Small Branches Research Articles

Accelerated Evolution of H7N9 Subtype Influenza Virus under Vaccination Pressure.

No avian H7N9 outbreaks have occurred since the introduction of H7N9 inactivated vaccine in the fall of 2017. However, H7N9 is still prevalent in poultry. To surveil the prevalence, genetic characteristics, and antigenic changes of H7N9, over 7000 oropharyngeal and cloaca swab specimens were collected from live poultry markets and farms in 15 provinces of China from 2017 to 2019. A total of 85 influenza virus subtype H7N9 strains were isolated and 20 representative strains were selected for genetic analysis and antigenicity evaluation. Results indicated the decreased prevalence of low-pathogenic H7N9 strains while highly-pathogenic H7N9 strains became dominated since the introduction of vaccine. Phylogenetic analysis showed that strains from 2019 formed an independent small branch and were genetically distant to strains isolated in 2013–2018. Analysis of key amino acid sites showed that the virus strains may adapt to the host environment evolutionally through mutation. Our analysis predicted additional potential glycosylation sites for HA and NA genes in the 2019 strains. Sequence analysis of HA gene in strains isolated from 2018 to 2019 showed that there were an increased nucleotide substitution rate and an increased mutation rate in the first and second nucleotides of coding codons within the open reading frame. The hemagglutination inhibition (HI) assay showed that H7-Re1 and H7-Re2 exhibited a lower HI titer for isolates from 2019, while H7-Re3 and rLN79 showed a high HI titer. The protective effect of the vaccine decreased after 15 months of use. Overall, under vaccination pressure, the evolution of influenza virus subtype H7N9 has accelerated.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12250-021-00383-x.

Double kissing inflation outside the stent secures the patency of small side branch without rewiring

BackgroundThe jailed balloon technique is widely used for coronary bifurcation lesions, but a residual risk of SB occlusion remains, necessitating SB rewiring and further interventions, including balloon inflation or stenting, which may result in failure and SB loss. This study introduced a novel modified technique of small side branch (SB) protection, namely, double kissing inflation outside the stent (DKo) technique, for coronary bifurcations without the need for SB rewiring.MethodsWe performed the DKo technique in consecutive patients in our center from 1/2019 to 12/2019. The procedure was as follows. We inserted a guide wire into both branches followed by proper preparation. The SB balloon was simultaneously inflated with main vessel (MV) stenting. The SB balloon remained in situ until it was kissing inflated with postdilation of the bifurcation core, which is different from traditional strategies. The proximal optimization technique was performed with a short noncompliant balloon strictly not exceeding the bifurcation. Rates of SB loss and in-hospital outcomes were evaluated.ResultsThe technique was successfully performed in all 117 enrolled patients without any rewiring or SB loss. The mean lesion lengths of the MV and SB were 38.3 ± 19.9 mm and 11.7 ± 7.1 mm, respectively. On average, 1.5 ± 0.6 stents were used per patient, while the mean pressure of the SB balloon was 7.4 ± 3.1 atm. DKo achieved excellent procedural success in the proximal and distal MVs: increased minimal lumen diameter (0.64 ± 0.58 mm to 3.05 ± 0.38 mm, p < 0.001; 0.57 ± 0.63 mm to 2.67 ± 0.35 mm, p < 0.001) and low residual stenosis (11.4 ± 3.4%; 7.2 ± 4.6%). DKo secured the patency of the SB without any rewiring and improved the SB stenosis with minimal lumen diameter (0.59 ± 0.48 mm to 1.20 ± 0.42 mm, p < 0.001) and stenosis (71.9 ± 19.4% to 42.2 ± 14.0%, p < 0.001). No MACE was noted in the hospital.ConclusionsDKo for bifurcation lesions was shown to be acceptable with high procedural success and excellent SB protection.

Science: A Sixth Sense

When we hear about science, a certain fear of formulae, complex reactions and theories comes to our mind. But have we ever thought of science as a concept beyond the textbooks? If we can understand how things work, why certain things happen the way we see them or what causes certain phenomena, science will no longer be limited to textbooks. The best way of familiarizing society to science is to first simplify it to an extent where the common man understands it not as magic but as a happening with proper reasoning. As per my opinion, science is the way of thinking how and why things happen around us. The reason gives the science behind it. Science has the power of existence. Science is not a subject to learn; it is the power of thinking. In a world where technology surpasses everything, science has still managed to find utmost importance in everyday life. Without science, technology wouldn't flourish and without technology, science would not have got the respect it deserves. I don’t know why, but we have divided science into different branches,for example physics, chemistry, mathematics and biology etc. Now they have become major subjects and have been divided into smaller branches. I think, these different branches or subjects are nothing but the various ways of thinking over the same problem. Science is all about understanding. All branches of science have made tremendous progress in giving directions to thoughts and ideas. This has ultimately led mankind to make advancements in all areas related to science. Whenever there is a new discovery or invention, it proves that we are taking science a step ahead, making it more accessible to the common man and in the course providing solutions to even the smallest of problems. If you don’t understand science, you will continuously feel that magics are happening in nature. There is nothing magical in the world of science, only our sense of power has some limits and that is why we are unable to experience or sense the waves and tiny matters. There are lots of phenomena happening in nature continuously with a reason. If we want to understand the reason behind it then we will definitely have to convert that reason into technology. Science is truly a fascinating world, where we see the tiniest inventions becoming the biggest comfort or the biggest discoveries helping mankind to leap forward without any hurdles. It is only due to the understanding of science, more importantly rocket science, that the sky is now no longer a limit. Man has also been able to give a reasonable scientific explanation to most of the so-called magical phenomena of nature. It is only because of science which is the backbone of technology, that man is able to achieve the comfort of happy living, by decoding problems while treading on the path of innovative thinking. So, every student has to learn conceptual basic science. You can understand science once you start thinking in a proper way. Every student needs to generate the habit of thinking on any problem. This will slowly decrease the fear about science. Lastly, to conclude I want to say that Science is the sixth sense for human beings so try to use it to experience the lovely and fascinating world.

Cross-sectional area reference values for high-resolution ultrasonography of the upper extremity nerves in healthy Asian adults.

In this study, multiple-site, cross-sectional area (CSA) reference values were established for major peripheral nerves, including small branches, in the upper extremity of a healthy Asian population.This study included 107 prospectively recruited age-matched, healthy subjects with a mean age of 46 years (range, 24–75 years). All subjects underwent standardized nerve conduction studies for the median, ulnar, peroneal, posterior tibial, and sural nerves. CSA was measured unilaterally at 21 sites of the median, ulnar, radial, posterior interosseous, superficial radial sensory, musculocutaneous, lateral antebrachial cutaneous, and medial antebrachial cutaneous nerves.According to their age, the subjects were assigned to the younger group (20–40 years, n = 40), the middle group (40–59 years, n = 40), and the older group (60–80 years, n = 27). The significant differences of CSA values between age groups were found only at certain sites, such as the median (wrist, P = .003), ulnar (medial epicondyle, P = .031; forearm, P = .022), radial (antecubital fossa, P = .037), and superficial radial sensory nerve (P = .028). The CSA significantly correlated with gender, height, weight, and body mass index.This study provides CSA reference values for nerves, including small sensory nerves in the upper extremity, which can be useful in the ultrasonographic investigation of various peripheral neuropathies in the upper extremity.

Innervation of digital joints: an anatomical overview.

IntroductionThe innervation of the digital joints as well as the anatomical relationships of the articular branches is present in this anatomical work to determine the technical feasibility of a selective and efficient denervation of the digital joints.Materials and methodsA study of 40 distal interphalangeal (DIP), 40 proximal interphalangeal (PIP), 50 metacarpophalangeal (MCP), 10 interphalangeal (IP) of the thumb, and 10 trapezo-metacarpophalangeal (TMC) joints was performed on ten hands. Under magnification and a proper surgical approach, we collected the course, the source origin, the number of articular nerve branches, and their caliber.ResultsIn total, 118 nerve branches arising from the proper palmar digital nerves were found on 10 DIP of each dissected long finger (n = 40). A total of 226 nerve branches were found on 10 PIPs of each long finger (n = 40), of which 204 branches (90.3%) had a palmar origin. Dorsal innervation was found for the ring and little finger, originating from the dorso-ulnar digital nerve. 212 branches were found on 10 MCP of long fingers (n = 40), including 87 branches of palmar origin (41.1%), 107 branches of dorsal origin (50.4%), and 18 branches of the motor branch of the ulnar nerve (8.5%). 42 articular branches directed to the TMC joint (n = 10) were found. 13 branches (31%) originated from the anterior sensory branch of the radial nerve, 13 branches (31%) originated from the lateral cutaneous nerve of the forearm, 5 branches (12%) originated from the palmar cutaneous branch of the median nerve, and 11 (26%) branches originated from the thenar branch of the median nerve. The involvement of the sensory anterior branch of the radial nerve was always present for the innervation of each TMC.Discussion and conclusionOur research shows that finger joints receive their primary innervation from small branches of the digital nerves with the exception of the MCP joint and the TMC joint. To obtain an efficient and a selective digital denervation for articular pain relief, it is necessary to plan the best surgical approach and it is crucial to recognize the articular nervous branch localization and source.

A Cadaveric Study of the Dorsal Nerve of the Clitoris: Mapping a 3D Danger Zone for Female Cosmetic Genital Surgery

Introduction The Dorsal Nerve of the Clitoris (DNC) innervates the clitoris and plays a major role in female sexual arousal. However, little research investigating the location of its terminal branches places them at risk of being severed during surgical procedures. For instance, the most common labiaplasty approach begins with an incision into the prepuce surrounding the glans clitoris. This area may house terminal branches of the DNC, leading to damage if severed. In this study we measured the distances of distal DNC branches from important surgical landmarks, as well as created a three-dimensional “danger zone,” which can be used by surgeons performing female cosmetic genital surgery. Methods A total of 19 female preserved cadavers were examined, yielding 38 DNC. The DNC was located by first making a shallow vertical incision from the pudendal cleft superiorly through the mons pubis. The body of the clitoris was located and the fascia surrounding the crura within the labia minora was carefully dissected to expose the DNC. The DNC was followed to its deepest point at the penetration of the perineal membrane, and was also followed superficially over the angle of the clitoris and toward the glans. The distal branches were carefully dissected to reveal the location at which the nerves penetrate the clitoris. Care was taken to not disturb the natural position and course of the nerves. Photographic evidence of each nerve was obtained, and various depth measurements were taken with Mitutoyo Absolute IP-67 digital calipers. Statistical analysis was conducted in Microsoft Excel. Results The distance from the distal-most DNC branch to the edge of the prepuce surrounding the clitoris was the most important and surprising measurement we obtained in this study. The mean distance was 10.80 mm (SD 5.31 mm). These terminal branches extend into the subcutaneous tissue of the prepuce (Figure 1), which serves as the initial incision point in the most common approach to the labiaplasty procedure. Without the ability to visualize the small distal DNC branches, surgeons operating in this area have a high risk of severing the nerves that provide sensation to the clitoris. As such, this reveals that surgeons performing surgeries in this region should avoid techniques involving excision of the clitoral hood. Another important measurement was the mean distance of the DNC as it passed over the angle of the clitoris to the edge of the labia minora, which was 30.35 mm (SD 6.44 mm). This measurement provides an understanding of the depth that the DNC travels within the labia minora, which is also relevant to labia excision in the labiaplasty procedure. Conclusion This study demonstrates that the most distal branches of the DNC extend further than expected, and terminate subcutaneously within the prepuce of the clitoris. This study also reveals the depth at which the DNC travels compared to the labia minora, which is an important depth for surgeons performing procedures in this region. While there is still much to be understood about the course of the DNC, these measurements are an important beginning to increasing the awareness of this region for female sexual health.

Malignant Arrhythmia in Acute Conus Artery Occlusion

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

Malignant Arrhythmia in Acute Conus Artery Occlusion

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

Abstract No. 48 Usefulness of cone-beam computed tomography during bronchial artery embolization

Bronchial artery embolization (BAE) is a well-established intervention for treating benign and malignant causes of hemoptysis with high success rate from 70-99%; a subset of these procedures involve bronchial artery chemoperfusion, which has been used in palliation of lung malignancies. One of the dreaded complications of BAE is non-target embolization resulting in spinal cord ischemia, occurring in 0.6-4.4% of patients. This study aims to examine whether the adjunct use of CBCT with digital subtraction angiography (DSA) has an impact on BAE interventions. Twenty-one (10M, 11F) patients of mean age 55.5 who underwent DSA with CBCT prior to BAE from 2010 to 2020 were evaluated for single-institutional retrospective study. Retrospective analysis of the dictated reports were performed in conjunction with the available stored images and findings were summarized into 3 categories: 1) CBCT added no benefit; 2) CBCT added benefit (i.e., increased diagnostic confidence) without change in procedural management; 3) CBCT added benefit with change in intraprocedural management. The frequency and percentage of each category were calculated. 14/21 patients (66.7%) (95% CI: 0.47-0.87) were placed into category 2 whereby CBCT increased diagnostic confidence for embolization. The remaining 7/21 (33.3%) patients (95% CI: 0.13-0.53) were placed into category 3. In 3 of these patients, CBCT resulted in microcatheter repositioning to a selective bronchial artery branch to avoid nontarget embolization of a spinal artery. In 2 patients, CBCT confirmed normal tissue perfusion resulting in microcatheter repositioning to find an alternate source. In the remaining 2 patients, CBCT showed additional intercostal collaterals to ipsilateral bronchial arteries, which were then embolized. No cases were placed into category 1. One patient (4.8%) had a complication of spinal cord ischemia likely related to non-target embolization via small posterior radiculomedullary arterial branches, which in retrospect were seen on CBCT but not DSA. No other complications were seen. Adjunct use of CBCT during BAE provides additional information beyond DSA. This resulted in increased diagnostic confidence 67% of the time and in 33% of cases resulted in intraprocedural change in management, often to avoid non-target embolization via DSA-occult spinal arteries.

Anticancer Potential of Calotropis procera: An Overview

Medicinal plants have incredible importance because of the presence of many types of components present in it, and they become the source for the synthesis of active pharmaceutical ingredients (API). Calotropis procera is a xerophytic shrub, with soft, tall; numerous shrubs with small flowering branches or small trees belonging to the family of Asclepiadaceae, distributed globally over the tropical and subtropical region of Asia and Africa. It is well known in traditional medicine to have cleansing and anti-ageing properties as well as used in the mitigation of various ailments as antiulcer, anti-leprotic, cytotoxic, anti-emetic, anti-coagulant and anticancer activities. It contains various chemical constituents like cardiac glycoside, triterpens, flavanoids, steroids and other phenolic components in various parts of plant was well known for its diverse pharmacological and biological activities. Different extracts of plant and parts of plants possess significant in-vitro and in-vivo cytotoxic, anti-tumour and anti-proliferative activity in various cell lines and tumor cells which indicate the considerable potential of Calotropis procera for anticancer adjutants. The objective of the presentr eview is to provide systematic information about the phytochemical and various extracts of Calotropis procera as potential candidate for cancer treatment.Â

Spatial imaging reveals the pathways of Zn transport and accumulation during reproductive growth stage in almond plants

The reproductive processes of several deciduous trees are highly sensitive to Zn deficiency. An understanding of the patterns of Zn storage and remobilization during bud development and bud break is critical for the development of fertilization strategies to prevent deficiencies and may be valuable in selection and breeding programs to develop more Zn-resilient cultivars. In this study, we provide insights into the in situ distribution of Zn in almond reproductive organs at tissue, cellular, and subcellular scales using synchrotron-based X-ray fluorescence. The concentrations of Zn in different parts of the vegetative and reproductive tissues were also analyzed. Our results show that the small branches subtending the flower and fruit, pollen grain, transmitting tissues of styles, and seed embryo are all important storage sites for Zn. An increase in Zn concentrations in almond reproductive organs mostly occur during the expanding growth phase, such as bud-flush and the mid-fruit enlargement stage; however, Zn transport to floral parts and fruit tissues was restricted at the pedicel and seed coat, suggesting a bottleneck in the export of Zn from the mother plant to filial tissues. Our results provide direct visual evidence for in-situ Zn distribution within the reproductive tissues of a deciduous tree species. This article is protected by copyright. All rights reserved.

The Propeller Myocutaneous Flap of the Upper Eyelid: Anatomical Study and its Clinical Implication.

The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region. The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2. The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result. Patients were followed up at 3-6-12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible. The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.

Mechanics of Arboreal Locomotion in Swinhoe’s Striped Squirrels: A Potential Model for Early Euarchontoglires

Differences between arboreal and terrestrial supports likely pose less contrasting functional demands on the locomotor system at a small body size. For arboreal mammals of small body size, asymmetrical gaits have been demonstrated to be advantageous to increase dynamic stability. Many of the extant arboreal squirrel-related rodents display a small body size, claws on all digits, and limited prehensility, a combination that was proposed to have characterized the earliest Euarchontoglires. Thus, motion analysis of such a modern analog could shed light onto the early locomotor evolution of eurarchontoglirans. In this study, we investigated how Swinhoe’s striped squirrels (Tamiops swinhoei; Scuiromorpha) adjust their locomotion when faced with different orientations on broad supports and simulated small branches. We simultaneously recorded high-Hz videos (501 trials) and support reaction forces (451 trials) of squirrels running on two types of instrumented trackways installed at either a 45° incline (we recorded locomotion on inclines and declines) or with a horizontal orientation. The striped squirrels almost exclusively used asymmetrical gaits with a preference for full bounds. Locomotion on simulated branches did not differ substantially from locomotion on the flat trackway. We interpreted several of the quantified adjustments on declines and inclines (in comparison to horizontal supports) as mechanisms to increase stability (e.g., by minimizing toppling moments) and as adjustments to the differential loading of fore- and hind limbs on inclined supports. Our data, in addition to published comparative data and similarities to the locomotion of other small arboreal rodents, tree shrews, and primates as well as a likely small body size at the crown-group node of Euarchontoglires, render a preference for asymmetrical gaits in early members of the clade plausible. This contributes to our understanding of the ancestral lifestyle of this mammalian ‘superclade’.

TCTAP A-019 Pre-dilation with a Scoring Balloon on Small Side Branch Occlusions During Long Coronary Stent Implantation

TCTAP A-019 Pre-dilation with a Scoring Balloon on Small Side Branch Occlusions During Long Coronary Stent Implantation

Needle Propagation and Twinkling Characteristics

AbstractRecently, a new lightning phenomena, termed needles, has been observed in both VHF and in optical along positive lightning leaders. They appear as small (&lt;100 m) leader branches that undergo dielectric breakdown at regular intervals (called twinkles). Providing a coherent and consistent explanation for this phenomenon is challenging as each twinkle is a form of negative breakdown that propagates away from the positive leader. In this study, we provide detailed observations of needles in VHF, observed during two lightning flashes. We show distributions of different needle properties, including twinkle propagation speeds, time between twinkles, and needle lengths, among others. We show a return stroke and multiple recoil leaders that quench needle activity. We also show that nearby needle activity does not seem to correlate together, and that needle twinkling can slow down by 10%–30% per twinkle. We conclude by presenting possibilities for how the positive leader could induce negative propagation away from the positive channel, and we argue that twinkles can propagate like a stepped leader or like a recoil leader depending on the temperature of the needle, which implies that needle twinkles can probably propagate without emitting VHF.

Microstructure evolution during dendrite coarsening in an isothermal environment: 3-D cellular automaton modeling and experiments

Microstructure evolution of columnar dendrites during isothermal coarsening is simulated by a three-dimensional (3-D) cellular automaton (CA) model. The 3-D CA model incorporates the thermodynamics, and kinetics aspects influenced by the factors of temperature, composition, and interfacial weighted mean curvature. After quantitative validation through grid independence test and the liquid pool migration problem, the 3-D CA model is applied to simulate the dendrite coarsening phenomena caused by the simultaneous melting and solidification for a SCN-2.0 wt.% ACE alloy in an isothermal environment. Several typical features of dendrite coarsening occurring in the 3-D space are reproduced by the CA model, including melting of tertiary and small secondary branches, interdendritic groove base advancement, and coalescence of neighboring dendrite arms. The simulated dendritic microstructure compares well with the in situ experimental observation. Besides, the simulated specific surface area of the solid/liquid interface decreases with time following a power-law relation with an exponent of 1/3. The simulated distribution curve of the interfacial weighted mean curvatures becomes narrower with time, and the peak gradually shifts to zero, showing that the S/L interface is flattened during the isothermal dendrite coarsening. The average thickness of the primary dendrite arm and the secondary dendrite arm spacing (λ2) are found to increase with time, and the third power of λ2 shows a nearly linear relationship with time. The CA model not only visualizes morphological evolution of the dendrite arms, but also provides insight into the complex interaction among local melting/solidification, solute diffusion, and variation of weighted mean curvature in the 3-D space.

Imaging of the hand : What should be considered regarding the nerves?

Peripheral nerve disorders of the hand and wrist are most commonly caused by entrapment neuropathies, while traumatic nerve injuries and neoplasms are less common. The indication for additional imaging methods and different imaging options, especially in patients with atypical symptoms or remaining unclear etiology of symptoms after completion of standard diagnostics, are presented. The imaging methods magnetic resonance (MR) neurography and neurosonography are introduced, and typical findings as well as diagnostic pitfalls are presented. The diagnostic gold standard, which comprises apast medical history, neurologic examination and electrophysiology, can often establish the diagnosis. Imaging methods, especially MR neurography and neurosonography, are gaining increasing importance in the diagnostic workup of atypical neuropathies, as well as in the determination of the exact lesion location and spatial lesion extension, especially for surgical planning. Recent technical advances allow high-resolution depiction of small distal terminal nerve branches. MR neurography allows for the high-resolution depiction of peripheral nerves of the hand and wrist. It can confirm the diagnosis of neuropathy, identify the exact lesion location, and rule out any differential diagnoses. Neurosonography is atime- and cost-efficient alternative diagnostic method.

Rituals and Votive Offerings at the Sanctuary of Demeter in Kaunos

The sanctuary of Demeter at Kaunos is one of seven sanctuaries of Demeter in Caria. The rocky outcrops at the sanctuary of Demeter in Kaunos, which were the stages for rituals, were central elements in the celebration of festivals and rituals performed in honour of Demeter at Kaunos. Numerous votives recovered from the cavities of the rocky outcrops were a special form of votive offerings and deposition practiced at this site. The votives consist of clay figurines, miniature pottery, kernoi, coins, and 60 thousand miniature lamps. A special feature of the clay figurines of young and mature men is holes in their hands, which served for the offering of small branches. The present article proposes an interpretation of the rocky outcrops, libation, hydrophoroi, food offerings, kernoi, male figurines holding branches, and lamps used at the rituals of Demeter. The features of the sanctuary of Demeter at Kaunos and its rich votive deposits have the potential to enrich our understanding of the Carian cults of Demeter.

Sporadic Malignant Perineurioma: A Rare Diagnosis Among Malignant Peripheral Nerve Sheath Tumors

Malignant perineurioma is a rare subset of malignant peripheral nerve sheath tumors (MPNSTs) with ultrastructural and immunohistochemical features of perineurial differentiation, distinguishing it from other MPNSTs, which typically demonstrate Schwannian features. The clinical course and prognosis of this rare tumor is not well defined. The electronic medical records were searched for patients with a diagnosis of MPNST. Patients with a pathologic diagnosis of malignant perineurioma or MPNST with perineurial features were identified and further evaluated. Five patients with malignant perineurioma, or MPNST with perineurial features, were identified. Four patients (2 male and 2 female) were included with tumors associated with a common digital nerve, small muscular branch to the deltoid, sciatic nerve, and accessory nerve. One patient with the pathology diagnosis meeting inclusion criteria was excluded, as no clinical information was available for this patient. Patients in our series presented at varied stages of disease. Clinical courses after diagnosis of malignant perineurioma, where follow-up was available, were largely uncomplicated with regard to recurrence and metastatic disease. Careful follow-up is indicated, and further work is needed to characterize the clinical course of these rare tumors.

Innervation of the Posterior Hip Capsule: A Cadaveric Study.

Recent studies of hip anatomy have turned to the posterior hip capsule to better understand the anatomic location of the posterior capsular sensory branches and identify nerves with potential for neural blockade. Current literature has shown the posterior hip capsule is primarily supplied by branches from the sciatic nerve, nerve to quadratus femoris, and superior gluteal nerve (1, 2). This cadaveric study investigated the gross anatomy of the posterior hip, while also identifying potential targets for hip analgesia, with emphasis on the superior gluteal nerve and nerve to quadratus femoris. Cadaveric study. UT Health San Antonio Anatomy Lab. In total, 10 total cadavers (18 hips total), were posteriorly dissected identifying nerve to quadratus femoris, superior gluteal nerve, and sciatic nerve. Nerves were labeled with radio-opaque markers. Following the dissections, fluoroscopic images were obtained at sequential angles to identify neural anatomy and help expand anatomic knowledge for interventional pain procedures. The posterior hip capsule was supplied by the sciatic nerve in 1/16 hips, the nerve to quadratus femoris in 15/18 hips, and the superior gluteal nerve in 6/18 hips. The nerve to quadratus femoris reliably innervates the posterior hip joint. Both the sciatic nerve and superior gluteal nerve have small articular branches that may be involved in posterior hip innervation, but this is not seen commonly. The results of this study may elucidate novel therapeutic targets for treatment of chronic refractory hip pain (i.e., the nerve to quadratus femoris).