We investigated the ramification patterns of four subclavian branches (i.e., vertebral artery, internal thoracic artery, thyrocervical trunk, and costocervical trunk) as the subclavian artery passes in front or behind the scalenus anterior muscle. The investigation was carried out on 56 cadavers (112 cases) during student dissection practice sessions at Osaka Dental University. In 110 of the 112 cases, the subclavian artery passed behind the scalenus anterior muscle. The pattern of ramification of the subclavian branches in these cases was classified into six types (types A-F). In the remaining two cases (two cadavers), the subclavian artery passed in front of the scalenus anterior muscle. In both of these latter cases, the pattern of ramification of the subclavian branches differed from the six pattern types observed as the subclavian artery passed behind the scalenus anterior muscle: the first branch was the vertebral artery; the second, the costocervical trunk; the third, the thyrocervical trunk; the fourth, the internal thoracic artery. This same pattern of ramification was observed in three previously reported cases (two cadavers) in which the subclavian artery passed in front of the scalenus anterior muscle. Taken together, these observations indicate that the ramification pattern reported here and in a previous investigation for the subclavian artery passing in front of the scalenus anterior muscle is characteristic of this anatomical condition.
IntroductionSweat secretion is controlled by the sympathetic nervous system and is less active during winter than in the summer. Raynaud’s phenomenon is affected by an excessive strain of the sympathetic nerves after exposure to a cold environment, thus reducing the quality of life of patients with collagen disease. Herein, we focus on the eccrine sweat glands that receive both adrenergic and cholinergic innervation. Our hypothesis is that excessive activation of sympathetic nerve in Raynaud’s phenomenon can affect sweating, especially in winter. This study is designed to evaluate the neuroactive sweating responses in patients with collagen disease and to assess its association with skin findings in peripheral circulatory disorders.Methods and analysisThe study will be conducted at a single centre in Japan. Patients with systemic sclerosis, Sjogren’s syndrome, systemic lupus erythematosus, mixed connective tissue disease, and dermatomyositis will be assessed using the quantitative sudomotor axon reflex test. The primary outcomes will be sweat volume and reaction time due to axon reflex and the Raynaud’s condition score. The secondary outcomes will include patient background, skin symptoms (digital ulcers, pernio-like eruptions, subcutaneous calcifications, telangiectasia, nailfold capillary dilatation/bleeding and degree of skin sclerosis) and skin surface temperature. Evaluation will be done two times, during the summer and winter, allowing for the assessment of seasonal differences in sweating responses.Ethics and disseminationEthical approval of this study was certified by the clinical research review board of Nagasaki University Hospital (Reference number: CRB19-001). We will disseminate the findings of this study through peer-reviewed publications and conference presentations.Trial registration numberjRCTs072190009; pre-results.
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