A thyroidea ima artery variation providing collateral circulation to the mediastinum.

The thyroidea ima artery (TIA) is a highly variable arterial deviation of the blood supply to the thyroid gland with critical implications for surgical neck procedures such as tracheostomy. Though relatively common in the population at large (~ 4%), most TIA variations are related to the origin of the artery and whether it emerges from the common sites of the brachiocephalic trunk, aortic arch, and right common carotid artery, or another more unique vessel-as opposed to its dispersion pattern. TIA variants generally supply the thyroid gland, occasionally co-occurring with absent thyroid arteries. Here, we report on a unique case of a four-pronged variation of the TIA discovered during an anatomy laboratory dissection of first-year medical students. This variant originated from the brachiocephalic trunk and had three branches terminating in the thyroid gland and a fourth branch traveling into the thorax to provide accessory circulation in the mediastinum. Specifically, small arterial branches from the inferior TIA branch supplied the anterior pericardium and surrounding adipose tissue, in addition to normal pericardiacophrenic circulation. We discuss the potential embryological and clinical relevance of this unique variation and voice further support for imaging as a requirement before surgical neck procedures to prevent catastrophic bleeding in the event of a TIA variant.

Patient educational needs of patients undergoing surgery for lung cancer.

There often exists a discrepancy between the information health care professionals (HCPs) provide to patients in preoperative teaching sessions and the information patients perceive as important. This study's purpose was to determine what information patients undergoing a lung cancer surgical resection wanted to learn before and after their surgery and also to uncover the information HCPs currently provide to these patients. Ten patients were interviewed preoperatively and postoperatively, and eleven HCPs involved in both their preoperative and postoperative care were interviewed. Emerging themes were noted. Patients reported that the most helpful aspects of the preoperative education included surgical details and the importance of physiotherapy, including exercises. Postoperatively, patients wished they had known more about postoperative pain. HCPs provided information that they felt prepared, informed and empowered their patients. Overall, patients expressed satisfaction with the information they received; they felt prepared for their surgery but not for postoperative pain control.

Ultrastructural localization of connexins (Cx36, Cx43, Cx45), glutamate receptors and aquaporin-4 in rodent olfactory mucosa, olfactory nerve and olfactory bulb.

Odorant/receptor binding and initial olfactory information processing occurs in olfactory receptor neurons (ORNs) within the olfactory epithelium. Subsequent information coding involves high-frequency spike synchronization of paired mitral/tufted cell dendrites within olfactory bulb (OB) glomeruli via positive feedback between glutamate receptors and closely-associated gap junctions. With mRNA for connexins Cx36, Cx43 and Cx45 detected within ORN somata and Cx36 and Cx43 proteins reported in ORN somata and axons, abundant gap junctions were proposed to couple ORNs. We used freeze-fracture replica immunogold labeling (FRIL) and confocal immunofluorescence microscopy to examine Cx36, Cx43 and Cx45 protein in gap junctions in olfactory mucosa, olfactory nerve and OB in adult rats and mice and early postnatal rats. In olfactory mucosa, Cx43 was detected in gap junctions between virtually all intrinsic cell types except ORNs and basal cells; whereas Cx45 was restricted to gap junctions in sustentacular cells. ORN axons contained neither gap junctions nor any of the three connexins. In OB, Cx43 was detected in homologous gap junctions between almost all cell types except neurons and oligodendrocytes. Cx36 and, less abundantly, Cx45 were present in neuronal gap junctions, primarily at "mixed" glutamatergic/electrical synapses between presumptive mitral/tufted cell dendrites. Genomic analysis revealed multiple miRNA (micro interfering RNA) binding sequences in 3'-untranslated regions of Cx36, Cx43 and Cx45 genes, consistent with cell-type-specific post-transcriptional regulation of connexin synthesis. Our data confirm absence of gap junctions between ORNs, and support Cx36- and Cx45-containing gap junctions at glutamatergic mixed synapses between mitral/tufted cells as contributing to higher-order information coding within OB glomeruli.