Terminal Branches Research Articles

Wartenberg’s syndrome – A unique presentation resulting from compression of the superficial radial nerve from an anomalous radial artery branch

Wartenberg’s syndrome is a compression sensorineural mononeuropathy of the superficial branch of the radial nerve. This case report describes a patient, who was severely debilitated by compression of the superficial branch of the radial nerve that she was unable to work. The case highlights a unique anatomical variation in the course of the deep terminal branch of the superficial radial artery causing compression of the superficial branch of the radial nerve. To the best of our knowledge, this has never been described before and should be considered a rare cause of Wartenberg’s syndrome. Surgery can provide both diagnostic and therapeutic benefits and should be considered early in such cases, especially when investigations are contradictory.

AxoDetect: an automated nerve image segmentation and quantification workflow for computational nerve modeling

Objective. Bioelectronic treatments targeting near-organ innervation have unprecedented clinical applications. Particularly in the spleen, the inhibition of the cholinergic inflammatory response by near-organ nerve stimulation has potential to replace pharmacological treatments in chronic and autoimmune diseases. A caveat is that the optimization of therapeutic stimulation parameters relies on in vivo experimentation, which becomes challenging due to the small nerve diameters (2 μ m), complex anatomy, and mixed axon type composition of the autonomic nerves. Effective development of in silico models requires tools which allow for fast and efficient quantification of axonal composition of specific nerves. Current approaches to generate such information rely on manual image segmentation and quantification. Approach. We developed a combined image-segmentation and model-generation software called AxoDetect: a target- and format-agnostic computer vision algorithm which can segment myelin, endo/epineurium, and both myelinated and unmyelinated fibers from a nerve image without training. Main results. AxoDetect is over 10 times faster on average when compared with current automatic methods while maintaining flexibility through the use of tunable pixel threshold filters to detect different types of tissue. When compared to a distribution-based and a manually segmented model of the splenic nerve terminal branch 1, the model generated with AxoDetect had comparable threshold prediction and was able to accurately detect an increase in activation threshold caused by the addition of surrounding fat tissue to the modeled nerve. Significance. AxoDetect contributes to the acceleration of neuromodulation treatment development through faster model design and iteration without requiring training. Furthermore, the computer vision approach and tunable nature of the filters in our method allow for its use in a variety of histological applications. Our approach will impact not only the study of nerves but also the design of implantable neural interfaces to enhance bioelectronic therapeutic options.

Transanal Hemorrhoidal Dearterialization (THD): A Single Center Experience on 100 Consecutive Cases

Introduction. Surgeons, using all available means for the treatment of the hemorrhoidal disease, must make compromises between the radicality of the potential surgical treatment (to prevent recurrence) and the maintenance of the postoperative functionality of the anorectum (avoiding stricture, anal fissures, incontinence, reduction of postoperative pain etc.). Materials and methods. All patients treated with the THD method using a system manufactured by THD S.p.A., Correggio, Italy, consisting of a proctoscope equipped with a Doppler probe and a light source was used to perform the operation. Results. Out of 100 operated patients, 64 (64%) were men and 36 (36%) were women. 54 patients had third degree hemorrhoidal disease, 32 had fourth degree, 7 patients had fourth degree hemorrhoidal disease with active bleeding and 7 patients had second degree hemorrhoidal disease with active bleeding. In the follow-up period, anal fissure formation in two patients and prolapse of a hemorrhoidal node in a treated patient with fourth-degree hemorrhoidal disease were noted. Discussion. It is estimated that more than 50% of the general population will experience at least one episode of symptomatic hemorrhoids during their lifetime. Morphological and hemodynamic changes that occur in patients with hemorrhoidal disease is the finding of an increased diameter of the terminal branches of the superior rectal artery that supplies the hemorrhoidal nodes. These branches are 10–11 in number, of which ligation of up to six is allowed for effective treatment with the THD method. Conclusion. If the THD technique is used according to the established standards, postoperative complications in patients in the form of fecal incontinence and chronic pain have not been described, which is also confirmed in our series. The absence of serious complications while addressing a hemorrhoidal disease at the level of the cause of its occurrence, makes the THD+mucopexy technique applicable in most cases. Correct manipulation of the instruments, precision in dearterization, mucopexy of the rectal mucosa and submucosa are imperative for achieving excellent results.

A new fossil species of a liverwort of the Frullania genus (Frullaniaceae, Marchantiophyta) from the Miocene amber of Simojovel de Allende, Chiapas, Mexico

The fossil record based on liverworts in Mexico remains poorly studied. To date, they have been documented only in Miocene amber deposits from Chiapas, southern Mexico. From this same amberiferous locality, here we described a new fossil species belonging to the Frullania genus. This plant is characterized by irregular, terminal branching of the Frullania type. Lobes obliquely oblong-rounded with rounded apex, sometimes with an inconspicuous one-celled apiculus. Ocelli are present in the lobes. Lobules distant from the stem, obliquely extended, inflated, some of the wider in the middle, narrowing toward its apex. Underleaves distant, lateral margins angular. This new record represents the second report of this genus for Mexico, indicating that the flora represented by liverworts was more important in southern Mexico during the Early Miocene.

Talaromyces sedimenticola sp. nov., isolated from the Mariana Trench.

Two fungal strains (K-2T and S1) were isolated from the deepest ocean sediment of the Challenger Deep located in the Mariana Trench. The internal transcribed spacer (ITS) gene sequences of the isolates K-2T and S1 differed from those of closely related species, such as Talaromyces assiutensis and T. trachyspermus. Phylogenetic analyses based on single and concatenated alignments of the genes, namely ITS, β-tubulin (benA), calmodulin (cam), and the second-largest subunit fragment of the RNA polymerase II (rpb2) showed that the isolates K-2T and S1 were clustered together with other Talaromyces species, such as T. trachyspermus and T. assiutensis, as evidenced by the position on a terminal branch with high bootstrap support. They could also be distinguished from their closest relatives with valid published names via morphological and physiological characteristics, for example, growth at 4°C-50°C with a pH in the range of 1.5-12. Based on their phylogenetic, morphological, and physicochemical properties, the isolates K-2T and S1 represent a novel species in the genus Talaromyces, and the proposed name is Talaromyces sedimenticola sp. nov. The type strain is K-2T (= GDMCC 3.746T = JCM 39451T).

Medial dorsal cutaneous nerve entrapment following inversion ankle sprain

The medial dorsal cutaneous nerve is one of the terminal branches of the superficial peroneal nerve that provides sensory innervation to the dorsum of the foot. It may be prone to injury by direct blow, iatrogenic surgical lesion or in rare situations secondary to ankle sprains. The authors report a case of persistent ankle pain in a female patient caused by a post- traumatic compressive neuropathy of the medial dorsal cutaneous nerve secondary to an ankle sprain which was successfully surgically treated with complete resolution of the symptoms.

Surgical treatment of intracranial epithelioid hemangioendothelioma: a case report

Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular neoplasm with an intermediate pattern of malignancy between benign neoplasms and angiosarcomas. Only 46 cases of intracranial localization of primary EHE in adults have been published.Case report: A 47-year-old male patient developed pronounced speech disorder of sensory and amnestic aphasia type, right-sided pyramidal hemiparesis within 3–4 days. Magnetic resonance imaging revealed a delimited left sided brain islet neoplasm with signs of hemorrhage and small perifocal edema. Intraoperatively, the neoplasm was represented by a conglomerate of pathologic vessels, with involvement of the terminal branches of the M2 segment of the middle cerebral artery, which prevented radical resection of the neoplasm. Based on histopathological and immunohistochemistry analysis of the neoplasm (positive expression of CD31, CD34, proliferative activity index Ki-67 10%) the morphologic diagnosis of EHE was established. 3 months after surgery, continued growth of the residual part of the neoplasm was noted. Temozolomide chemotherapy was clinically ineffective. The patient died due to the development of dislocation syndrome after 9 months.Discussion. The malignant characteristics of EHE include invasive growth, recurrence, and metastasis, which is more common in intracranial localization of the neoplasm. If EHE is suspected, radical surgical removal of the neoplasm should be sought.

Comprehensive analysis of splenic artery variations using computed tomography angiography: development of the IPALGEA classification system.

The splenic artery, an essential component of abdominal vascular anatomy, exhibits significant variations with clinical implications in surgical and radiological procedures. The lack of a standardized classification system for these variations hinders comparative studies and surgical planning. This study introduces the IPALGEA classification system, based on computed tomography angiography (CTA) findings, to address this gap. A retrospective analysis was conducted on 302 patients who underwent CTA at a tertiary university hospital between August 2021 and January 2022. The study focused on the evaluation of splenic artery variations, including the origin, course, terminal branching patterns, and the relationship between the inferior polar artery and the left gastroepiploic artery. The IPALGEA classification was developed to standardize the reporting of these variations. The study highlighted a significant prevalence of splenic artery variations, with the most common pattern being a superior course relative to the pancreas. The IPALGEA classification effectively categorized these variations, emphasizing the relationship between the inferior polar artery and the left gastroepiploic artery. The findings revealed that the bifurcation distance of the celiac trunk varied significantly between genders and that the presence of an inferior polar artery correlated with a shorter hilus distance. The IPALGEA classification offers a comprehensive and standardized approach to categorize splenic artery variations. This system enhances our understanding of abdominal vascular anatomy and has significant implications for surgical and radiological procedures, potentially reducing surgical complications and improving patient outcomes.

Selective Neurectomy in Spastic Paralysis of the Upper Extremity

Selective neurectomy refers to the targeted transection of motor nerve fibres at their entry into the muscle in order to reduce the increased muscle tone in cases of spastic paralysis. This procedure has regained popularity in recent years, especially in the upper extremity. First and foremost, it requires an exact knowledge of the topographical anatomy of muscle innervation. To be able to control the extent and localisation of the denervation, the terminal nerve branches must be visualized precisely during the procedure. For a meaningful reduction of muscle tone, 2/3 to 4/5 of nerve fibres must be resected. This article presents the historical development, principles and operative details of this technique as well as clinical results.

The Platyrrhine Primate Cebus imitator Uses Gaze to Manipulate and Withdraw Food to the Mouth

Orienting a food item held in the hand to withdraw and optimally place it in the mouth for eating (withdraw-to-eat) is mediated by vision in catarrhine anthropoids and by nonvisual strategies in strepsirrhine primates. The present study asks whether vision contributes to the withdraw-to-eat movements in a platyrrhine anthropoid Cebus imitator, a member of a monophyletic primate suborder whose stem group diverged from catarrhines about 40 million years ago. Cebus imitator’s gaze and hand use for foraging for fruit is examined in its fine branch niche, the terminal branches of trees. Video of reach, grasp and withdraw-to-eat movements with associated gaze were examined frame-by-frame to assess food manipulation and its sensory control. Cebus imitator uses vision and touch to reach for and grasp food items with precision and whole hand grasps. They use vision to orient food items held in-hand into a precision grip and their withdraw-to-eat is assisted with a vertically oriented hand. The conjoint use of vision, a precision grasp, and hand posture and a central representation of object control likely originated in stem anthropoids and was derived from the staged evolution of the visual manipulation of food and other objects.

Analisis Dampak Keberadaan PT. Pelindo Multi Terminal Branch Belawan Terhadap Sosial Ekonomi Masyarakat Belawan I Kecamatan Medan Belawan

Ports have assumed a vital part in expanding financial development. As a result, banks, shipping companies, customs, immigration, quarantine, and other activity centers all gather at the port. The purpose of the study is to examine how the existence of Belawan Port affects the well-being of the community around it, as measured by; individuals' pay, work open doors, training, wellbeing, level of safety, and foundation offices. This exploration is subjective examination where the exploration is completed straightforwardly in the field. Huberman which is partitioned into information assortment, information decrease, information show and reaching determinations. Belawan Port ought to have an effect in working on the government assistance of individuals of Belawan I, Medan Belawan Locale, in any case, the state of being found in the truth of life in Medan Belawan Region is that the establishments and spatial preparation of Medan Belawan Locale are still entirely apparent and many ghetto houses are found. organized nearly along the edge of the railroad tracks and in a ghetto region that isn't reasonable for living in. So it tends to be reasoned that the presence of Pt. The people of Belawan I, Medan Belawan District, have not benefited significantly from Pelindo Multi Terminal Branch Belawan.

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.

Two new species of Callophyllis (Rhodophyta, Kallymeniaceae) from the Russian Pacific coast

ABSTRACT Seven species of Callophyllis have been known off the Pacific coast of Russia; hovewer, molecular data have been obtained only for three species. In this study we re-examined the genus along the Russian Pacific coast using a comparative morphological study and molecular analyses based on rbcL and nrLSU. Five genetic species were identified on the Russian coast based on phylogenetics and species delimitation (ASAP and p-distance) analyses; while C. beringensis, C. papulosa and C. platyna were outscore of the analyses. The results of the molecular analyses uncovered one undescribed species, which we named C. selivanovae sp. nov. The divergence between this species and other species of the genus varied from 1.16% to 5.66%, while intraspecific divergence in the genus was in a range of 0.00%–0.22%. In phylogenetic trees C. selivanovae was recognized as sister to a diverse clade including C. thompsonii, C. beringensis, C. violacea, C. flabellulata and C. variegata from the Pacific coast of Canada. Callophyllis selivanovae from the southeastern coast of Kamchatka is morphologically close to C. beringensis, described from St. Paul Island (Bering Sea); the two species differ in features of branching, shape and size of the terminal branches. We propose a new name, C. perestenkoae sp. nov., for the algae previously listed in the Russian flora as ‘C. flabellata’. Pacific specimens assigned to C. perestenkoae differ from C. flabellata from the type locality (Atlantic, France) in having irregular branching, thicker apical branches, and smaller cystocarps. We also filled in the gaps in the description of C. radula for which procarp and tetrasporangia are described herein for the first time.

Juniperus communis L. essential oils in the Natura 2000 site ‘Serranía de Cuenca’ (Central Spain)

Terminal branches from single male plants of Juniperus communis L. were collected in the Natura 2000 site ‘Serranía de Cuenca’, an environmentally valuable but depopulated area in the Iberian Peninsula, with the aim of studying the yield and composition of their essential oils. The results showed significant differences in terms of essential oil yield (0.15–0.53%) and composition of the collected samples. Unexpectedly, this variability was not related to the geographical origin of the plants. The main compounds detected were α-pinene (12.3–56.4%), β-phellandrene (10.0–29.8%) and limonene (3.4–25.7%). Samples stood out from those in other European areas because of their high content of β-phellandrene. Plant breeding programs could be useful in obtaining chemotypes and cultivars that ensure an adequate and stable essential oil composition. On the other hand, given that bioactivities depend on this composition, their high variability a priori enlarges their potential applications. This work is a starting point for identifying potential uses of common juniper that may enable economic, social and environmental alternatives for the development of this area.

Anatomy of the pudendal nerve in clinically important areas: a pictorial essay and narrative review.

The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.

Time-resolved characteristics of oscillatory particle-laden air flow in a realistic human airway model

Human airways represent a complex flow system with a spatially and temporally variable character of air flow during respiration. In this paper, we experimentally studied the oscillatory flow of air with monodispersed micron-sized liquid particles in a transparent, anatomically realistic model of human upper airways and several bronchi generations using phase-Doppler anemometry (PDA). The PDA provided point-wise high-frequency measurements of axial velocities of individual aerosol particles in multiple positions of the airways (in the trachea and the upper bronchi) for three breathing regimes with a sinusoidal course. Typical time-resolved velocity plots at several positions within the model were documented and analysed using dimensionless criteria. Local mean air velocity and turbulence time-lines disclosed specific flow dynamic features in the multiple bifurcation system, namely the transit of vortical structures, oscillations induced by flow reversals, and inspiratory flow separations behind bifurcations. The results elucidated the laminar, transitional and turbulent flows during inspiratory and expiratory breathing phases. The character of the flow varies significantly with position in the airways, while the breathing regime has a generally low effect on the flow character. Inspection of the flow in the terminal branches indicated the need to add further branches for more realistic results there.

A Variant Dorsalis Pedis Artery and Its Relationship with the Deep Fibular Nerve

During a cadaveric dissection session, a distinctive neurovascular pattern was identified in the left leg of a 66-year-old female cadaver. The Anterior Tibial Artery (ATA), while maintaining a normal origin and luminal diameter, exhibited a shortened course, terminating in the upper third of the leg. In the lower third of the leg, the Fibular Artery (FA), known as the peroneal artery, traversed through the interosseous membrane to the anterior compartment, persisting as the Dorsalis Pedis Artery (DPA). The Deep Fibular Nerve (DFN), displaying a usual course in the upper two-thirds of the leg, crossed the variant DPA posteriorly and divided into two terminal branches on its posterolateral side. The medial terminal branch proceeded to cross the artery anteriorly within the anterior tarsal tunnel. This distinctive relationship between the DFN and the variant DPA renders the nerve susceptible to compression and may result in “anterior tarsal tunnel syndrome”.

Surgical Significance of Variant Anatomy of Inferior Mesenteric Artery and Left Colic Artery: A Computed Tomography Angiographic Study

Introduction: A variation in vessel morphology determines flow dynamics and vascular disease pathogenesis. Definite information on the distinctive anatomical variations of the mesenteric vessels is extremely important for laparoscopic surgical procedures and interventional radiological procedures in the abdominal region. Three-dimensional-computed tomography angiography (3D-CTA) is a less invasive method to evaluate vascular anatomy using a visual tracking method on high-definition images, contrast-enhanced inferior mesenteric artery (IMA) can be traced to its terminal branches beside the colon wall. Subjects and Methods: Abdominal contrast-enhanced computed tomography scan data from 180 patients was retrospectively collected, reconstructed, and analyzed. The origin, length of IMA from origin to the first branch, branching patterns of IMA, and tracking patterns of the ascending branch of left colic artery (LCA), were examined, and their associations with clinical features were analyzed. Results: IMA displayed variations in the level of origin ranging from upper 1/3 of L3 to upper 1/3 of L4, mean length from origin to the first branch was 27.4 ± 7.8 mm. Observed branching patterns of IMA were grouped according to Yada classification: Type 1 (52.2%), Type 2 (15.5%), Type 3 (14.4%), and Type 4 (17.7%). Tracking of the ascending branch of LCA before anastomosis with marginal artery revealed four patterns: Type A LCA pattern in 43.9%; Type B LCA anatomy pattern was (19.4%); Type C LCA anatomy pattern was (20.0%); and Type D LCA anatomy pattern was observed (16.7%). Conclusion: Preoperative understanding of the vascular variations of IMA and LCA can be obtained by 3D-CTA. This may be helpful to surgeons in planning preoperative strategies to prevent iatrogenic injuries.

Study on Smartphone Vision Syndrome in Smartphone Users: A Prospective Randomised Controlled Study

Introduction: Recent International reports on ocular health shared that diplopia and dry eye are the prevalent ocular disorders caused by overuse of smartphone in young adults. Studies on smartphone usage in young adult’s reports that the smartphone use begins at the age group ranges from 12-18 years old, were the minimum duration of smartphone use per day is 4-6 hours. The association between smartphone use and prevalence of ocular manifestations has recommended the need of health education programs on smartphone use and its ocular impacts. Increasing use of smart devices also can cause acute acquired comitant esotropia in adolescents. Aim: To investigate the influence of smartphone reading on the ocular surface and to compare the influences of smartphone use on ocular symptoms, status of tear film stability and volume assessment. Materials and Methods: This is a prospective randomized controlled study on volunteers who continued reading for 2 hours on different smartphone screens. A total of 100 volunteers above 18 years of age without any ocular diseases had participated in the study. A structured questionnaire was used to collect the details in the present cadaveric case, found that the IMA divided into two terminal branches. The ascending branch emanated the left colic and sigmodal artery whereas the descending branch continued as superior rectal artery. This was similar to type 2 pattern of Yada’s classification. The expert knowledge of normal and variant Anatomy of abdominal aorta is of utmost importance to the interventional Radiologists, laparoscopic Surgeons, and Surgical Oncologist in succeeding surgery with minimal complications. Keywords: Abdominal aorta, Colon, Yada's classification. of smartphone usage and the visual acuity, tear film stability and volume assessment test and Intraocular pressure (IOP) was taken as some of the parameters in the study. Results: The continuous use to smartphone causes various problems, headaches, eye dryness, earache, fatigue, and musculoskeletal manifestations. The visual acuity, tear film stability and tear volume and IOP of both right and left eye was analysed and found to be statistically significant among the control and SPVS group. The ocular manifestations are noted and correlated with the duration of usage. The precautions were recommended further from the results of the study. Conclusion: The prevalence of eye diseases is high in most of the age groups and it is important to educate about the adverse effect of smartphone usage in all categories. The study also suggests about the screen time limitation and usage of smartphones for young adults.

Coniferophytes from the Bajo de Veliz Formation (Gzhelian-Asselian), San Luis Province, Argentina

In this contribution, we analyze the presence of fossil coniferophytes from the Bajo de Veliz Formation (Paganzo Basin) that were initially referred to Walchia or Paranocladus and have not been described until now. These specimens consist mainly of leafy branches exhibiting foliar heteromorphism characteristic of upper Paleozoic coniferophytes from Gondwana. This group includes Genoites sp. with lax arranged ovules on the last order branches, Krauselcladus sp. represented by a small vegetative branch with biand trifurcated leaves, and Buriadia cf. Buriadia heterophylla Seward et Sahni emend. Serbet, Escapa, Taylor, Taylor et Cúneo, 2010, showed axes with multifid leaves and ovules on terminal branches. Vegetative fragments with small lanceolate leaves are assigned to Ferugliocladus cf. F. riojanum Archangelsky et Cúneo, 1987. In addition, an isolated, probably male reproductive structure similar to those known for th latter species was identified. The presence of Buriadia is recognized for the first time in the Carboniferous-Permian of Argentina, as well as the identification of vegetative buds or shoots, a previously undocumented characteristic for this Paleozoic coniferophyte from Gondwana.