underlying pathophysiological mechanisms of atherosclerosis in coronary bifurcations are complex and multifactorial. Understanding these mechanisms is fundamental to comprehending lesions at the bifurcation level and informing future treatment strategies. This review aims to present the currently available data regarding the pathophysiological and prognostic role of the carina in coronary bifurcations, offering an interpretation of these findings from the perspective of interventional cardiologists, providing valuable insights for their clinical practice.

Ratio of pulmonary artery diameter to ascending aortic diameter and its association with right ventricular failure after left ventricular assist device implantation

BackgroundSeveral invasive hemodynamic parameters help predict right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. However, prediction using non-invasive parameters alone has not been established. The ratio of the diameters of the pulmonary artery (PAD) to those of the ascending aorta (AoD) may indicate past hemodynamic load and cardiac dysfunction. We aimed to investigate a predictive model for RVF after LVAD implantation using non-invasive parameters including PAD/AoD ratio. MethodsWe studied 141 patients who underwent primary LVAD implantation and 117 healthy individuals with computed tomography (CT) data. RVF was defined as the need for a subsequent right ventricular assist device or intravenous inotrope administration for more than 30 days after LVAD implantation. The PAD/AoD ratio was measured at the level of the pulmonary artery bifurcation on the CT transaxial slices. ResultsRVF was observed in 29 patients. The correlation between PAD and AoD differed among healthy individuals, patients with and without RVF. Patients with RVF had higher total bilirubin and log brain natriuretic peptide (BNP) levels, a lower left ventricular end-diastolic diameter (LVDd) index, and a higher PAD/AoD ratio than those without RVF. Decision tree analysis indicated that the subgroup with a high PAD/AoD ratio (≥1.09) and a small LVDd index (<35.4 mm/m2) showed the highest probability of RVF (100 %), while the subgroup with a low PAD/AoD ratio (<1.09) and low log BNP (<2.79) showed the lowest probability of RVF (1 %). ConclusionCombining non-invasive parameters with the PAD/AoD ratio can predict RVF with high accuracy.

Management of gunshot injury to the abdominal aorta and inferior vena cava: a case report of a combat patient wounded in the Russo-Ukrainian war

BackgroundRusso-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava.Case presentationA 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars’ explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the “golden hour” principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava.ConclusionsApplication of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies.

214. THORACIC CAVITY/ CAGE RATIO IS PREDICTOR FOR SURGICAL DIFFICULTY OF MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background Esophagectomy for esophageal cancer is highly invasive surgery. Minimally invasive esophagectomy (MIE) was introduced as a less invasive surgery, and conventional MIE (C-MIE) is being increasingly performed worldwide. Recently, robot-assisted MIE (RAMIE) was developed with the aim of further minimization of invasiveness, and is expected to spread in the future. When performing MIE, we sometimes experienced difficult cases. In this study, we aimed to clarify the factors related to surgical difficulty of MIE. Methods We evaluated 362 patients who underwent MIE (285 C-MIEs and 77 RAMIEs) for esophageal squamous cell carcinoma between April 2010 and February 2023. We used computed tomography to evaluate the occipitofrontal diameter of thoracic cavity and cage at brachiocephalic vein (BV), tracheal bifurcation (TB) and inferior right pulmonary vein (IRPV) levels, respectively. We calculated the thoracic cavity/cage ratio (TRRC) at each level. The cut-off values of TCCR at each level for thoracic procedure time were calculated using the receiver operating characteristic. Furthermore, total score consisted of four degrees (0,1,2,3) by the TCCR at three levels was calculated. We assessed clinicopathological and anatomical factors and determined the independent factors influencing the thoracic procedural time as parameter of difficulty in MIE. Results We divided the patients into C-MIE group and RAMIE group. Patients in each group were divided into two cohorts according to median thoracic procedure time (C-MIE: 307 and RAMIE: 409 minutes, respectively). In the C-MIE group, univariate analysis demonstrated that sex, body mass index (BMI), and the TCCR at BV, TB and IRPV levels were correlated with thoracic procedure time. The total TRRC score was also correlated with thoracic procedure time in univariate analysis. Next, multivariate analysis was done using sex, BMI, and the total TCCR score. Multivariate analyses demonstrated that BMI (p = 0.0005) and the total score (p = 0.0069) were independent factors for thoracic procedure time. In the RAMIE group, univariate analysis demonstrated that BMI and the TCCR at BV and TB levels were correlated with thoracic procedure time. Multivariate analyses demonstrated that the TCCR at TB level (p = 0.0187) was only independent factor for thoracic procedure time. Conclusions The TCCR and the total score based on it could be useful in assessing surgical difficulty of both C-MIE and RAMIE. C-MIE was affected by the diameter at all levels of the thoracic cavity due to restricted mobilities of thoracoscopic instruments. On the other hand, RAMIE’s articulated forceps prevent it from being affected by entire thoracic cavity. Consequently, only the TCCR at TB level, which is one of the most less flexible field, affects the difficulty in RAMIE.

Increased Aortic Stiffness With Acute Exercise in Heart Failure: Assessment by Cardiovascular Magnetic Resonance

This study aimed to investigate the acute changes in proximal aortic distensibility, a measure of aortic stiffness, induced by acute exercise in participants with and without heart failure (HF). Participants with HF (n = 24) and without HF (n = 26) underwent cardiovascular magnetic resonance (CMR) (1.5 T) imaging at rest and after submaximal supine bicycle ergometry. The participants were further categorized into HF with reduced ejection fraction (HFrEF) (n = 14) and HF with preserved ejection fraction (n = 10) based on the left ventricular ejection fraction. At rest and immediately after exercise, cine CMR images of the cross-sectional ascending and descending aorta at the pulmonary artery bifurcation level were obtained to determine aortic distensibility (AoD), with lower AoD indicating greater aortic stiffness. Differences in means of values at rest and before and after exercise were compared using the nonparametric Wilcoxon sign test. There was no significant difference in AoD at rest between subjects with HF and controls. However, immediately after exercise, participants with HF but not controls exhibited a significant reduction in AoD, indicating higher aortic stiffness related to exercise (median [interquartile range] for the ascending aorta: 3.16 (1.26) × 10-3 mm Hg-1 to 2.39 (1.57) × 10-3 mm Hg-1 and the descending aorta: 4.19 (2.58) × 10-3 mm Hg-1 to 2.96 (1.79) × 10-3 mm Hg-1) (both p = 0.023). This decrease was particularly observed in participants with HFrEF but not in those with HF with preserved ejection fraction. Exercise-induced aortic stiffness, detectable by noninvasive CMR, may contribute to unfavorable ventricular-vascular interactions during exercise in participants with HF, especially HFrEF.

A cadaveric study on superior hypogastric plexuses

Introduction: The superior hypogastric plexus (SHP) is found around the level of aortic bifurcation. It is important in surgical procedures in the pelvis.Methods: Ten (5; M &amp; 5; F) fresh intact adult human cadavers were dissected. Following the initial dissection, all of them were further sectioned sagittal in the midline and separated in to half pelvises, and assessed. The study was carried out in the Department of Anatomy, Faculty of medicine Ragama, Sri Lanka from 2022 to 2024. The ethical clearance was obtained.Results: In all specimens, left connecting fibers from the inferior mesenteric plexuses (IMA) crossed the left common iliac artery and joining to the superior hypogastric plexuses. In 80%, right connecting nerve fibers from the inferior mesenteric plexuses crossed the right common iliac artery and joined the superior hypogastric plexus (SHP). Eighty percent of the specimens had, well-defined nerve strands, whereas 20% contained a delicate and irregular meshwork. In all of the specimens, the median root, or a nerve root from abdominal aortic plexus from the IMA were present. In 80% specimens, the SHP was located between the aortic bifurcation and the sacral promontory. In 20%, it extended across the pelvic brim and ended on the body of the S1 vertebra.Conclusion: The majority of the SHP were located below the aortic bifurcation and had well-defined nerve strands, rest traversed the pelvic brim and terminated on the body of the S1 vertebra. Further larger sample studies are recommended.

Comprehensive Analysis of Mandibular First Molar Root and Canal Morphology in Saudi Patients Using Cone Beam Computed Tomography (CBCT).

BACKGROUND The goal of conventional endodontic therapy is to clean the root canal system thoroughly, restore tooth function, and prevent re-infection. Success depends on understanding root canal morphology, resolving apical periodontitis, and using proper techniques. Studies highlight variations in root canal anatomy, with cone-beam computed tomography (CBCT) being crucial for accurate diagnosis despite its high cost and limited availability. MATERIAL AND METHODS This retrospective study reviewed CBCT images of 1820 (907 male, 913 female) patients aged 18 to 78 years. Analysis included 2081 mandibular first molars for variations in root and canal morphology and right- and left-side symmetry. Inter-orifice distance was measured, along with distance from the cementoenamel junction (CEJ) to the level of canal bifurcation. RESULTS In this study, 96.01% of teeth had 2 roots and 3.89% had 3 roots. The percentages of canal configuration were 77.70% for 3 canals, 21.58% for 4 canals, 0.67% for 2 canals, and 0.05% for 1 canal. The inter-orifice distance was 2.07 mm for 2 canals in 1 root and 2.86 mm for 2 canals in separate distal roots. Distance from the CEJ to canal bifurcation varied significantly between 2 canals within 1 distal root (3.35 mm), 2 canals in separate distal roots (1.60 mm), as well as between distal (3.35 mm) and mesial roots (1.10 mm). CONCLUSIONS In mandibular first molars, only 3.89% have additional distolingual roots. Sex and ethnicity showed no influence on number of roots and canals. Distal canals showed a deeper bifurcation and greater inter-orifice distance than did mesial canals.

Unraveling Renal Arteries Morphogenesis from Tridimensional Human Embryos Reconstruction

During human morphogenesis, the definitive kidneys derive from the metanephros during Carnegie Stage 14 to 23. The pronephros and the mesonephros develop previously and successively to finally lead to the formation of the urinary tract. Renal vascularization, first described in 1912 by Félix using a "ladder theory" model, is highly variable and current available morphogenesis descriptions do not explain all reported anatomical variations. The aim of this work was to study the morphogenesis of the human metanephros and its vascularization by three-dimensional reconstructions of human embryos. Histological sections of 23 human embryos from the Carnegie Collection and 5 human embryos from the French collection (Carnegie stages 14 to 23) were completely digitalized and reconstructed in three dimensions using specific softwares and then analyzed by descriptive method using manual annotation. In all studied embryos, the mesonephric arteries did not reach the metanephros irrespective to the position of the metanephros during its cranial ascent. Before the end of the cranial metanephros migration (15 embryos), at the level of the aorto-iliac bifurcation, a "primitive" vascularization was shown in 9 of them. The renal artery originated from the primitive iliac arteries for 8 embryos and from the inferior mesenteric artery in one embryo. Further, a capillary cluster emerging from the lateral wall of the aorta and extending toward the metanephros was found in 2 embryos (Carnegie stages 21 and 22). This may correspond to a phenomenon of neoangiogenesis responsible of the definitive renal artery. The present study reported the morphogenesis of human renal arteries between Carnegie stages 14 and 23 using an original method of tridimensional computerized reconstructions of historical human embryos. Some original findings, in contradiction with the original Felix's description, may explain the most frequently reported anatomical variations.