Number Of Terminal Branches Research Articles

A prospective observational study on the anatomical variations of recurrent laryngeal nerve and its application in the prevention of injury during thyroid surgery in a tertiary care centre

BackgroundThyroid gland is the largest and most vascular structure among the endocrine glands. The recurrent laryngeal nerve and the superior laryngeal nerve are closely related to the thyroid gland; these nerves control voice and are vital in breathing. Anatomical preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid surgery. Visual identification of RLN has decreased the rates of permanent RLN palsy during thyroid and parathyroid operations. Prior knowledge about the branching patterns will help in predicting and preventing injury to the nerve during thyroid surgery.Aim and objectivesThe aim of the study is to observe the terminal branching pattern of recurrent laryngeal nerve before its entry into the larynx.MethodsAn observational study with 50 participants who fulfilled the inclusion and exclusion criteria were enrolled in the study. After a complete evaluation and pre-anaesthetic checkup, the patients were operated and intraoperative findings of RLN branching were recorded and compared for the study.ResultsIn our study, out of the 50 patients who underwent thyroid surgery during the course of the study, right-sided RLN branching was demonstrated in 25 patients (21 right hemithyroidectomy and 4 total thyroidectomy). Ten patients had RLN bifurcation, 7 had trifurcation, 5 had numerous branches, and 3 with no branching pattern were noted. Similarly, out of 29 patients (25 left hemithyroidectomy and 4 total thyroidectomy) in whom left-sided RLN branching was studied, bifurcation was seen in 10 patients, trifurcation in 12 patients, and multiple branching was observed in 7.ConclusionThe anatomical variations seen in RLN may increase the risk of vocal cord palsy due to its injury. Anatomical variations are categorized according to the original direction of the RLN and the number of terminal branches in the larynx. This classification aids in the identification and preservation of its branches, hence facilitating a safer thyroidectomy.

Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR)

Background: To date, there is no single standard for conducting HAL-RAR operations. The constant discussion raises the question of the number of terminal branches of the superior rectal artery, which must be ligated in the submucosal layer of the rectum in order to provide the adequate dearterialization of hemorrhoids. Aim: To study the anatomy of the branches of the superior rectal artery and to develop recommendations for the optimal ligation of the terminal branches of the superior rectal artery. Methods: 150 protocols of the previous operations have been studied. In order to further objectify our results, the results of radiation diagnostics (CT and MRI) were revised for 100 patients without pathological changes of the rectum and anal canal to study the variant anatomy of the superior rectal artery and its terminal branches in the rectal wall. Results: In 148 patients, 6 terminal branches were identified, in 2 (1.333%) patients, 5 branches were found. 100 cases without pathological changes were also analyzed (60 MRI and 40 CT scans). In all the cases, 6 terminal branches of the superior rectal artery were determined, located at 1, 3, 5, 7, 9 and 11 o'clock positions of the conventional dial. At the same time, a large number of identified anatomical options for the branching of the VPA and the method for reaching the rectal wall should be noted, which we used as a basis to propose a classification. Conclusion: In the vast majority of cases, there are 6 terminal branches of the superior rectal artery, located in the lower ampulla of the rectum at approximately 1, 3, 5, 7, 9 and 11 hours of the conventional dial. A number of variants of the vascular anatomy of the proximal branches are possible, but 6 distal branches are involved in the direct blood supply of the hemorrhoids. When performing selective Doppler-controlled dearterialization of hemorrhoids, it is expedient to ligate 6 arterial vessels.

Regulation of fluorescence, morphology, surface wettability and function of naphthalimide-based self-assembly system by metal coordination

Three naphthalimide-based supramolecular gelators (N1, N2 and N3) that contained one, two, or three naphthalimide groups, respectively, were designed and synthesized, and the self-assembly processes of the three gelators were studied using different technique. Their self-assembly behavior could be regulated through the number of terminal branches. More importantly, their self-assembled structure, fluorescence behavior and surface wettability and function could be regulated through metal coordination, and helical nanofibers could be formed by gel N2 with Cd2+, Co2+, Eu3+, Tb3+, Mn2+, Ni2+ and Hg2+. The fluorescence emission intensities of these gels could change with different degrees under the addition of different metal ions, and a super-hydrophilic surface could be obtained from xerogel N3 in the presence of Co2+, Eu3+, Mn2+ and Tb3+. Specifically, gelator N3 could selectively and sensitively respond to Fe2+ in the solution and gel state with a response time of 0.5 s and a low limit of detection of 1.84 nM. This work provided a new regulation method for the supramolecular self-assembly process.

Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study

The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.

Morphological evaluation of terminal branches of the facial nerve within the parotid gland in fetus cadavers

Purpose: The aim of present study was to describe the branching pattern of the facial nerve according to interconnections between the branches, to examine the number of terminal branches, to determine anatomical variations and to emphasize the importance of these in terms of pediatric parotid surgery.Materials and Methods: Thirty-two parotid regions from eight female and eight male fetus cadavers (gestational ages between 21.0 and 35.5 weeks according to foot lengths) were dissected. The branching pattern of the facial nerve, terminal branch numbers and interconnections between the branches were examined and described. In present study, the facial nerve was classified using Davis et al.’ classification. But, we encountered interconnections between facial nerve branches that were not mentioned previously and the branching patterns formed by these interconnections were named as Type x and Type y.Results: Out of the total 32 cases, 13 (40.63 %) were Type I, 7 (21.88 %) were Type II, 3 (9.38 %) were Type III and 5 (15.63 %) were Type VI. Type IV and Type V were not encountered. Type x were in 2 (6.25 %) cases and Type y were in 2 (6.25 %) cases. The mean total number of nerve terminal branches was 7.90 ± 1.49.Conclusion: Investigation outcomes presented in this study have defined branching pattern and anatomical variations of the facial nerve branches and can be assist with the protection of the nerve during surgical procedures and prevent surgery-associated damage to the nerve, and thus facial paralysis.

†Bittacopsocus-a new bizarre genus of †Permopsocida (Insecta) from Burmese Cretaceous amber.

A new insect species (†Bittacopsocus megacephalus Beutel, Prokop, Müller et Pohl gen. et sp. nov.) is described, based on a single small male (ca. 2.5 mm) embedded in mid Cretaceous Burmese amber. The species shows some resemblance with the mecopteran family Bittacidae, mainly due to strongly elongated and thin legs. However, the structural affinities are apparently due to convergency. Different features, but especially the mouthparts and the pattern of wing venation, indicate that the species belongs to the extinct order †Permopsocida (?Archipsyllidae). However, it differs markedly from all species previously described in this extinct group. The very thin and strongly elongated legs are probably autapomorphic. A very unusual feature is the antenna with only seven segments and extremely elongated flagellomeres. The two pairs of wings are unusually narrow. M and CuA are basally fused. Proximal rows of spines, two series of closed cells, and a distinctly increased number of terminal branches of M are present in the forewings, in contrast to other archipsyllid genera. It is conceivable that Bittacopsocus megacephalus used its long legs to rest suspended in the vegetation like Bittacus. The head structures tentatively suggest predatory behavior but the feeding habits are unclarified yet.

ANATOMICAL VARIATIONS OF THE CELIAC TRUNK: A SYSTEMATIC REVIEW.

ABSTRACTIntroduction: The celiac trunk (CT) is one of the abdominal portion branches of the aortic artery and, together with the superior mesenteric and inferior mesenteric arteries, participates in the abdominal viscera vascularization through a series of anastomoses. Absence of CT or variation in the number of terminal branches implies in varied abdominal arteries origins, which may have implication in surgical approaches. Objective: To analyze the anatomical variations of the celiac trunk and possible associated surgical clinical implications. Methods:It is a systematic review of articles indexed in the PubMed, Lilacs, SciELO, Springerlink, Scienc Direct and Latindex databases from August to September 2017. Original articles involving the anatomical variations of the celiac trunk in humans were included. The presence/absence of the celiac trunk, the number of terminal branches and the place of origin of its branches in variant cases of the normal anatomical pattern, were considered for this study. Results: At the end of the research, 12 articles were selected, characterized by sample, anatomical structure evaluation method and main results. The normal anatomical pattern was the most prevalent in most studies (75.0%). CT was absent in 41.7% of the findings. The most prevalent anatomical variation was the presence of CT with bifurcation (66.7%). It was also observed the origin of the common and splenic hepatic arteries from the mesenteric arteries (25.0%). The presence of only one branch (16.7%) and quadrifurcation (8.33%) were other findings. Conclusion: CT variations are not uncommon findings, with different anatomic variants being reported. Thus, the importance of knowing the possible variations of this structure is emphasized, which may have implications for surgical interventions and imaging studies related to the abdominal region.

Extracranial Course of the Facial Nerve Revisited.

The extrapetrous course of the facial nerve has been a matter of study and debate since XIX century. Two different classifications have been classically proposed and widely accepted by most of the authors. Nevertheless, there are reported cases which do not fit in any of those. The aim of this study is to propose a new and useful classification. We have used 23 embalmed Caucasian adult cadavers (11 male and 12 female) belonging to the Bodies Donation and Dissecting Rooms Centre of the University Complutense of Madrid. The extra-petrous facial nerve was dissected in the possible specimens resulting in 38 facial nerves. The studied parameters were length, diameter of divisions, terminal branches, and nerve connections. In every specimen two main divisions were found, temporofacial and cervicofacial. They divided into five terminal branches from cranial to caudal: temporal, zygomatic, buccal, marginal or mandibular, and cervical. Based on the comparison with previous proposed classifications, we have unified the patterns in 12 types being the most frequent types the type 3 (eight cases, 21.05%), with connections between temporal, zygomatic and buccal branches and the type 8 (eight cases, 21.05%), a complex network between temporal, zygomatic, buccal, and mandibular branches. The number of terminal branches was so variable. We propose a new 12-patterned classification which summarizes the previous ones. However, we consider that a good study of the number of terminal branches, connections between branches or with other cranial nerves are more useful for surgeons to avoid injuries to the facial nerve during surgery than complex classifications. Anat Rec, 302:599-608, 2019. © 2018 Wiley Periodicals, Inc.

Superficial Branch of Radial Nerve in Fetuses—A Morphometric Study

Superficial branch of radial nerve shows variation at its termination. Although authors in the past have reported its clinical implication in adults, there is a dearth in the literature regarding its importance in infants and children. Further knowledge of its variability is important in surgical procedures of the wrist in neonates and also during nerve repair due to injury in pediatric cases. The aim was to study the variations in the path and the terminal branch off pattern of the superficial branch of radial nerve. Forearm and dorsum of the hand of twenty full term fetuses were dissected meticulously to observe the termination of radial nerve. Measurements were taken from predefined bony landmarks. Number of terminal branches on the dorsum of the hand was also studied. Appropriate statistical tests were applied and results were tabulated. The variability in its supply to digits was also noted. Understanding and awareness of variations in the superficial branches of radial nerve is essential and will minimize the risk of iatrogenic injuries during surgical procedures. Further it will also help in the management and repair of the nerve injuries.

Time-Lapse Retinal Ganglion Cell Dendritic Field Degeneration Imaged in Organotypic Retinal Explant Culture.

PurposeTo develop an ex vivo organotypic retinal explant culture system suitable for multiple time-point imaging of retinal ganglion cell (RGC) dendritic arbors over a period of 1 week, and capable of detecting dendrite neuroprotection conferred by experimental treatments.MethodsThy1-YFP mouse retinas were explanted and maintained in organotypic culture. Retinal ganglion cell dendritic arbors were imaged repeatedly using confocal laser scanning microscopy. Maximal projection z-stacks were traced by two masked investigators and dendritic fields were analyzed for characteristics including branch number, size, and complexity. One group of explants was treated with brain derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) added to the culture media. Changes in individual dendritic fields over time were detected using pair-wise comparison testing.ResultsRetinal ganglion cells in mouse retinal explant culture began to degenerate after 3 days with 52.4% surviving at 7 days. Dendritic field parameters showed minimal change over 8 hours in culture. Intra- and interobserver measurements of dendrite characteristics were strongly correlated (Spearman rank correlations consistently > 0.80). Statistically significant (P < 0.001) dendritic tree degeneration was detected following 7 days in culture including: 40% to 50% decreases in number of branch segments, number of junctions, number of terminal branches, and total branch length. Scholl analyses similarly demonstrated a significant decrease in dendritic field complexity. Treatment of explants with BDNF+CNTF significantly attenuated dendritic field degeneration.ConclusionsRetinal explant culture of Thy1-YFP tissue provides a useful model for time-lapse imaging of RGC dendritic field degeneration over a course of several days, and is capable of detecting neuroprotective amelioration of dendritic pruning within individual RGCs.

A robust and efficient curve skeletonization algorithm for tree-like objects using minimum cost paths

Conventional curve skeletonization algorithms using the principle of Blum's transform, often, produce unwanted spurious branches due to boundary irregularities, digital effects, and other artifacts. This paper presents a new robust and efficient curve skeletonization algorithm for three-dimensional (3-D) elongated fuzzy objects using a minimum cost path approach, which avoids spurious branches without requiring post-pruning. Starting from a root voxel, the method iteratively expands the skeleton by adding new branches in each iteration that connects the farthest quench voxel to the current skeleton using a minimum cost path. The path-cost function is formulated using a novel measure of local significance factor defined by the fuzzy distance transform field, which forces the path to stick to the centerline of an object. The algorithm terminates when dilated skeletal branches fill the entire object volume or the current farthest quench voxel fails to generate a meaningful skeletal branch. Accuracy of the algorithm has been evaluated using computer-generated phantoms with known skeletons. Performance of the method in terms of false and missing skeletal branches, as defined by human experts, has been examined using in vivo CT imaging of human intrathoracic airways. Results from both experiments have established the superiority of the new method as compared to the existing methods in terms of accuracy as well as robustness in detecting true and false skeletal branches. The new algorithm makes a significant reduction in computation complexity by enabling detection of multiple new skeletal branches in one iteration. Specifically, this algorithm reduces the number of iterations from the number of terminal tree branches to the worst case performance of tree depth. In fact, experimental results suggest that, on an average, the order of computation complexity is reduced to the logarithm of the number of terminal branches of a tree-like object.

Phosphoinositide 3-kinase alpha-dependent regulation of branching morphogenesis in murine embryonic lung: evidence for a role in determining morphogenic properties of FGF7.

Branching morphogenesis is a critical step in the development of many epithelial organs. The phosphoinositide-3-kinase (PI3K) pathway has been identified as a central component of this process but the precise role has not been fully established. Herein we sought to determine the role of PI3K in murine lung branching using a series of pharmacological inhibitors directed at this pathway. The pan-class I PI3K inhibitor ZSTK474 greatly enhanced the branching potential of whole murine lung explants as measured by an increase in the number of terminal branches compared with controls over 48 hours. This enhancement of branching was also observed following inhibition of the downstream signalling components of PI3K, Akt and mTOR. Isoform selective inhibitors of PI3K identified that the alpha isoform of PI3K is a key driver in branching morphogenesis. To determine if the effect of PI3K inhibition on branching was specific to the lung epithelium or secondary to an effect on the mesenchyme we assessed the impact of PI3K inhibition in cultures of mesenchyme-free lung epithelium. Isolated lung epithelium cultured with FGF7 formed large cyst-like structures, whereas co-culture with FGF7 and ZSTK474 induced the formation of defined branches with an intact lumen. Together these data suggest a novel role for PI3K in the branching program of the murine embryonic lung contradictory to that reported in other branching organs. Our observations also point towards PI3K acting as a morphogenic switch for FGF7 signalling.

Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity.

Spastic flexion deformity of the elbow is mainly mediated by the biceps brachii and the brachialis muscles, innervated by the musculocutaneous nerve. Selective neurectomy of the musculocutaneous nerve showed promising results to relieve excessive spasticity in the long term but lacks of a consensual surgical strategy. The aim of the study was to describe the distal branching pattern of the motor branches of the musculocutaneous nerve in an attempt to develop guidelines for surgery. Sixteen arms of fresh cadaver specimen were dissected. We recorded the site of each primary and terminal motor branch as a percentage of the distance from the coracoid process to the lateral epicondyle. The biceps muscle was innervated by one to five primary motor branches. The first branch emerged from the nerve at an average of 37.1% of the arm length, and the most distal terminal branch at 55.7%. The brachialis muscle received one to three primary branches. The first branch exited the nerve at an average of 51.7% of the arm length and the last terminal branch at 69.3%. The average number of terminal branches dedicated to the biceps and the brachialis muscles were, respectively, 7.9 and 6.5. According to our findings, we recommend to dissect the musculocutaneous nerve between 18 and 75% of the distance between the coracoid process and the lateral epicondyle to identify the motor terminal branches to the biceps brachii and the brachialis muscle, sparing sensory branches.

Methodology and evaluation of the renal arterial system.

IntroductionThe broad range of medical images and image processing technologies are applied in urology. The aim was to propose methodology to assess three–dimensional (3D) arrangement of renal arterial tree and to build a statistical model for analyzing the layout of arteries in the sections of the kidney.MethodsThe series of kidney CT slices are analyzed using image processing procedures and further the 3D model of arterial systems is converted to a graph tree which includes information about features of the renal arterial system.ResultsThe selected endocast was transformed to the form of the 3D connected tubes, further to the tree data structure and next analyzed. The information about 3D coordinates of the nodes, also branch length and diameter were stored. Renal arterial system of the considered kidney possessed 181 branches with 14 bifurcation levels. The number of branches was highest at the 9th bifurcation level. The mean length of the arterial branch on each bifurcation level was constant (6 mm). The branch diameters rapidly decreased after each bifurcation. The number of terminal branches increases up to 9th level where there are 19 terminal branches. The mean length of terminal arteries was 7.17 mm while the mean radius 0.46 mm. A statistically significant correlation between parameters that described sub–trees was noticed. It was observed that the individual artery segments occupy a separate space in the kidney volume.ConclusionsThe methodology has the potential to assist in presurgical planning based on branching patterns of the renal arterial system and corresponding pathology.

Atorvastatin enhances neurite outgrowth in cortical neurons in vitro via up-regulating the Akt/mTOR and Akt/GSK-3β signaling pathways

To investigate whether atorvastatin can promote formation of neurites in cultured cortical neurons and the signaling mechanisms responsible for this effect. Cultured rat cerebral cortical neurons were incubated with atorvastatin (0.05-10 μmol/L) for various lengths of time. For pharmacological experiments, inhibitors were added 30 min prior to addition of atorvastatin. Control cultures received a similar amount of DMSO. Following the treatment period, phase-contrast digital images were taken. Digital images of neurons were analyzed for total neurite branch length (TNBL), neurite number, terminal branch number, and soma area by SPOT Advanced Imaging software. After incubation with atorvastatin for 48 h, the levels of phosphorylated 3-phosphoinoside-dependent protein kinase-1 (PDK1), phospho-Akt, phosphorylated mammalian target of rapamycin (mTOR), phosphorylated 4E-binding protein 1 (4E-BP1), p70S6 kinase (p70S6K), and glycogen synthase kinase-3β (GSK-3β) in the cortical neurons were evaluated using Western blotting analyses. Atorvastatin (0.05-10 μmol/L) resulted in dose-dependent increase in neurite number and length in these neurons. Pretreatment of the cortical neurons with phosphatidylinositol 3-kinase (PI3K) inhibitors LY294002 (30 μmol/L) and wortmannin (5 μmol/L), Akt inhibitor tricribine (1 μmol/L) or mTOR inhibitor rapamycin (100 nmol/L) blocked the atorvastatin-induced increase in neurite outgrowth, suggesting that atorvastatin promoted neurite outgrowth via activating the PI3K/Akt/mTOR signaling pathway. Atorvastatin (10 μmol/L) significantly increased the levels of phosphorylated PDK1, Akt and mTOR in the cortical neurons, which were prevented by LY294002 (30 μmol/L). Moreover, atorvastatin (10 μmol/L) stimulated the phosphorylation of 4E-BP1 and p70S6K, the substrates of mTOR, in the cortical neurons. In addition, atorvastatin (10 μmol/L) significantly increased the phosphorylated GSK-3β level in the cortical neurons, which was prevented by both LY294002 and tricribine. These results suggest that activation of both the PI3K/Akt/mTOR and Akt/GSK-3β signaling pathways is responsible for the atorvastatin-induced neurite outgrowth in cultured cortical neurons.

Oligodendrorhynchus hesperides gen. et sp. n. (Heteronemertea) from the Bellingshausen Sea

Oligodendrorhynchus hesperides gen. et sp. n. (Heteronemertea) from the Bellingshausen Sea A new genus and species of heteronemertean from the Antarctic (Bellingshausen Sea), Oligodendrorhynchus hesperides, is described and illustrated. Some morphological features with major systematic significance are following: the mode of branching of the proboscis and its low number of terminal branches; the lack of horizontal lateral cephalic slits but in their place a pair of shallow epidermal depressions; a gelatinous amorphous connective stratum between the outer longitudinal and circular muscle layers; the presence of a rhynchocoelic nerve; isolated fibres of the rhynchocoel circular muscle layer interwoven with bundles of the adjacent body-wall inner longitudinal muscle fibres in the intestinal region. Other anatomical characters which can also be used to distinguish the new taxon from existing heteronemertean species that have a branched proboscis are also discussed.

3D image texture analysis of simulated and real-world vascular trees

A method is proposed for quantitative description of blood-vessel trees, which can be used for tree classification and/or physical parameters indirect monitoring. The method is based on texture analysis of 3D images of the trees. Several types of trees were defined, with distinct tree parameters (number of terminal branches, blood viscosity, input and output flow). A number of trees were computer-simulated for each type. 3D image was computed for each tree and its texture features were calculated. Best discriminating features were found and applied to 1-NN nearest neighbor classifier. It was demonstrated that (i) tree images can be correctly classified for realistic signal-to-noise ratio, (ii) some texture features are monotonously related to tree parameters, (iii) 2D texture analysis is not sufficient to represent the trees in the discussed sense. Moreover, applicability of texture model to quantitative description of vascularity images was also supported by unsupervised exploratory analysis. Eventually, the experimental confirmation was done, with the use of confocal microscopy images of rat brain vasculature. Several classes of brain tissue were clearly distinguished based on 3D texture numerical parameters, including control and different kinds of tumours – treated with NG2 proteoglycan to promote angiogenesis-dependent growth of the abnormal tissue. The method, applied to magnetic resonance imaging e.g. real neovasculature or retinal images can be used to support noninvasive medical diagnosis of vascular system diseases.

To improve the “target” of transanal hemorrhoidal dearterialization

Sir, We read with interest the paper by Toh et al. [1]. This study was carried out with the critical attitude of those who want to improve a surgical treatment that is very effective but can still be improved. Our comments about the study results concern the ‘‘functional anatomy’’ of the lower rectum. Actually, in addition to the exact number of terminal branches of the higher rectal arteries, a fundamental factor in this surgical approach is the correct understanding of the topography of these branches and their relationship with the rectal wall. Hemorrhoidal dearterialization with transanal hemorrhoidal dearterialization (THD) ensures an excellent control of rectal bleeding, and in most cases, the resolution of prolapse thanks to a ‘‘tailored mucopexy’’. The complex vascular network of the ‘‘corpus cavernosum recti’’ is the key to perfecting this therapeutic approach. According to our experience, there are always more than three (usually six) terminal branches of hemorrhoidal arteries to be ligated [2]. The target of therapy should be the point at which the arteries enter the submucosa of the low rectum, just before supplying blood to the ‘‘corpus cavernosum recti’’ [3]. In this way, an extraparietal arterial ligation can be avoided, and action can be taken right where the arterial hyperflow could have the greatest effect on the hemorrhoids. Use of Doppler-guided THD allows a detailed identification of the arteries and a rigorous and effective ligation of them. Moreover, the surgeon avoids taking big bites when suturing and making a ‘‘blind dearterialization’’ that would be at greater risk of bleeding and might partially alter both the anatomy and dynamics of the rectal wall, thus affecting rectal compliance and causing postoperative functional disturbances.

Temporalis muscle innervation patterns are generally conserved across subjects

The temporalis muscle is structurally complex; its muscular architecture is often misrepresented and its innervation pattern is not well characterized. In this study we digitized and mapped the 3D extramuscular and intramuscular mandibular nerve course from foramen ovale to its terminal branches in the temporalis muscle belly in four formalin embalmed cadaveric specimens. The muscle mass was dissected and digitized in layers to map its volume. The digitized nerve and muscle volume data were reconstructed into a 3D model using Maya® for visualization. Lateral 2D views were then manually registered to a common geometrical template using linear and non‐linear transformation techniques in Adobe Photoshop CS5. The extramuscular innervation consisted of three deep temporal nerves corresponding to anterior, middle and posterior portions of the muscle, masseteric and buccal nerves. Intramuscularly, the extent of muscle mass innervated by each of the nerves differed depending on the number of terminal branches. The spatial distribution of registered nerve branches was generally conserved suggesting that the degree of terminal branching was indicative of neurogenic control. We noted abundant intramuscular nerve fiber anastomosis from the anterior to posterior extent of the muscle in individuals. This work was supported by the American Association of Anatomists Visiting Scholarship.

Long-Term In Vivo Imaging and Measurement of Dendritic Shrinkage of Retinal Ganglion Cells

To monitor and measure dendritic shrinkage of retinal ganglion cells (RGCs) in a strain of transgenic mice (Thy-1 YFP) that expresses yellow fluorescent proteins in neurons under the control of a Thy-1 promoter. A total of 125 RGCs from 16 eyes of Thy-1 YFP transgenic mice were serially imaged with a confocal scanning laser ophthalmoscope for 6 months after optic nerve crush. Quantitative analysis of cell body area, axon diameter, dendritic field, number of terminal branches, total dendritic branch length, branching complexity, symmetry, and distance from the optic disc was used to characterize the morphology of RGCs, describe the patterns of axonal and dendritic degeneration, identify the morphologic predictors for cell survival, and estimate the rate of dendritic shrinkage. RGC damage was observed prospectively to begin with progressive dendritic shrinkage, followed by loss of the axon and the cell body. In a small proportion of RGCs, progressive axonal changes including fragmentation, beading, retraction, and bulb formation were also observed. RGCs with a larger dendritic field and a longer total dendritic branch length in general have a better survival probability. The rate of dendritic shrinkage was variable with a slower rate observed in cells having a larger dendritic field, a longer total dendritic branch length, and a greater distance from the optic disc. Estimating the probability of RGC survival and measuring the rate of dendritic shrinkage could become a new paradigm for investigating neuronal degeneration and evaluating the response of neuroprotective treatment.