Morphological study of the phrenic nerve to determine a reference value for the myelinated fiber density in elderly individuals

Phrenic nerves (PNs) play an important role in respiration; however, very few morphological studies have assessed them. This study aimed to provide control reference values, including the density of large and small myelinated PN fibers, for future pathological studies. We assessed a total of nine nerves from eight cases among consecutive autopsy cases registered to the Brain Bank for Aging Research between 2018 and 2019 (five men and three women, mean age 77.0 +/- 7.0 years). The nerves were sampled distally, and their structures were analyzed using semi-thin sections stained with toluidine blue. The mean and standard deviation of the density of each myelinated fiber of the PN was 6908 +/- 1132 fibers/mm(2) (total myelinated fiber), 4095 +/- 586 fibers/mm(2) (large diameter myelinated fiber; diameter >= 7 mu m), and 2813 +/- 629 fibers/mm(2) (small diameter myelinated fiber; diameter <7 mu m). There was no correlation between myelinated fiber density and age. This study provides the density measurement of the human PN myelinated fiber, and these findings can be used as reference values for the PN in elderly individuals.