NJCA
  • Users Online: 175
  • Print this page
  • Email this page
  • Email this page
  • Facebook
  • Twitter


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 187-193

Branching pattern of superior mesenteric artery and its variations: Cadaveric study


1 Associate Professor, Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Professor and HOD, Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
3 Assistant Professor, Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

Date of Submission07-Jul-2022
Date of Decision26-Aug-2022
Date of Acceptance23-Sep-2022
Date of Web Publication29-Oct-2022

Correspondence Address:
Manicka Vasuki Anaimalai Kandavadivelu
Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_117_22

Rights and Permissions
  Abstract 


Background: Superior mesenteric artery (SMA) originates at L1 level as a ventral branch of abdominal aorta. It supplies the derivatives of midgut which extends below the opening of major duodenal papillae in the 2nd part of the duodenum till the junction between the right 2/3rd left 1/3rd of the transverse colon. After its origin, it descends obliquely inside the mesentery up to the root of right iliac fossa. It is accompanied by superior mesenteric vein to its right side and is surrounded by a plexus of autonomic nerves. The SMA gives branches to jejunum, ileum and right colic, inferior pancreaticoduodenal (IPD), ileocolic, and middle colic artery. Variations in the course and branching pattern of SMA are of significant importance in gastrointestinal surgeries. Methodology: A prospective study was conducted with the convenient sample size of thirty cadavers. After opening the anterior abdominal wall, peritoneum and viscera were carefully separated and cleaned. The abdominal aorta with its branches was identified. SMA was identified at its origin. The course of the artery and its branches were traced and noted. The findings were tabulated and analyzed. The relation of superior mesenteric vein with the artery was identified and noted. Results: Variations in the branches of SMA were observed in 14 cadavers. We observed the absence of middle colic artery in four cadavers. Higher origin of ileocolic artery was found in two cadavers. One common trunk divides into middle colic artery and accessory right colic artery and another common trunk divides into right colic artery and ileocolic artery in a cadaver. The right colic artery and middle colic artery were found to take origin from a common trunk in a cadaver. The common trunk for IPD (artery and middle colic artery was found in one cadaver. The common trunk for right colic artery and ileocolic artery was observed in four cadavers. Accessory right colic artery was observed in four cadavers. The common trunk for accessory right colic artery and middle colic artery was found in two cadavers. Accessory right colic artery, right colic artery, ileocolic artery, and ileal branches had their origins from a common trunk in a cadaver. Variations in relation between SMA and superior mesenteric vein were found in two cadavers. Conclusion: Awareness and knowledge regarding the variations in SMA and its relation with vein are important for surgeons and radiologists to avoid both intraoperative and postoperative complications during surgical and diagnostic procedures involving intestines.

Keywords: Anastomosis, ileum, jejunum, middle colic artery, right colic artery, superior mesenteric vein


How to cite this article:
Anaimalai Kandavadivelu MV, Govindarajan A, Saminathan S, Hepzibah DJ. Branching pattern of superior mesenteric artery and its variations: Cadaveric study. Natl J Clin Anat 2022;11:187-93

How to cite this URL:
Anaimalai Kandavadivelu MV, Govindarajan A, Saminathan S, Hepzibah DJ. Branching pattern of superior mesenteric artery and its variations: Cadaveric study. Natl J Clin Anat [serial online] 2022 [cited 2023 Feb 6];11:187-93. Available from: http://www.njca.info/text.asp?2022/11/4/187/359870




  Introduction Top


The superior mesenteric artery (SMA), artery of midgut arises from the anterior aspect of abdominal aorta 1 cm below the celiac trunk at the level of lower border of L1 vertebra. It runs downward, behind the splenic vein and the body of the pancreas accompanied by superior mesenteric vein in the left side. Then, it courses anterior to left renal vein, the uncinate process of the pancreas and the 3rd part of the duodenum. After entering the root of the mesentery, passes obliquely toward the right iliac fossa providing several branches to the large gut. The trunk of the artery shows slight convexity to the left and is surrounded by a plexus of autonomic nerves. The artery terminates by anastomosing with its ileocolic branch.[1]

The SMA usually gives the inferior pancreaticoduodenal (IPD), right colic, middle colic, and ileocolic branches from its right side, while jejunal and ileal branches arise from the left side. Within the mesentery, the jejunal and ileal branches form vascular arcades. The terminal end of the vascular arcades forms an irregular and incomplete marginal artery of small gut. Compared to jejunal branches, ileal branches are more numerous and smaller in caliber.[1]

IPD, right colic, middle colic, and ileocolic artery arises successively from above downward. IPD artery arises from SMA or from its first jejunal branch. It divides into anterior and posterior branches.

Middle colic artery takes it origin from the SMA along the lower border of the pancreas and immediately enters into the root of transverse mesocolon. Within the mesocolon, it gives off the right and left branches. The right branch reaches the hepatic flexure and anastomoses with the ascending branch of right colic artery. The left branch joins with the ascending branch of the left colic artery (branch of inferior mesenteric artery) close to the left colic flexure.

The right colic artery takes origin from the middle of the concavity of the SMA. On reaching the ascending colon, the artery divides into the ascending and descending branches which join middle colic and the ascending branch of the ileocolic arteries, respectively.

Ileocolic artery takes origin from the right side of SMA and enters the right iliac fossa. The artery divides into the ascending and descending branches. The ascending branch joins with the right colic artery and the descending branch joins with the terminal part of SMA. The descending branch of the ileocolic artery gives four set of branches – anterior cecal, posterior cecal, appendicular, and ileal branches. The ileocolic artery vascularizes the terminal ileum, cecum, appendix, and right colon.[2]

In few cases, there may not be anastomosis between the middle colic and left colic arteries and in such a condition, a direct retroperitoneal anastomotic arcade, the arc of Riolan, the other collateral pathway is observed between the trunks of superior and inferior mesenteric arteries.[2]

The marginal artery of Drummond is a potential collateral pathway between the superior and inferior mesenteric arterial systems. This anastomotic channel arises from the descending branch of the ileocolic artery. It communicates this branch to the right colic artery through right colic artery's ascending and descending branches, then the right and left branches of middle colic artery, the ascending and descending branches of the left colic artery and sigmoid branches of the inferior mesenteric artery terminating in the superior rectal artery. When well developed, this can be a source of collateral circulation to the colon, particularly in the event of colonic resection.[3],[4]

The collateral pathway may not be complete in many cases at the splenic flexure, the site called as Griffith's point. The absence of collaterals from the left branch of the middle colic artery can compromise the arterial supply during bowel surgery or in case of occlusive disease.[3],[4] Hence, a study was done to understand the variation in the branching pattern of SMA in South Indian cadavers.


  Materials and Methods Top


This was a prospective study carried out with convenient sample size of thirty well-embalmed cadavers irrespective of age and sex. The study was conducted from December 2020 to April 2022 during routine dissection of abdomen for 1st year MBBS students. Institutional Ethical Committee clearance was obtained (Letter no. 20/249). The anterior abdominal wall of the cadavers was incised and reflected. The peritoneum and viscera were carefully separated and cleaned. Abdominal aorta and its branches were identified. Origin of SMA, number of jejunal, and ileal branches arising from SMA and pattern of origin of its branches (IPD artery, middle colic, right colic, and ileocolic arteries) were traced and recorded.[5] The findings were tabulated and analyzed.


  Results Top


SMA had its origin from the abdominal aorta in all 30 cadavers [Table 1]. The number of jejunal and ileal branches ranged from 12 to 18. IPD artery originated from SMA in all the cadavers. We observed the variations of SMA in 14 cadavers and found the absence of middle colic artery in four cadavers [Figure 1]. In its absence, the ascending branch of the right colic artery compensated it in supplying the transverse colon. In a cadaver, a small branch was arising from the descending branch of the right colic artery and found to supply the second part of the duodenum [Figure 1]. Higher origin of ileocolic artery was found in two cadavers [Figure 2]. The descending branch of the right colic artery gave branch to cecum in two cadavers [Figure 3]. The common trunk divides into middle colic artery and accessory right colic artery and another common trunk divides into right colic artery and ileocolic artery in a cadaver [Figure 4]. The right colic artery and middle colic artery were found to take origin from a common trunk in a cadaver [Figure 5]. The common trunk for IPD artery and middle colic artery was observed in a cadaver [Figure 6]. The common trunk for right colic artery and ileocolic artery was found in four cadavers [Figure 7]. Accessory right colic artery was observed in four cadavers [Figure 8]. The common trunk for accessory right colic artery and middle colic artery was found in two cadavers [Figure 8]. Accessory right colic artery, right colic artery, ileocolic artery, and ileal branches had their origins from a common trunk in a cadaver [Figure 9]. A small branch was found connecting right colic artery and ileocolic artery [Figure 10].
Figure 1: Absence of middle colic artery and branch to the duodenum from the descending branch of the right colic artery

Click here to view
Figure 2: Absence of the middle colic artery and high origin of ileocolic artery

Click here to view
Figure 3: Branch from the right colic artery joins with the ileocolic artery and 3rd branch of the right colic artery to cecum

Click here to view
Figure 4: One common trunk divides into middle colic artery and accessory right colic artery and the other common trunk divides into right colic artery and ileocolic artery

Click here to view
Figure 5: Common trunk divides into right colic artery and middle colic artery

Click here to view
Figure 6: Common trunk divides into inferior pancreaticoduodenal artery and middle colic artery

Click here to view
Figure 7: Common trunk divides into right colic artery, ileocolic artery, and ileal branch

Click here to view
Figure 8: Right colic artery, Accessory right colic artery and ileocolic artery from superior mesentric artery

Click here to view
Figure 9: From a common trunk, right colicartery, accessory right colic artery, ileocolic artery and ileal branches originate

Click here to view
Figure 10: A small branch connecting the right colic artery and ileocolic artery

Click here to view
Table 1: Distribution of different variations of SMA in the study sample

Click here to view


Variations were found in relation to the SMA and superior mesenteric vein in two cadavers. Normally, superior mesenteric vein is on the right side of SMA. In one cadaver, superior mesenteric vein was on the right side of SMA in the upper part, crossed the artery in the middle and on the left side of SMA in the lower part [Figure 11]. In another cadaver, a small tributary of superior mesenteric vein crossed superficial to right colic artery. The right colic artery was found underneath the tributary of superior mesenteric vein, but middle colic artery was seen superficial to the tributary of superior mesenteric vein [Figure 12].
Figure 11: Superior mesenteric artery is medial and superior mesenteric vein is lateral in the upper part and reverse in the lower part

Click here to view
Figure 12: Small tributary of superior mesenteric vein crosses superficial to the right colic artery and artery was underneath the tributary. Middle colic artery was superficial to superior mesenteric vein

Click here to view



  Discussion Top


The early embryological circulation is symmetrical and is modified throughout the development to form a functioning fetal circulation which is connected to placenta. Soon after the birth, the changes occur rapidly to accommodate disconnection from the placenta and begin exchange of gases in the lungs. As the embryo grows, restructuring of early vessels occurs where in the capillaries fuses to form arteries/veins and even the direction of blood flow gets altered before the final positioning of the vessels. The preliminary circulatory components develop by vasculogenesis in the extraembryonic tissues. The endothelial heart tubes, dorsal aortae, and umbilical and vitelline vessels are formed by vasculogenesis within the developing embryo. As angiogenesis proceeds, angioblasts arise in splanchnic and somatic tissues and endothelial sprouts and branches appear to the earlier vessels. A capillary network appears first and then larger arteries and veins are defined by the selection and enlargement of definite paths in this network. Initially, the dorsal aortae are the longitudinal vessels present in the embryo.[6]

Embryological basis for variations

Paired dorsal, lateral, and ventral intersegmental vessels arise from each of the paired dorsal aorta. With subsequent fusion of dorsal aorta, many ventral branches regress and only the tenth, thirteenth, and twenty-first paired ventral vessels fuse in the midline to give rise to coeliac artery to supply foregut, SMA to supply midgut and inferior mesenteric artery to supply hindgut, respectively.[7]

These ventral branches are known vitelline or omphalomesenteric arteries surround the intestine and the umbilical vesicle from the dorsal to ventral aspect. The two layers of mesentrium dorsale approach each other with the development of the intestine. The ventral paired branches coalesce in the median line to form four roots of vessels for the gut. Between the 4th and 7th gestational week, a longitudinal paraaortic anastomosis appears between the four roots with disappearance of two central roots. The longitudinal anastomosis now joins the first and fourth root. The first omphalomesenteric artery forms this truncus coeliacus and the fourth root forms SMA. The hepatic, splenic, and left gastric arteries originate at the longitudinal anastomosis connecting the first and fourth roots. Then, the anastomosis disappears from the fourth root which is the future SMA.[7]

During ventral migration of the gut, the SMA migrates more caudally. The variations may arise due to the partial disappearance of the ventral splanchnic artery and the ventral longitudinal channel. If the separation of the longitudinal anastomosis occurs at a more cranial level, one of the branches of celiac trunk will be displaced to SMA. If the first or 4th root disappears, a celiac mesenteric trunk may develop.[7]

Butler et al.[8] observed IPD arose as a branch from SMA in 60% and arose as a common trunk with first jejunal artery in 40%. However, in our study, we found IPD artery as a branch from SMA in 29 cadavers (96.6%) and as a common trunk of origin with middle colic artery in one cadaver (3.3%).

Nelikanti et al.[9] studied the branching pattern of SMA in 15 cadavers and 35 fetuses. In this study, IPD artery arose from the middle colic artery in one cadaver and right colic artery was absent in one cadaver and three fetuses. The right colic artery and middle colic artery arose from the common trunk in two fetuses and right colic artery from ileocolic artery in one fetus. In our study, we did not find IPD artery originating from the middle colic artery and absence of right colic artery. We found common trunk for right colic artery and middle colic artery in one cadaver (3.3%).

Basmajian[10] found in his study that SMA gave origin to 12–20 number of jejunal and ileal branches which was similar to our study.

Mane and Shinde[11] found 7–13 number of jejunal and ileal branches originated from SMA and also noted that jejunal artery gave additional supply to transverse colon and pancreas in two cadavers which was not similar to our study.

Gourley and Gering[12] reported that jejunal and ileal branches were 12–20 in number which was similar to our study.

Igiri et al.[13] observed that jejunal and ileal branches were from 8 to 15 in number in their study. They also found that single large jejunal artery gave many branches to supply jejunum in one cadaver which was not similar to our study.

Bergman et al.[14] reported that middle colic artery and right colic artery originated as a common stem in 25% of cases and middle colic artery arose as a branch from the SMA in 60% of cases. The right colic artery originated as one of the branches from SMA only in 28% of specimens and was absent in 13% of specimens. Ileocolic artery originated as a branch from SMA in 63% and along with right colic artery as a common trunk in 37%.

While performing colon interposition following esophagectomy, middle colic artery and its origin are important for the surgeons. The division of the artery proximal to the branch and may preserve the blood flow to the distal portions of the graft.[14]

In our study, we found right colic artery and middle colic artery arose from a common trunk in one cadaver (3.3%), middle colic artery and accessory right colic artery arose from a common trunk and right colic artery and ileocolic artery from another trunk in one cadaver (3.3%), and right colic artery and ileocolic artery arose from a common trunk in four (13.2%) cadavers.

Peters et al.[15] observed that middle colic artery originated as a branch from SMA in 80% and as a common trunk with the right colic artery in 8%. They found multiple middle colic arteries in 12% of cases, absent middle colic artery in 8% of cases, and middle colic artery originated from Inferior mesenteric artery in 4% of cases. In their study, he also observed the absence of the right colic artery in 4%, multiple origin of right colic artery in 16% and right colic artery and middle colic artery originated as a common trunk in 8% of cases. They reported that marginal artery of Drummond (anastomoses between the branches of SMA and inferior mesenteric artery) in 52% of cases in their study. We found marginal artery in all cadavers. We found accessory right colic artery in four cadavers (13.2%). In our study, we did not find the multiple origin of the right colic artery.

Sonneland et al.[16] reported that the absence of the right colic artery in 12.6%, right colic artery originated as a single vessel in 78%, right colic artery presented as two vessels in 8.7%, and three right colic arteries originated in 0.7% from SMA in their study. In our study, single right colic artery was found in 86.8%; two right colic arteries were found in 13.2%. We did not find three right colic vessels in our study.

Poytner[17] observed that right colic artery and middle colic artery originated as a common trunk in 30%−40% which was reported earlier by Henry Hollinshead.[18] We found right colic artery and middle colic artery as a common trunk in two cadavers (7.2%).

Ashwini et al.[19] found that 90% cases of middle colic artery and 66% cases of ileocolic artery originated from the SMA artery. In 46% cases, the right colic artery originated from SMA, whereas in 10% cases, it arose as a common stem with the middle colic artery and in 34% with the ileocolic artery. The right colic artery was absent in 10% of cases. In our study, we did not find the absence of the right colic artery. We found the right colic artery and middle colic artery originated as a common trumk in one cadaver (3.3%) and right colic artery and ileocolic artery originated as a common trunk in four cadavers (13.2%).

Srivastava et al.[20] found coeliaco-mesenteric trunk in 5%. They divided the branching pattern of SMA into four types. Classical pattern is Type 1, Type 2-coeliaco-mesenteric trunk, Type 3-having accessory right colic artery, and type 4-common trunk for right colic artery and middle colic artery. Accessory right colic artery was found in 4% in their study. We found Type 3: Accessory right colic artery was found in four cadavers (13.2%) and Type 4: Right colic artery and middle colic artery arose as a common stem in one cadaver (3.3%).

Manimekalai et al.[21] found celiaco-mesenteric trunk in one computed tomography angiogram.

Kalaimani et al.[22] found celiaco-mesenteric trunk in one cadaver. In our study, we did not find celiaco-mesenteric trunk.

Usually, superior mesenteric vein is on the right side of SMA. We found variations of superior mesenteric vein in relation with SMA in two cadavers (6.6%). These variations were not reported in the previous studies.

The pattern of blood supply is important for the pathological conditions involving the colon. For carcinoma of the colon, accompanying arteries are to be ligated during resection of the involved colon. The ischemia of the involved colon may occur. Most of the lymphatic vessels draining the colon run along with the blood vessels, it is therefore important for surgeons to appreciate the variations in the blood supply of the colon for maximum possible lymphatic field excision in colonic resections done for carcinoma.[23]


  Conclusion Top


Superior mesenteric vessels are often encountered in various surgical and interventional procedures. In the present study, we have reported different variations of SMA and its branching pattern. These variations may help surgeons performing laparotomy, laparoscopic procedures, angiographic procedures, and colonic resection for malignancies, particularly surgical resection of carcinoma of the head of the pancreas. Furthermore, the study of superior mesenteric vessels is of importance when pancreatic carcinoma invades the superior mesenteric vein.

Acknowledgment

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. The results from such research can potentially increase humankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. We thank nonteaching staff of our department for their support during the study.[24]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Standring S. Gray's Anatomy the Anatomical Basis of Clinical Practice. 42nd ed. London: Churchill Livingstone; 2016. p. 1192-93.  Back to cited text no. 1
    
2.
Datta AK. Essentials of Human Anatomy: Thorax and Abdomen. 6th ed. Kolkatta: Current Books International; 2014. p. 138-9.  Back to cited text no. 2
    
3.
Geroulakos G, Cherry KJ. Diseases of Visceral Circulation. London, New York: Arnold, Distributed in USA by Oxford University Press; 2002. p. 228  Back to cited text no. 3
    
4.
Fisher DF Jr., Fry WJ. Collateral mesenteric circulation. Surg Gynecol Obstet 1987;164:487-92.  Back to cited text no. 4
    
5.
Romanes GJ. Cunningham's Manual of practical Anatomy. Thorax and Abdomen. Vol. 2. London: Oxford University Press; 2004. p. 137.  Back to cited text no. 5
    
6.
Standring S. Gray's Anatomy the Anatomical Basis of Clinical Practice. 42nd ed. London: Churchill Livingstone; 2016. p. 222-3.  Back to cited text no. 6
    
7.
Carlson BM. Human Embryology and Developmental Biology. 5thed. Philadelphia: Elsevier Saunders; 2013.  Back to cited text no. 7
    
8.
Butler P, Mitchell AW, Ellis H. Liver, Gallbladder, Pancreas, Spleen. Applied Radiological Anatomy. Cambridge: Cambridge University Press; 2012.  Back to cited text no. 8
    
9.
Nelikanti JP, Kala M, Chadaram BK, Mentey VK. Study of superior mesenteric artery and blood supply of cecum and appendix in dead fetuses. Int J Pharm Med Res 2015;3:23-30  Back to cited text no. 9
    
10.
Basmajian JV. The main arteries of the large intestine. Surg Gynecol Obstet 1955;101:585-91.  Back to cited text no. 10
    
11.
Mane RM, Shinde C. A morphometric study of Superior mesenteric artery and its implication in laparoscopic surgery. Int J Med Res Rev 2015;3:372-7.  Back to cited text no. 11
    
12.
Gourley EJ, Gering SA. The meandering mesenteric artery: A historic review and surgical implications. Dis Colon Rectum 2005;48:996-1000.  Back to cited text no. 12
    
13.
Igiri AO, EKong MB, Egembe GO, Asuquo OR. The pattern of arrangementsnand distributions of the superior mesenteric artery in a Nigerian Population. Int J Morphol 2010;28:33-6.  Back to cited text no. 13
    
14.
Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of Human Anatomic Variation, Text, Atlas and World Literature. Munich: Urban and Schwarzenberg. 1998.  Back to cited text no. 14
    
15.
Peters JH, Kronson JW, Katz M, DeMeester TR. Arterial anatomic considerations in colon interposition for esophageal replacement. Arch Surg 1995;130:858-62.  Back to cited text no. 15
    
16.
Sonneland J, Anson BJ, Beaton LE. Surgical anatomy of the arterial supply to the colon from the superior mesenteric artery based upon a study of 600 specimens. Surg Gynecol Obstet 1958;106:385-98.  Back to cited text no. 16
    
17.
Poytner CW. Congenital Anomalies of Arteries and Veins of Human Body with Bibilography. University studies (University of Nebraska). Nebraska: Lincoln, Neb 1922;22:106.  Back to cited text no. 17
    
18.
Henry Hollinshead W. Anatomy for Surgeons. 2nd ed. New York, London: Harper and Row; 1971. p. 492.  Back to cited text no. 18
    
19.
Ashwini H, Sandhya K, Hatti A, Jaishree H. Branching pattern of the colic branches of Superior mesenteric artery – A cadaveric study. Int J Biol Med Res 2013;4:3004-6.  Back to cited text no. 19
    
20.
Srivastava A, Bali S, Dhiraj S. Variations in branching pattern of Superior mesenteric artery – A cadaveric study. J Den Med Sci 2018;17:4-9.  Back to cited text no. 20
    
21.
Manimekalai MR, Chitra S, Thilagavathy J. A study of anatomical variations in the origin and the branching pattern of the Superior mesenteric artery. Res J Pharm Biol Chem Sci 2017;8:762-6.  Back to cited text no. 21
    
22.
Kalaimani A, Bharathi G, Carolin Chirty K, Ayyadurai S, Abishek M. A common celiac – Mesenteric trunk and variations in their branching patterns – A case report. J Evol Med Dent Sci 2013;2:4097-101.  Back to cited text no. 22
    
23.
Manyama M, Lukanima A, Gesase A. A case of celiacomesenteric trunk in a Tanzanian man. BMC Res Notes 2013;6:341.  Back to cited text no. 23
    
24.
Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat 2021;34:2-4.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed708    
    Printed28    
    Emailed0    
    PDF Downloaded476    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]