Single Trunk Research Articles

A Case Report of Dicephalus Dipus Dibrachius –A Rare Variant of Conjoined Twins

Conjoint twins are a rare type of monoamniotic twins, with an estimated incidence of 1.5 per 100,000 births worldwide. Fusion occurs between same body parts due to a defect in embryological development. Cardiovascular and other congenital anomalies lead to dismal prognosis with conjoined twins. Early prenatal diagnosis can help in parental counseling regarding the management of pregnancy, including termination or post-natal surgical separation. Ultrasonography and other imaging techniques are vital in making the anatomical survey for evaluating future options. We report a rare variant of conjoined twins, Dicephalus Dipus Dibrachius, where the fetus has two heads, but a single trunk, with two upper and two lower limbs, diagnosed at 9 weeks and 4 days of gestation, with the help of ultrasonography and color Doppler imaging.

Anatomy of facial nerve in maned wolf (Chrysocyon brachyurus - Illiger, 1815)

Abstract: Maned Wolf (Chrysocyon brachyurus) is considered one of the largest and most beautiful canids in South America, inhabits the Cerrado biome, and presents nocturnal habits, especially during the twilight period. It is in danger of extinction, mainly due to anthropic activity in its habitat. What certainly raises the importance of studying and better understanding its biology. The mammalian Facial Nerve is the seventh cranial pair and controls the functions of facial expression muscles and others. Once the anatomical descriptions of this canid are scarce, this paper aimed to describe the anatomy of Facial n. in Maned Wolf and correlate it with that of domestic canids, a phylogenetically close species whose anatomy is well known. For this research, four adult specimens were used, whose carcasses were collected along highways in southeastern Goiás State - Brazil (SISBIO 37072-2), or donated by the Wildlife Screening Center (CETAS) in Catalão - Goiás State. The specimens were fixed in a 10% aqueous formalin solution and stored in the same solution. Dissection was performed by macroscopic anatomical methods. The research was carried out with a favorable opinion of the Animal Use Ethics Committee (CEUA) of the Federal University of Uberlândia (UFU) (under n° 067/12). Anatomical preparations of post-mortem Maned Wolf did not reveal the presence of Caudal Auricular, Internal Auricular, nor Stylohyoid n.. Small ramifications of Facial n. can be considered as collateral branches. The Facial n. emerged as a single trunk, Facial n. Trunk, which branches into Auriculopalpebral, Dorsal Buccal, and Ventral Buccal n..

The course of posterior interosseous nerve in the wrist capsule. An anatomical study using the modified Sihler's staining.

Thirty dorsal wrist capsules were collected bilaterally from 15 donors (thirty capsules) within 12 hours of death. By the dorsal incision the capsules were collected in the same manner. The specimens were stained according to the protocol of modified Sihler's staining technique. The preserved capsules were analysed under 8-16× magnification of optical microscope for the presence of major posterior interosseous nerve trunks, their major and minor branches, and nerve connections. Three main types of nerve course were identified within the joint capsule. Type I - the most common, with the presence of a single trunk with the excursion of the first main branch on the radial side, two main branches on the ulnar side, the presence of the prevailing number of small branches on the radial side and the presence of 3-4 branches extending beyond the level of the carpo-metacarpal joints. Type II with the presence of two main nerve trunks, running almost in parallel with the first main branch on the radial side, two main branches on the ulnar side with presence of a predominant number of small branches on the radial side and the presence of 3-4 branches running beyond the level of carpo-metacarpal joints. Type III (least often) with the presence of crossed main nerve trunks. The modified Sihler's staining technique allows for transparent visibility of the nerves innervation the dorsal wrist capsule. However does not allow accurate assessment as histological examination, especially in evaluation of nerve endings, but it gives a significantly larger area of nerve observation.

Celiomesenteric trunk: New classification based on multidetector computed tomography angiographic findings and probable embryological mechanisms.

BACKGROUNDIn previous studies, celiomesenteric trunk (CMT) was narrowly defined as a hepato-gastro-spleno-mesenteric (HGSM) trunk, but other possible types were ignored. With the widespread use of multidetector computed tomography (MDCT) angiography, it is easy to collect a large sampling of data on arterial anatomy of the abdomen in daily radiological practice. A new classification system for CMT may be created based on its MDCT angiographic findings and variation patterns.AIMTo identify the spectrum and prevalence of CMT according to a new classification based on MDCT angiographic findings, and discuss the probable embryological mechanisms to explain the CMT variants.METHODSA retrospective study was carried out on 5580 abdominal MDCT angiography images. CMT was defined as a single common trunk arising from the aorta and its branches including the superior mesenteric artery and at least two major branches of the celiac trunk. Various types of CMT were investigated.RESULTSOf the 5580 patients, 171 (3.06%) were identified as having CMT. According to the new definitions and classification, the CMT variants included five types: I, II, III, IV and V, which were found in 96 (56.14%), 57 (33.33%), 4 (2.34%), 3 (1.75%) and 8 (4.68%) patients, respectively. The CMT variants also were classified as long type (106 patients, 61.99%) and short type (65 patients, 38.01%) based on the length of single common trunk. Further CMT classification was based on the origin of the left gastric artery: Type a (92 patients, 53.80%), type b (57 patients, 33.33%), type c (11 patients, 6.43%) and type d (8 patients, 4.68%).CONCLUSIONWe systematically classified CMT variants according to our new classification system based on MDCT angiographic findings. Dislocation interruption, incomplete interruption and persistence of the longitudinal anastomosis could all be embryological mechanisms of various types of CMT variants.

Gluteal Vein Anatomy: Location, Caliber, Impact of Patient Positioning, and Implications for Fat Grafting.

Deaths in gluteal autografting occur due to gluteal vein injuries, but data are lacking on the precise location and caliber of these veins. The authors sought to present the first in vivo study of gluteal vein anatomy utilizing magnetic resonance imaging. Magnetic resonance imaging venography of 16 volunteer hemi-sections was conducted in the supine, prone, prone with a bump (jack-knife), and left and right decubitus positions in 1 session after a single contrast administration. Caliber and course of the superior and inferior gluteal veins (SGV/IGV) were analyzed vs bony landmarks and position changes. The SGV has a very short submuscular course before splitting into 2 smaller branches superolaterally. The IGV runs immediately deep to the gluteus maximus in the center of the buttock as a single large trunk, on average 56 mm deep (mean 27 mm of muscle belly and 30 mm subcutaneous fat). No intramuscular or subcutaneous branches greater than 2 mm were found. In the prone position, the IGV and SGV have an average caliber of 5.96 mm and 5.63 mm. Vessel caliber decreased by 21% and 27%, respectively, in the jack-knife position and by 14% and 15% in lateral decubitus. The SGV and IGV are immediately deep to gluteus maximus approximately 6 cm deep with a caliber on the order of 6 mm in the prone position. The distribution of these vessels suggests there is no "safe zone" in the intramuscular or submuscular planes. The jackknife or lateral decubitus positions can decrease vein caliber by up to 27%, possibly reducing the risk of injury due to either traction or direct cannula impact.

Anatomical Study of Anterior Inferior Cerebellar Artery and Its Reciprocal Relationship with Posterior Inferior Cerebellar Artery Based on Angiographic Data

Anterior inferior cerebellar artery (AICA) can present with a myriad of variations. However, the previous studies of AICA anatomy were based on small-scale cadaveric investigation. In this study, we performed an angiographic study of AICA in 500 Chinese with Han nationality based on digital subtraction angiography (DSA). Patients admitted to our institution between 2015 and 2018 who had underwent DSA were potential candidates for this retrospective evaluation. The exclusion criteria were: a) patients with vascular diseases of the posterior circulation; b) ischemic diseases or moyamoya disease of the anterior circulation. Five hundred patients were identified. The patients ranged in age from 6 to 75 years. Two hundred thirty-seven (62.9%, 237 of 377) patients had bilateral AICAs at the same level, and 140 (37.1%, 140 of 377) had bilateral AICAs at different levels. The developing states of AICA were grade 0 in 31 (3.5%, 31 of 896), grade 1 in 373 (41.6%, 373 of 896), grade 2 in 313 (34.9%, 313 of 896), and grade 3 in 179 (20.0%, 179 of 896) hemispheres. Two hundred twenty-one (22.1%, 221 of 1000) presented with AICA-PICA common trunks. Thirty-one (3.1%, 31 of 1000) hemispheres showed no obvious AICA angiographically. AICA arose as a single trunk in 865 (86.5%, 865 of 1000) hemispheres, and as duplicate trunks in 104 (10.4%, 10 of 1000) hemispheres. Triplicate or more trunks were not seen. AICA originating from the basilar artery fenestration accounted for 4% (20 of 500) of the cases. This is the first attempt using DSA data to perform a large-scale investigation of AICA variations. The ever-growing need of endovascular intervention calls for more suitable anatomical explanation of the vascular structures.

Bird species diversity in Altai riparian landscapes: Wood cover plays a key role for avian abundance.

AimsWe aim to understand bird richness and variation in species composition (beta diversity) along a 630 km riparian landscape in the Altai Mountains of China and to test whether vegetation cover is the main explanation of species diversity.MethodsWe selected nine regions along a gradient of natural vegetation change. Bird surveys and environmental measurements were conducted at 10 points in each of the nine regions. We collected environmental land cover variables such as wood cover (area proportion of trees and shrubs with saplings in habitats; here trees are woody plant with a single trunk and higher than 3 m, shrubs and saplings are distinguished from trees by their multiple trunks and shorter height) and tree cover, and two climate factors which were Annual Mean Temperature (AMT) and Annual Precipitation (AP). We used Liner Regression Models to explore the correlation between bird species richness and environmental variables. We used Sørensen's dissimilarity index to measure birds' beta diversity, and quantified the contribution of environmental variables to this pattern using a Canonical Correspondence Analysis (CCA).ResultsWood cover was the strongest predictor of overall, insectivore, and omnivore bird richness. Regions with wood cover contained more bird species. Beta diversity was overall high in the studied regions, and turnover components occupied a major part of beta diversity. Wood cover and AP were significant predictors of bird species composition explaining 33.24% of bird beta diversity together.ConclusionsWood vegetation including trees, shrubs, and saplings, rather than only trees, contains high bird richness. High beta diversity suggests that expansion of the existing nature reserves is needed in the riparian landscapes to capture the variation in bird species composition. Thus all wood cover in the overall riparian landscapes of Altai Mountains should be protected from farming and grazing to improve bird conservation outcomes.OPEN RESEARCH BADGES This article has earned an Open Data Badge for making publicly available the digitally‐shareable data necessary to reproduce the reported results. The data is available at Raw bird data in this study: osf.io/78qcw; Raw environment data: osf.io/qr5cw.

Aberrant bifurcation of intercostobrachial nerve in the axilla: A case report

Intercostobrachial nerve (ICBN) studies have been undertaken by many authors as it is a highly variable structure with numerous patterns reported worldwide. ICBN is a frequently damaged structure in Axillary Lymph Node Dissection (ALND) or mastectomy. Compression of this nerve, due to the enlargement of axillary lymph nodes from cancer breast may be presented as referred pain along the medial side of arm. Different patterns on the course and distribution of the ICBN have been described in literature. We encountered a lesser known variation of the ICBN where it pierced the second intercostal space as a single trunk and immediately divided into two branches. The putative clinical implications of this aberrant bifurcation are of value in significantly diminishing complications such as pain and sensory disturbances presenting after mastectomy and ALND. The findings of the presentation may be of use by surgeons and interventionists in approaching the area in a more precautious manner.

Effect of Paretic and Non-paretic Side Spine Taping on Balance Ability in Patients with Stroke

Background: A number of researchers have attempted to improve the balance of stroke patients, however there is still a question as to whether taping is effective in increasing balance. Objective: To determine the effect of paretic and non-paretic side taping on the balance ability in patients with stroke. Design: A single-blind randomized controlled trial Methods: This randomized single-blind controlled clinical trial with a repeated measures study included 45 subjects who were randomly assigned to paretic side taping groups (n=15), non-paretic side taping groups (n=15), and trunk exercise groups (n=15). Trunk exercise and paretic side taping groups had taping on the paralyzed erector spinae, while the non-paretic side taping group had taping on the non-paralyzed erector spinae. Trunk exercises were performed for 30 minutes to promote core muscles. The balance ability measured the center of pressure movement (paretic side, non-paretic side,forward, backward, limit of stability) in the sitting position. All measurements were evaluated using BioRescue. Results: All three groups showed significant increase in all variables after 4 weeks. The paretic and non-paretic side taping groups had a significant increase in all variables after 30 min of attachment. However, there was no significant difference among the three groups. Conclusions: Paralysis and non-paralysis taping improved the balance ability of patients with stroke in an immediate effect of 30 min. However, after 4 weeks of intervention, taping with trunk exercise did not differ from single trunk exercise. In future studies, various analyses need to be conducted through more diverse evaluations.

Artisans and dugout canoes reveal pieces of Atlantic Forest history.

Dugout canoes are boats made from a single tree trunk. Even with the modernization of fishing, they are still made and used for artisanal fishing on the coast of southern and southeastern Brazil and in other regions of the world. Various tree species are used to construct these canoes and choosing a species is related to characteristics of the location, available raw materials and purpose of the boat. Our objective was to better understand the variation in dugout canoes in relation to tree species, tree size and fishing use, over time, along a coastal strip of southern and southeastern Brazil within the Atlantic Forest domain. We interviewed 53 artisans and analyzed 358 canoes that ranged from 1 to around 200 years old. Schizolobium parahyba is currently used the most. In the past, species of the family Lauraceae (Nectandra sp. / Ocotea sp.) were frequently used, as well as Cedrela fissilis and Ficus sp. The size of the canoes varied based on time, coastal region, environment where the boat is used (exposed or sheltered) and type of fishing. The average size of recent canoes was smaller than older canoes for more common species (S. parahyba and C. fissilis), reflecting changes in the vegetation of the biome over time, both in the species and size of individuals available. Latitudinal variation can also influence the availability of tree species along the studied regions. An increase in environmental monitoring has contributed to a decline in constructing dugout canoes, resulting in the use of fiberglass canoes and other motorized boats. Although canoe size varied based on region, location and use, today some of the older canoes represent large trees of the past and pieces of Atlantic Forest history.

Targeted Drug Delivery in Plants: Enzyme-Responsive Lignin Nanocarriers for the Curative Treatment of the Worldwide Grapevine Trunk Disease Esca.

Nanocarrier (NC)‐mediated drug delivery is widely researched in medicine but to date has not been used in agriculture. The first curative NC‐based treatment of the worldwide occurring grapevine trunk disease Esca, with more than 2 billion infected plants causing a loss yearly of $1.5 billion, is presented. To date, only repetitive spraying of fungicides is used to reduce chances of infection. This long‐term treatment against Esca uses minimal amounts of fungicide encapsulated in biobased and biodegradable lignin NCs. A single trunk injection of <10 mg fungicide results in curing of an infected plant. Only upon Esca infection, ligninolytic enzymes, secreted by the Esca‐associated fungi, degrade the lignin NC to release the fungicide. The specific antifungal activity is confirmed in vitro and in planta (in Vitis vinifera L. cv. ‘Portugieser’). All treated plants prove to exhibit significantly fewer symptoms several weeks after treatment, and their condition is monitored for 5 years (2014–2018), proving a long‐term curative effect of this NC treatment. This study proves the efficacy of this NC‐mediated drug delivery for agriculture, using a minimum amount of fungicides. It is believed that this concept can be extended to other plant diseases worldwide to reduce extensive spraying of agrochemicals.

The Nur Ashki Jerrahi Tariqah in Mexico City: a Branch from Istanbul’s Halveti Jerrahi Tariqah

This article aims at focusing on the facts and agents which made the establishment of the Nur Ashki Jerrahi tariqah in Mexico City possible, as a branch from the Halveti Jerrahi tariqah in Istanbul. With this in mind, I will discuss the presence of Sufism in the American continent in order to delve into the history that allowed the encounter between Lex Hixon and Shaykh Muzaffer Ashki al-Jerrahi in 1978, in New York City. This moment, recorded in the Islamic prayer spaces of the Nur Ashki Jerrahi communities in Mexico City and New York City, is the starting point in the story that paves the way for a new branch of the tariqah of Istanbul. More than 30 years later, Lex Hixon and Shaykh Muzaffer Ashki al-Jerrahi are still remembered in Mexico given their openness towards the feminine and towards all other sacred traditions which are part of a single trunk, while expressing themselves in various branches.

Transient coma as Percheron’s artery stroke

The artery of Percheron is a rare anatomic variation in the brain vascularization, in which a single arterial trunk arises from the posterior cerebral artery to supply both sides of brain structures, i.e., the thalamus and midbrain. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report the case of a Caucasian woman who completely recovers after transient coma due to Percheron artery infarction.

OPTIMIZATION OF SURGICAL TACTICS FOR TREATING PATIENTS WITH GASTRIC CANCER IN CASE OF VARIANT ANATOMY OF THE CELIAC-MESENTERIC BASIN

Relevance: The variability of the visceral vessels occurs from 10 to 30%. There are anatomical options in which the main arteries of the stomach depart from the aorta or superior mesenteric artery. The recommended standardized surgical technique for radical treatment of gastric cancer is defined for typical vascular anatomy. Objective: To improve the results of surgical treatment of patients with gastric cancer (GC) by optimizing the diagnostic algorithm and correcting surgical techniques. Material and Methods: The results of surgical treatment of 296 patients with gastric cancer cT1-4N1-2M0, who were treated at I.P. Pavlov First St. Petersburg State Medical University from 2012-2017. In the main group of patients (n = 176), the proposed diagnostic and treatment algorithm was applied (spiral computed tomography in the angiographic mode (SCTA) + with the discharge of the vessel participating in the blood supply to the stomach from the aorta (AO) and / or the superior mesenteric artery (SMA) extended lymph node dissection D2 + № 16a2, № 16b1). All patients were radically operated. The evaluation of the diagnostic characteristics of SCTA was performed. The results of treatment were evaluated in 108 patients of the main group. The comparison group (n = 120) consisted of patients in whom vascular anatomy was not studied. Estimated blood loss, time of operation, the frequency of perioperative complications and long-term survival. Results: In 32,9 % (n = 58) patients, variant anatomy of the visceral vessels of the upper abdominal cavity was detected. Additional arteries with typical trifurcation were found in 21,6 % (n = 38) of cases; celiac trunk bifurcation was determined in 10,2 % (n = 18) of patients; the absence of the celiac trunk and a single celiac-mesenteric trunk were found in 1,1 % (n = 2) of patients. The sensitivity of SCTA was 95,7 %, specificity 94,4 %, total accuracy 95,4 %. As a result of the applied diagnostic and treatment algorithm, the standard volume of D2 lymph node dissection was performed in 124 (70,4 %) patients during the surgical treatment of the main group of patients. Expansion of lymphadenectomy to D2 + was required in 52 (29,5 %) patients. Metastases to lymph nodes of groups № 16a2 and № 16b1 in patients who underwent extended D2 + lymph node dissection were detected in 16 (30,8 %) cases. The average blood loss in the main group was 1,95 times less and amounted to 126,5±22 ml, and in the comparison group - 246,7±34 ml (M ± m, p = 0,0276). A comparison of the average duration of the operation did not show any significant differences: in the comparison group it was 188,2 ± 16,4 minutes, while the main group was slightly lower - 172,3 ± 21,5 minutes. In the main group, the total number of complications was 14 cases (13,5 %) and was significantly lower than in the comparison group - 29 cases (25,9 %). Survival for 1-2-3 years in patients of the main group was higher than the comparison group and amounted to 92,6, 75,0, 53,7 % and 90,8, 71,8, 47,5 %, respectively. The relapsefree 1-2-3-year survival of the group of patients to whom the diagnostic and treatment algorithm was applied was also higher than in the comparison group and amounted to 90,7, 73,1, 48,1 % and 90,8, 68, 3, 44,2 %, respectively. The median survival was significantly better in the main group of patients - 31,4 months, in the comparison group - 28,5 months. Conclusions: Performing SCTA at the preoperative stage is an effective way to visualize the great vessels, allowing to plan the volume of the operation, to avoid perioperative complications. Expanding the volume of lymph node dissection to D2 + № 16a2, № 16b1 when the vessel participating in the blood supply to the stomach from the AO and / or SMA is released, as it allows to improve the long-term results of treatment of patients with gastric cancer, by increasing radical surgery.

Deformation of the Date Palm tree trunk in Dammam Metropolitan Area: causes and consequences

Date palm (Phoenix dactylifera) is one of the elegant trees that performs several landscaping functions. Its single trunk textured by bases of the cut leaves distinguishes it from other ornamental trees. This cylindrical textured trunk is one of the major attractive features emphasized the use of date palms as ornamental landscaping trees. Across the Kingdom of Saudi Arabia, Date palms in public landscaping schemes have experienced deformation of their trunks. This is a function of several factors related to plantation, irrigation, and maintenance. This research to investigate and categorise the causes, types, and forms of date palm trees‘ trunks deformation. Prior to a field survey, a randomly conducted pilot survey to collect data from different areas where date palms are used as landscaping ornamental trees across the Dammam Metropolitan Area (DMA). It applies direct observation, measuring and analysis to develop preliminary understanding of the phenomena; and apply its outcomes on a case study of the Dammam City Seafront (DCS). The result showed that date palm trees‘ trunks deformation has occurred at bottom, middle, and upper parts as results of several factors; and it is as high as almost 97% among investigated trees. However, 58% of deformation symptoms processes have been noticed on bottom third of the date palm trees‘ trunks, near soil surface; and 27.5% of them are in the King Abdullah Seafront Park (KASP). The study proves statistically that sprinkler and bubbler irrigation systems are of major responsibility for near ground deformation of palm trees‘ trunks, which expands at rate of 3.5 and 3.3 CM/Year.

Deformation of the Date Palm tree trunk in Dammam Metropolitan Area: causes and consequences

Date palm (Phoenix dactylifera) is one of the elegant trees that performs several landscaping functions. Its single trunk textured by bases of the cut leaves distinguishes it from other ornamental trees. This cylindrical textured trunk is one of the major attractive features emphasized the use of date palms as ornamental landscaping trees. Across the Kingdom of Saudi Arabia, Date palms in public landscaping schemes have experienced deformation of their trunks. This is a function of several factors related to plantation, irrigation, and maintenance. This research to investigate and categorise the causes, types, and forms of date palm trees‘ trunks deformation. Prior to a field survey, a randomly conducted pilot survey to collect data from different areas where date palms are used as landscaping ornamental trees across the Dammam Metropolitan Area (DMA). It applies direct observation, measuring and analysis to develop preliminary understanding of the phenomena; and apply its outcomes on a case study of the Dammam City Seafront (DCS). The result showed that date palm trees‘ trunks deformation has occurred at bottom, middle, and upper parts as results of several factors; and it is as high as almost 97% among investigated trees. However, 58% of deformation symptoms processes have been noticed on bottom third of the date palm trees‘ trunks, near soil surface; and 27.5% of them are in the King Abdullah Seafront Park (KASP). The study proves statistically that sprinkler and bubbler irrigation systems are of major responsibility for near ground deformation of palm trees‘ trunks, which expands at rate of 3.5 and 3.3 CM/Year.

Deformation of the Date Palm tree trunk in Dammam Metropolitan Area: causes and consequences

Date palm (Phoenix dactylifera) is one of the elegant trees that performs several landscaping functions. Its single trunk textured by bases of the cut leaves distinguishes it from other ornamental trees. This cylindrical textured trunk is one of the major attractive features emphasized the use of date palms as ornamental landscaping trees. Across the Kingdom of Saudi Arabia, Date palms in public landscaping schemes have experienced deformation of their trunks. This is a function of several factors related to plantation, irrigation, and maintenance. This research to investigate and categorise the causes, types, and forms of date palm trees‘ trunks deformation. Prior to a field survey, a randomly conducted pilot survey to collect data from different areas where date palms are used as landscaping ornamental trees across the Dammam Metropolitan Area (DMA). It applies direct observation, measuring and analysis to develop preliminary understanding of the phenomena; and apply its outcomes on a case study of the Dammam City Seafront (DCS). The result showed that date palm trees‘ trunks deformation has occurred at bottom, middle, and upper parts as results of several factors; and it is as high as almost 97% among investigated trees. However, 58% of deformation symptoms processes have been noticed on bottom third of the date palm trees‘ trunks, near soil surface; and 27.5% of them are in the King Abdullah Seafront Park (KASP). The study proves statistically that sprinkler and bubbler irrigation systems are of major responsibility for near ground deformation of palm trees‘ trunks, which expands at rate of 3.5 and 3.3 CM/Year.

Limited persistence of residues and metabolites in fruit and juice following penicillin trunk infusion in citrus affected by Huanglongbing

The Florida citrus industry has suffered from Huanglongbing (HLB or citrus greening), a bacterial disease caused by Candidatus Liberibacter asiaticus (CLas), for almost 13 years with the citrus fruit production declining >70% between 2004 and 2017. With a sense of urgency, scientists with Florida Department of Agriculture and Consumer Services were tasked to seek a possible solution to mitigate the disease. Field trials (2014–16) were conducted to evaluate the effectiveness and environmental detectability of antibiotics used to combat HLB in experimental and commercial groves of Hamlin and Valencia varieties of sweet orange, and grapefruit. Across two year-long experiments, Penicillin G (PCN-G) was administered via trunk infusion into trees and subsequently detected in leaves, fruit and roots within 24 h. PCN-G started degrading 72 h post-infusion, with no detection at day 15 at or above 0.1 mg/L, the minimum level considered lethal to microbes. Reduction of CLas titer, as estimated by qPCR, was observed in treated trees when compared to control trees, and in many cases the rate of titer change over time was greater than that in control trees. Residue analysis of treated fruit for presence of PCN-G and two metabolites through UHPLC/MS confirmed that no PCN-G was present in fruit at harvest time, though metabolites were detected in low concentrations (<1 ppm). We suggest that PCN-G treatment of HLB infected citrus through a single trunk infusion at least 132 days prior to harvest may be a method for control of HLB with potentially minimal impacts on food safety and the environment, though further research will likely lead to improved methods.

Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications

Composite tissue allotransplantation of the face has led to renewed interest in the vascularization of the maxilla. The maxillary artery, which is deep within the tissue and difficult to access, is considered the main artery of the maxilla. The objective of this study was to describe the distribution of the maxillary artery in the deep regions of the face and maxilla. Twenty-four maxillae were studied, of which 20 were injected with latex and four with India ink. The maxillary artery in the pterygopalatine fossa gave rise to the sphenopalatine artery, infraorbital artery, descending palatine artery, and posterior superior alveolar artery in all 24 cases. The posterior superior alveolar artery gave rise to a periosteal branch and an intraosseous branch (in the wall of the maxillary sinus) in 18 cases. The branch passed through part of the wall and the entire wall in eight and ten cases, respectively, and anastomosed at the anterior nasal spine and the infraorbital foramen. The descending palatine artery presented as a single trunk in four cases, a greater palatine artery and a lower palatine artery in 18 cases, and four branches in two cases. Intraosseous and periosteal anastomoses were found along with anastomosis through the incisive foramen, which were obstructed in three cases. The vascular territories were studied. The maxillary artery created an intraosseous and periosteal anastomotic network, explaining the supply pathways during different surgical procedures, risk of hemorrhage with orthognathic surgery (Le Fort type I) in a sinus lift for preimplant surgery, and the vascular territories.

Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial

BackgroundComputerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients’ position and the double needle technique using posterior anterocrural approach. MethodsIn Double Needles Celiac Neurolysis Group (n=17), we used two needles posterior anterocrural technique injecting 12.5mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n=17), we used single needle posterior anterocrural approach. 25mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. ResultsThe failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8±1.2 vs. 8.9±1; p=0.046, p≤0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5±5.1 vs. 15.4±1.8; p≤0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis=2 (0–5), 2 (0–4), 3 (0–6), 3 (2–6) and single needle celiac neurolysis=3 (0–5), 2 (0–5), 2 (0–4), 4 (2–6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p≤0.001). There were no statistically significant differences as regards rescue analgesia and complications (p>0.05). ConclusionSingle needle celiac neurolysis with changing patients’ position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.