Origin Of Branch Research Articles

A Study on Distribution and Mode of Origin of Median Nerve and its Relation to the Flexor Retinaculum

Introduction:The precise knowledge of level of origin of muscular branches of median nerve are essential in free muscular transfers to restore the mobility of fingers after trauma and to understand the various presentations of nerve entrapment. The anatomical knowledge and variations of recurrent nerve is important to prevent the complications during the release of transverse carpal ligament.Aim & Objectives: To study the points of origin of muscular branches with respect to IEL and number of branches to muscles of forearm and also learn the mode of origin of recurrent nerve and its relation to the flexor retinaculum.Subjects and Methods:Dissection 40 upper limbs procured from embalmed cadavers of Dr. VRK Women’s Medical College, Hospital and Research Centre, Hyderabad, for the study.Results:The mean of point of origin of NPT was 1.21 cm proximal and 1.20 cm distal to IEL whereas for NFCR, NPL, NFDS and AIN nerve it was 2.12 cm, cm, 4.54 cm and 3.29 cm distal to IEL respectively. The number of branches to muscles of forearm varied from 1 to 3. The recurrent nerve was arising from lateral and intermediate branches of median nerve in 39 (97.5%) and 1 specimens (6%) respectively. Its relationship with flexor retinaculum was extra ligamentous in 33 specimens (82.5%) and transligamentous in 7 specimens (17.5%). It innervated APB, FPB and OP in 19 specimens (47.5%), only APB, FPB in 16 specimens (45%) and only APB, OP in 3 specimens (7.5%).Conclusion:All the muscular branches of median nerve were arising predominantly distal to IEL except nerve to pronator teres. The number of branches varied from 1 to 3. In majority of the specimens, the recurrent nerve was arising from the lateral terminal branch of median nerve and its relation with flexor retinaculum was extraligamentous.

Variation in the origin of the first motor branch of the ulnar nerve to the flexor carpi ulnaris muscle

Introduction/PurposeSurgical decompression of the ulnar nerve in the treatment of cubital tunnel syndrome is performed in close proximity to the first motor branch of the ulnar nerve to flexor carpi ulnaris (FCU). Understanding the variability of this branch is important for improving surgical interventions. The purpose of this study was to determine the location and anatomical variation of the first motor branch to flexor carpi ulnaris.MethodsEmbalmed cadavers were dissected to expose the ulnar nerve as it courses past the medial epicondyle of the humerus. Digital calipers were used to measure the distance between the point of origin of the first motor branch of the ulnar nerve to FCU and the most prominent aspect of the medial epicondyle. The length of the ulna was also measured and correlated with data from ulnar nerve measurements. Statistical significance was defined as a p‐value < 0.05.OutcomesData was obtained from 113 cadaveric elbows. The location of the branch point was most consistently found (88.5% of specimens) distal to the medial epicondyle (average 19.42 mm, standard deviation 4.39, 95% confidence interval 18.54 – 20.29). In 11.5% of elbows, however, the branch point occurred proximal to the medial epicondyle (average 16.02 mm, standard deviation 4.53, 95% confidence interval 13.28 – 18.76 mm). The average distance was 18.42 mm distal to the medial epicondyle in females and 20.45 mm in males, with a statistically significant difference between genders (p‐value = 0.02). The correlation between the branch point of the first motor branch of the ulnar nerve to FCU and ulna body size was also explored.ConclusionThis study has demonstrated that the first motor branch of the ulnar nerve is most consistently located 18.54 to 20.29 mm distal to the medial epicondyle. Males had a significantly greater distance from the origin of the first motor branch of the ulnar nerve to FCU from the medial epicondyle compared to females. No statistically significant correlation was found related to laterality. Additionally, the prevalence of the anatomical variant in which branching of the first motor nerve from the ulnar nerve occurs proximal to the medial epicondyle was estimated. Prior to this study, the prevalence of this variant had not been reported.Support or Funding InformationThe authors would like to thank Midwestern University for the use of the specimens in this study.

Superior Mesenteric Vein-First Approach for Robotic Salvage Surgery with Indocyanine Green Fluorescence Angiography

Inadequate lymphadenectomy is still a major concern in colon cancer surgery. The superior mesenteric vein (SMV)-first approach is a novel, standardized, reproducible method for robotic complete mesocolic excision surgery. Our aim was to present the application of the SMV-first approach principles to facilitate robotic salvage surgery for recurrent disease within the mesocolon. A 78-year-old female presented with a malignant lymph node deposit within residual right mesocolonic tissue, approximately 3months following a laparoscopic right hemicolectomy for colon cancer. Dissection was initiated with a transverse curvilinear incision along the inferior aspect of the remaining ileocolic pedicle to identify the SMV. Dissection continued along the ventral aspect of the SMV in a cephalad direction to identify and expose the middle colic vessels at their origin. The use of idocyanine green (ICG) confirmed the vascular anatomy, demonstrating the right branch of the middle colic artery traversing the malignant deposit in the residual mesocolon. Following ligation at the origin of the right branch of the middle colic and ileocolic vessels, the retro-mesocolic plane dissection was completed to excise the malignant deposit and the residual mesocolon. The patient was discharged home the following day. The pathological specimen confirmed metastatic poorly differentiated adenocarcinoma in one of nine lymph nodes, and the vascular pedicle resection margin was negative for tumor. Following the SMV-first approach principles provides a safe plane for dissection, and, in conjunction with ICG, facilitates the delineation of the vascular anatomy, to enable robotic salvage surgery to be performed.1-3.

3:45 PM Abstract No. 96 Modified octopus technique with reduction in gutter leaks for thoracoabdominal aneurysm repair

Endovascular aneurysm repair (EVAR) is a minimally invasive approach to repair of thoracoabdominal aneurysms (TAA) in patients who are poor surgical candidates. Aneurysms that involve the origin of the visceral branches of the abdominal aorta can be challenging to manage due to the inability of conventional stents to manage blood flow to vital organs when using fenestration and snorkeling approaches. Here, we review the efficacy and potential adverse effects of a novel modified octopus technique using an iliac branch device (IBD) in the management of these patients. All patients who underwent two-stage EVAR procedures were identified through our electronic medical record system. Patient comorbidities, sex, aneurysm size and location, and treatment indications were identified along with intra and postprocedural complications. The number of additional stents used in the visceral branches during stage 2 of the procedure was quantified. Average change in maximal aneurysmal dilatation and 30-day and 1-year re-intervention rates related to aneurysm management were calculated. 14 patients were identified in our database. 12 underwent complete 2-stage EVAR between January 2014 and September 2019. One patient is awaiting stage 2 and one patient was not a candidate for stage 2. Seven patients underwent EVAR with modified octopus approach. The celiac trunk, SMA, and bilateral renal arteries were all stented using this approach using 28 additional stents. Intra and postprocedural complications are listed in Table 1. Two patients required re-intervention for endoleak repair. The average change in maximal aneurysmal dilatation was -0.46 cm with 30-day and 1-year re-intervention rates of 0.00% and 28.57%, respectively. There were no aneurysmal ruptures or intraprocedural complications using the modified octopus approach. The modified Octopus approach described here offers a novel alternative to current TAA repair techniques, increasing the number of patients eligible for endovascular intervention. The preliminary results in our retrospective review elucidate the safety, efficacy, and promising outcomes of this innovative approach to TAA repair.Table 1FenestratedPeriscopeSnorkelModified Octopus Using IBDPostoperative ComplicationsEndoleaks1212Rupture0000Central neurologic deficits0001Peripheral neurologic deficits0011Bowel/bladder incontinence0001Thromboembolism0101Small bowel obstruction0010Bleeding requiring transfusion or embolization0210Visceral branch thrombosis0000Graft collapse0000Intraoperative ComplicationsEndoleak0200Rupture0000Bleeding requiring transfusion1110Access site hematoma0210Graft collapse0010 Open table in a new tab

Visualization and quantification of the atrioventricular conduction axis in hearts with ventricular septal defect using phase contrast computed tomography

ObjectiveTo visualize and quantify the atrioventricular conduction axis in the setting of ventricular septal defect using phase contrast computed tomography. MethodsWe used the SPring-8 synchrotron radiation facility in Hyogo prefecture in Japan, processing and reconstructing the data with 3-dimensional software. ResultsWe studied 8 hearts obtained from patients known to have had ventricular septal defects, aged from 6 to 150 days, with a median of 24.5 days. None of the individuals, however, had undergone corrective surgery. The penetrating bundle was found at a median of 1.43 mm from the septal crest, with a range of 0.99 to 1.54 mm. The distance to the nonbranching bundle to the right ventricular endocardium was 1.10 mm, with a range from 0.49 to 2.49 mm, to the origin of the left bundle branch was 2.46 mm, with a range from 1.7 to 3.18 mm, and to the origin of the right bundle branch was 2.34 mm, with a range from 0.50 to 2.59 mm. The median distance from the edge of the caudal limb of the septomarginal trabeculation to the right bundle branch was 1.04 mm, with a range from 0.81 to 1.16 mm. ConclusionsWe were able to show the precise location of the axis, with our findings suggesting that longitudinal sutures placed along the posteroinferior rim should be effective in avoiding iatrogenic injury, but sutures should not be placed in the valley between the limbs of the septomarginal trabeculation.

Radiological and surgical differences between congenital end-to-side (Abernethy malformation) and side-to-side portocaval shunts

ObjectiveDistinguishing retrohepatic end-to-side portocaval shunts (ES-PCS) and side-to-side portocaval shunts (SS-PCS) can be difficult, but it is essential for determining the treatment strategy. Our experience with retrohepatic PCS is analyzed. MethodsSince 2007, 9 children (5/9 ES-PCS and 4/9 SS-PCS) were surgically treated. Radiology studies included Doppler-ultrasound, CT/MRI and angiography/occlusion test (8/9). ResultsCT in 5/5 ES-PCS revealed the portal vein (PV) entering the left side of the vena cava with a uniform shape. 4/4 SS-PCS showed aneurysmal PV containing the origin of the main intrahepatic portal branches (IHPB) entering the cava anterior aspect or slightly to the right with a variable length (from long to short/wide). ES-PCS anatomy showed caudate lobe absence with the fistula entering the left cava aspect free of parenchyma, but anterior through the caudate lobe in SS-PCS. With the angiography/occlusion test, the IHPB was undeveloped in ES-PCS (portal pressure > 38 mmHg) and hypoplasic in SS-PCS (portal pressure < 25 mmHg). ES-PCS treatment included: 1/5 hepatectomy and 4/5 definitive banding (one by laparoscopy); while in SS-PCS: 1/4 liver transplantation, 2/4 1-step closure (one by laparoscopy), and 1/4 definitive banding. ConclusionFistula shape, cava relationship, IHPB and portal pressures differ between the two shunt types. A question arises regarding the need for secondary complete closure after banding. Level of evidenceLevel IV

Suprascapular nerve block - do it yourself

Background:Suprascapular nerve (SSN) block using bone reference points (BARO) is a technique that in principle is accessible to practitioners without experience in locoregional anesthesia or ultrasound guidance. The primary objective was to validate the feasibility of SSN BARO by an orthopedic surgeon. The secondary objective was to provide a description of the path of the sensory branches from the SSN to the shoulder.Methods:A BARO was performed on 15 cadaveric shoulders by an intern in orthopedic surgery. Ten ml of methylene blue and 0.75% ropivocaine were injected around the SSN. 2.5ml of a red latex solution were also injected to identify the injection site. The distribution of the sensory branches of the NSS was also described.Results:The average distance between the SSN and the injection site was 1.5cm (0-4.5cm). The most frequent injection site was the proximal third of the scapular neck. Fifteen SSNs were marked upstream of the origin of the sensory branches. The 15 SSN produced 3 sensory branches that innervate the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.Conclusion:SSN BARO by an orthopedic surgeon is a simple, reliable, and accurate technique. Injection near the suprascapular notch is recommended to mark the SSN upstream of its three sensory branches.

On the origins of anthropological criminology. Discussion on monomania (moral insanity)

This article presents a brief excurse into the history of the conception of one of the leading movements of criminological science &amp;ndash; anthropological criminology. Analytical review of the opinion of leading psychiatrists and forensic pathologists of the early XIX century is given regarding the facts of commission of motiveless violent crimes by individuals without evident mental disorder, which were increasingly recorded by law enforcement of that time. This phenomenon was sequentially named &amp;ldquo;delirium-free mania&amp;rdquo;, &amp;ldquo;monomania&amp;rdquo;, &amp;ldquo;moral insanity&amp;rdquo;, and other terms. The methodology is based on the retrospective analysis of the discourse field formed in the early XIX century around the phenomenon of &amp;ldquo;monomania&amp;rdquo; (moral insanity) in Russian and foreign literature on law and forensic psychiatry. The materials presented in this article allow reallocating emphases in the scientific discourse on the origins of criminal anthropology branch within criminology. The main conclusion of the conducted research consists in the fact that beginning of the study of monomania (moral insanity) should be viewed as the starting point in formation of anthropological criminology &amp;ndash; one of the two leading branches of criminological science (alongside sociology of crime). This conclusion is made on the basis of analysis of the rarest foreign and Russian literature, most of which has not been republished for approximately 200 years. &amp;nbsp;

Hot Subdwarf Stars Identified in Gaia DR2 with Spectra of LAMOST DR6 and DR7. I. Single-lined Spectra

Abstract 182 single-lined hot subdwarf stars are identified by using spectra from the sixth and seventh data releases (DR6 and DR7) of the Large Sky Area Multi-Object Fibre Spectroscopic Telescope survey. We classified all the hot subdwarf stars using a canonical classification scheme, and got 89 sdB, 37 sdOB, 26 sdO, 24 He-sdOB, 3 He-sdO, and 3 He-sdB stars, respectively. Among these stars, 108 hot subdwarfs are newly discovered, while 74 stars were reported by previous catalogs. The atmospheric parameters of these stars were obtained by fitting the hydrogen (H) and helium (He) lines with non-local thermodynamic equilibrium model atmospheres. The atmospheric parameters confirm the two He sequences and the two subgroups of He-sdOB stars in our samples, which were found by previous studies in the T eff– diagram. Our results demonstrate different origins of field hot subdwarf stars and extreme horizontal branch stars in globular clusters, and provide strict observational limits on the formation and evolution models of the different sub-types of these evolved objects. Based on the results, we evaluated the completeness of the Geier et al. catalog. We found the fraction of hot subwarf stars is between 10% and 60%, depending on the brightness of the sample. A more accurate estimation for the hot subdwarf fraction can be obtained when similar results from composite spectra will become available.

WITHDRAWN: Cerebral Arterial Infundibula Are Preaneurysmal Lesions Caused by Direct Flow Impact

To investigate whether arterial infundibular widening is a preaneurysmal lesion or not. Two hundred and nine patients with cerebral angiography were enrolled. The morphology, size and location of infundibula and cerebral aneurysms were studied in two-dimensional angiography and three-dimensional software space. Computational fluid dynamics (CFD) analysis was performed. 234 infundibula and 129 infundibulum-like aneurysms (IFAs) were detected. In two-dimensional space, the typical morphology of an infundibulum was a symmetric dilatation at the arterial branch origin with a small vessel branch emanating from the tip and a wide base connecting the parent artery. In three-dimensional space, the infundibulum was dissymmetric with always one side longer than the other side. Furthermore, the infundibulum tilted upstream rather than downstream, with the longer side located downstream and the shorter side upstream in all cases. All the 129 IFAs occurred on the distal wall of the vessel branch origin, and no IFAs grew from the proximal wall of the branch origin. The possible development process of an infundibulum to an IFA was described in four development stages. The CFD analysis revealed that these lesions were associated with direct flow impingement in all cases. All the hemodynamic parameters on the distal wall of infundibula and IFAs were significantly (P<0.0001 or P<0.05) decreased compared with on the distal wall after virtual lesion removal. The infundibulum is a preaneurysmal lesion associated with high total pressure and high wall shear stress resulted from direct flow impingement and will progress to an aneurysm with time.

Study of pattern of origin of central branches of middle cerebral artery by using 64-slice computed tomography angiography

Background and Aims: Middle cerebral artery (MCA), a branch of the internal carotid artery, is the most commonly affected vessel in cerebrovascular diseases. Various studies have reported for variations in the origin pattern of MCA. The detection of these variations is of clinical relevance for the clinicians for planning their line of treatment. The present study was performed to identify the variations using 64-slice computed tomography (CT) angiography. Materials and Methods: The present study was performed in 45 participants (32 males and 13 females). MCA was identified and observed for a different pattern of origin of the central (perforating) branches using 64-slice CT angiography. Results: The observations revealed that the M1 segment of MCA showed single, dual, or multiple origins of central branches. Single central branch of MCA originated in 8.88% of cases, double branches were observed in 11.11% of cases, whereas the multiple branches were found in 66.67% of cases and mix pattern was observed in 13.3% of cases. These central branches coursed through the anterior perforating substance to reach the basal area of the subcortical zone. Conclusions: The present study revealed the variations in origin of the central branches of MCA using 64-slice CT angiography and the knowledge of radiological identification of these variations can be of use for radiologists and neurosurgeons dealing with cerebrovascular diseases.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases.

To improve the prenatal diagnosis for anomalous origin of pulmonary artery branches by comparing and analyzing different types of fetal echocardiography features. Between June 2012 and December 2018, fetal echocardiographic features were analyzed retrospectively from fetuses with a prenatal diagnosis of anomalous origin of pulmonary artery branch. The main points of identification were summarized. A total of 12 fetuses were diagnosed, including anomalous origin of a pulmonary artery branch from the innominate artery and six cases with unilateral absence of pulmonary artery. The shared characteristic sonographic finding was the lack of confluence at the bifurcation of the main pulmonary artery. The differences between the two conditions are highlighted by the origin of the anomalous vessel. In fetuses with anomalous origin of one pulmonary artery branch, the affected pulmonary artery arose from the posterior wall of the ascending aorta as noted on three vessels and trachea view as well as the long axis of the left ventricular outflow tract. This is in contrast to fetuses with unilateral absence of pulmonary artery, where the origin of affected pulmonary artery arises from the base of the innominate artery via the ipsilateral patent arterial duct as evident on the three vessels and trachea view and the coronal view of innominate (brachiocephalic) artery. (1) The main similarity is an absence of a confluence at the bifurcation of the main pulmonary artery. (2) The main distinguishing feature is the origin of the anomalous vessel from either the subclavian or directly from the aorta.

Anomalous Origin of Left Atrial Branch from Right Coronary Artery: Incidence and Implications

Anomalous Origin of Left Atrial Branch from Right Coronary Artery: Incidence and Implications

TAA 21. Hybrid Repair of Ruptured Aortic Arch Aneurysm Combined With Aberrant Right Subclavian Artery: Case Report

Surgical repair of aortic arch aneurysms is still an invasive procedure requiring arch replacement during deep hypothermic circulatory arrest. Endovascular aortic arch repair is less invasive compared with the open surgical aortic arch repair in treating aortic arch disease; this correlates with low morbidity and mortality rates, even in high-risk patients. Aortic arch diseases, such as aneurysms and dissections, often involve the origin of the supra-aortic branches. Surgical aortic arch debranching is therefore indicated before covering of these branches. On the other hand, an aberrant right subclavian artery is the most common abnormality arising in the development of the aortic arch. We describe an original method of revascularization followed by stent graft insertion in the case of ruptured aortic arch aneurysm with existing aberrant right subclavian artery. A 56-year-old woman was admitted to our emergency department because of chest pain, cough, and hemoptysis. At the time of admission, the blood pressure was 200/100 mm Hg; pulse rate was 115 beats/min. The initial laboratory findings showed hemoglobin level of 8.9 g/dL. The computed tomography scan showed a 6-cm fusiform aneurysm of the aortic arch 0.5 cm distal to the left carotid artery, extravasation of the contrast material from the posterior wall, and aberrant right subclavian artery (Fig 1). After a multidisciplinary team discussion, a decision was made to perform a hybrid procedure as a safer and more viable option than surgical replacement of the aortic arch. In our case, the hybrid procedure was performed in three steps: bilateral subclavian to carotid bypass with supraclavicular access, followed by midline sternotomy and aorta-bicarotid bypass (Dacron 16/8 mm) from ascending aorta, and finally implantation of an endovascular stent graft that completely covered the aortic arch. The operation was performed under brain oxygenation monitoring. No extracorporeal circulation was used. After the procedure, normal blood flow to the branches of the aortic arch was restored; the aortic aneurysm was completely isolated, and there was no endoleak (Fig 2). The patient was discharged 15 days after the operation with stable hemodynamics, without symptoms of neurologic deficiency and in a good general condition. Endovascular repair after aortic arch debranching has the potential to reduce the morbidity and mortality rates in patients with ruptured aortic arch aneurysm and abnormality of the supra-aortic branches.Fig 2Aorta-bicarotid bypass, bilateral subclavian to carotid bypass, and aortic stent graft.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Selective neurotomy of the sciatic nerve branches to the hamstring muscles: An anatomical study

BackgroundHamstring spasticity can bring about a flexion deformity of the knee, liable to cause disability. Surgical treatment by selective neurotomies of the sciatic nerve branches leading to the hamstring muscles may then be indicated. Few studies have investigated the precise origin of these branches on the sciatic nerve, describing the innervation pattern of the hamstring muscles. Further anatomical data are needed to enhance surgical techniques in neurotomies of the sciatic nerve branches, to define the best incision and surgical approach and what section and length of the SN need to be exposed. Therefore, we performed an anatomical study to: (1) define a surgical approach to perform selective neurotomies of the sciatic nerve branches for hamstring spasticity?(2) whether the anatomical variants of the hamstring innervation have been identified? HypothesisOur anatomical data could lead to the definition of an approach to the sciatic nerve for the purpose of selective neurotomy. Material and methodsTwenty posterior compartments of the thigh were dissected. We counted each branch of the sciatic nerve leading to the hamstring and described their arising point using the centre of the lateral surface of the great trochanter and the lower edge of the gluteus maximus muscle as main anatomical landmarks. We also described the presence of branch divisions and their muscular penetrating points. ResultsThe mean distances between the center of the lateral surface of the great trochanter and the emergence of branches from the SN were: 2.2±3.6cm (−5 to 9cm) for the long head of the biceps femoris muscle, 2.3±3cm (−4 to 10cm) for the semitendinosus muscle, and 2.2±3cm (−5 to 8cm) for the semimembranosus muscle. No branches originated from the sciatic nerve below the lower edge of the gluteus maximus muscle. In summary the branches innervating the hamstrings originated from the SN within an interval of 15cm (5cm above and 10cm below the centre of the lateral surface of great trochanter). The average number of sciatic nerve branches for the hamstring muscles was 4.7 (minimum: 3; maximum: 6) with 1.8 branches for the long head of the biceps [1 in 7/20 (35%), 2 in 10/20 (50%), and 3 in 3/20 (15%)], 1.5 branches for the semitendinosus [1 in 11/20 (55%) and 2 in 9/20 (45%)], 1.4 branches for the semimembranosus [1 in 12/20 (60%) and 2 in 8/20 (40%)]. No branches had a common origin with cutaneous nerves. DiscussionThis anatomical study enabled us to propose an approach to exposing the sciatic nerve in order to perform a selective neurotomy: horizontal cutaneous incision on the gluteal fold, incision of the lower edge of the gluteus maximus, exposure of the sciatic nerve to a distance of 10cm below the great trochanter, and visualization of the nerve branches to the hamstring muscles. Exposure of the nerve above the great trochanter is not necessary because the branches which emerge from the SN above the great trochanter are still contiguous with the SN. Level of evidenceIV: prospective study without control.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch from the aorta and unilateral absence of pulmonary artery by echocardiography

Objective To improve the prenatal diagnosis and differential diagnosis ability for anomalous origin of one pulmonary artery branch from the aorta (AOPA) and unilateral absence of pulmonary artery (UAPA) by comparing and analyzing different types of fetal echocardiography features. Methods Fetal echocardiographic features were analyzed retrospectively in fetus with prenatal diagnosis of UAPA or AOPA between June 2012 and December 2018, and the different types of fetal echocardiography characteristics and main points of identification were summarized. Results A total of 6 fetuses with AOPA and 6 fetuses with UAPA were diagnosed.Among the 6 fetuses with AOPA, 5 cases were anomalous origin of right pulmonary artery from the aorta (AORPA), including 3 cases with isolated AORPA and 2 cases combined with Berry syndrome, and 1 case was anomalous origin of left pulmonary artery from the aorta (AOLPA) with an absent pulmonary valve. All 6 cases of AOPA had proximal form. Among the 6 fetuses with UAPA, 4 cases were isolated unilateral absence of right pulmonary artery, 1 case was isolated unilateral absence of left pulmonary artery and 1 case was unilateral absence of left pulmonary artery combined with tetralogy of Fallot (TOF). The main common characteristic sonographical findings included: there was no confluence at the bifurcation of the main pulmonary artery on multiple views, and the affected pulmonary branch was not attached to the main pulmonary artery. The different characteristic sonographical findings in fetus included: the affected pulmonary artery of AOPA arosed from the right posterior or left posterior portion of the ascending aorta on three vessels and trachea view (3VT) and long axial view of left ventricle, and 3VT and the coronary view of brachiocephalic trunk artery showed that the abnormal origin of pulmonary artery branch of UAPA connected with the root of brachiocephalic trunk artery by the ipsilateral vertical arterial duct (DA), and color Doppler flow imaging showed that the blood flow of the affected pulmonary artery branch was isolated in the pulmonary field. Conclusions AOPA and UAPA have many similarities in the characteristics of fetal echocardiography. 3VT and long axial view of left ventricle are the best views for displaying proximal AOPA, 3VT and the coronary views of the root of brachiocephalic trunk artery are the best views for displaying UAPA. Key words: Echocardiography; Fetus; Unilateral absence of pulmonary artery; Anomalous origin of one pulmonary artery branch from the aorta

Innervation of flexor hallucis longus muscle: an anatomical study for selective neurotomy.

The aim of the study was to describe the innervation of flexor hallucis longus (FHL) and obtain its surgical coordinates to facilitate selective neurotomy. Fifteen embalmed lower limbs of adults were studied. Anatomical dissections to isolate the innervating branches of FHL were performed. Distance between the supplying nerve of FHL, including both its origin and termination, and the medial malleolus were obtained, providing anatomical coordinates beneficial for surgery. In all cases, FHL was innervated by only one branch, which originated from the tibial nerve. Mean distance between the medial malleolus and the nervous branch origin was 21.39 ± 3.05 cm. Mean distance between the medial malleolus and the nervous branch termination was 12.7 ± 1.59 cm. Length of the nervous branch innervating FHL was proportional to the length of the leg, measuring 8.69 ± 2.45 cm. All nerves were located 15-17.4 cm above the medial malleolus. This anatomical study traced valuable surgical coordinates useful for performing selective peripheral neurotomy on the nerve branch innervating the FHL.

An archaeal origin of the Wood–Ljungdahl H4MPT branch and the emergence of bacterial methylotrophy

The tetrahydromethanopterin (H4MPT) methyl branch of the Wood-Ljungdahl pathway is shared by archaeal and bacterial metabolisms that greatly contribute to the global carbon budget and greenhouse gas fluxes: methanogenesis and methylotrophy, including methanotrophy1-3. It has been proposed that the H4MPT branch dates back to the last universal common ancestor4-6. Interestingly, it has been identified in numerous recently sequenced and mostly uncultured non-methanogenic and non-methylotrophic archaeal and bacterial lineages, where its function remains unclear5,7. Here, we have examined the distribution and phylogeny of the enzymes involved in the H4MPT branch and the biosynthesis of its cofactors in over 6,400 archaeal and bacterial genomes. We find that a full Wood-Ljungdahl H4MPT pathway is widespread in Archaea and is likely ancestral to this domain, whereas this is not the case for Bacteria. Moreover, the inclusion of recently sequenced lineages leads to an important shortening of the branch separating Archaea and Bacteria with respect to previous phylogenies of the H4MPT branch. Finally, the genes for the pathway are colocalized in many of the recently sequenced archaeal lineages, similar to bacteria. Together, these results weaken the last universal common ancestor hypothesis and rather favour an origin of the H4MPT branch in Archaea and its subsequent transfer to Bacteria. We propose a scenario for its potential initial role in the first bacterial recipients and its evolution up to the emergence of aerobic methylotrophy. Finally, we discuss how an ancient horizontal transfer not only triggered the emergence of key metabolic processes but also important transitions in Earth's history.

V.P. Zhukovsky’s role in the development of domestic pediatrics and neonatology

Vasily Pavlovich Zhukovsky (1861–1938) belongs to Russian pediatricians who pioneered the field of pediatrics in 19th – beginning of 20th centuries and established it as an independent branch of medicine, however, his representation in modern history of medicine literature is lamentably scarce. He contributed a lot in institutionalization of pediatrics, worked out new actual problems of pediatrics. His doctoral dissertation subject was problem of rickets, a vaguely known disease in those days. V.P. Zhukovsky was one of the first to study special features in physiology and pathology in newborns, he wrote one of the first Russian manuals in neonatology “Diseases of newborn children” published in 1897. He is also the author of a special monograph “Congenital heart defects in children at birth” (St. Petersburg, 1913). He paid a lot of attention to the problems of infant mortality, especially newborn mortality; clearly raised the question of necessity of antenatal care of the fetus and of the obstetricians and pediatricians’ team working. He contributed a lot in organization of teaching of pediatrics, to amelioration of work of the children ambulatories and the department for the newborns at St. Petersburg obstetrical institution (nowadays Maternity clinic number 6 named after Professor V.F. Snegiryov), where he worked from 1897 to 1910 as one of the first Russian neonatologists. He can be by right considered one of the pioneers of Russian neonatology as he stand at the origins of new branches of Russian pediatrics such as neonatology, pediatric neurology and cardiology.

Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections

ObjectiveThe objective of this study was to compare multibranched endovascular aneurysm repair (MBEVAR) of postdissection thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) with MBEVAR of degenerative TAAAs and PRAAs and to assess the role played by the preoperative correction of potential complicating factors, such as true lumen compression and false lumen origin of vital branches, using adjunctive maneuvers. MethodsFrom July 2005 to July 2017, there were 162 patients who underwent elective MBEVAR of TAAAs and PRAAs. Data on demographics, procedural details, and outcomes were collected prospectively. ResultsThe mean age was 73 ± 8 years, and 119 of 162 (74%) were men; 19 of 162 (12%) had prior aortic dissections. Patients with dissections were younger (65 ± 11 years vs 74 ± 7 years; P = .002) and were less likely to have smoked (13/19 [68%] vs 135/143 [94%]; P = .002) or to have peripheral artery disease (0/19 [0%] vs 35/143 [24%]; P = .01) compared with those without dissections. Patients with prior dissections were more likely to have Crawford type II (10/19 [53%] vs 22/143 [15%]; P = .001) and type III (6/19 [32%] vs 16/143 [11%]; P = .03) TAAAs and were more likely to require at least one pre-MBEVAR adjunctive procedure (14/19 [74%] vs 55/143 [38%]; P = .006) compared with those without dissection. There was no difference in perioperative death, stroke, or paraplegia rates between the two groups. Median follow-up was 2.4 years (interquartile range, 0.8-4.7) and did not differ significantly between the two groups. There were no significant differences in branch vessel occlusion, endoleak rate, or aneurysm-related death between the two groups. ConclusionsPatients with chronic type B aortic dissection are more likely to have extensive aneurysms and more likely to require adjunctive procedures to provide the appropriate anatomic substrate for MBEVAR, but this does not appear to affect the conduct of MBEVAR or its outcomes.