Novel Nerve-Sparing In Situ Assembly of an Expandable Titanium Cage to Maximize Endplate Coverage After Posterior Corpectomy for Comminuted Lumbar Burst Fractures.

BACKGROUND AND OBJECTIVES: The ability to maximize corpectomy cage endcap size and vertebral endplate coverage after corpectomy for lumbar burst fractures (L1-L5) is limited by the presence of lumbar nerve roots and the larger cross-sectional area of the lumbar endplates relative to the restrictive corridor for cage insertion. This work aims to provide details and clinical examples of a novel operative technique for 3-column reconstruction and stabilization of comminuted lumbar burst fractures. METHODS: Through a standard posterior midline approach and following posterior instrumentation and lateral extracavitary corpectomy, an in-situ assembly of a modular corpectomy cage that respects adjacent neural structures, restores segmental alignment, and maximizes endplate coverage across a lordotic segment is completed. RESULTS: Radiographic evidence of anatomic spinal reconstruction and stabilization with complete or near-complete endplate coverage without incurrence of new clinical deficit after this novel treatment of lumbar burst fractures. CONCLUSION: The fixation approach described in this report may be a valuable modification to a long-standing technique used for treating comminuted lumbar burst fractures (L1-L5) from a posterior-only approach without incurring additional neurological deficits and by improving endplate and apophyseal ring coverage.

Impact of Neurons on Patient-Derived Cardiomyocytes Using Organ-On-A-Chip and iPSC Biotechnologies.

In the heart, cardiac function is regulated by the autonomic nervous system (ANS) that extends through the myocardium and establishes junctions at the sinus node and ventricular levels. Thus, an increase or decrease in neuronal activity acutely affects myocardial function and chronically affects its structure through remodeling processes. The neuro-cardiac junction (NCJ), which is the major structure of this system, is poorly understood and only a few cell models allow us to study it. Here, we present an innovant neuro-cardiac organ-on-chip model to study this structure to better understand the mechanisms involved in the establishment of NCJ. To create such a system, we used microfluidic devices composed of two separate cell culture compartments interconnected by asymmetric microchannels. Rat PC12 cells were differentiated to recapitulate the characteristics of sympathetic neurons, and cultivated with cardiomyocytes derived from human induced pluripotent stem cells (hiPSC). We confirmed the presence of a specialized structure between the two cell types that allows neuromodulation and observed that the neuronal stimulation impacts the excitation-contraction coupling properties including the intracellular calcium handling. Finally, we also co-cultivated human neurons (hiPSC-NRs) with human cardiomyocytes (hiPSC-CMs), both obtained from the same hiPSC line. Hence, we have developed a neuro-cardiac compartmentalized in vitro model system that allows us to recapitulate the structural and functional properties of the neuro-cardiac junction and that can also be used to better understand the interaction between the heart and brain in humans, as well as to evaluate the impact of drugs on a reconstructed human neuro-cardiac system.

Ectopic craniopharyngioma of the orbit: illustrative case.

BACKGROUND: Craniopharyngiomas are uncommon malformations of the sellar or parasellar region that are partly cystic and calcified and have low histological grade. The typical age of presentation is bimodal, with peak incidence rates in children at age 5 to 14 years and in adults at age 50 to 74 years. The usual clinical manifestations are related to endocrine deficiencies due to mass effect along with visual impairment and increased intracranial pressure. If a tumor is favorably localized, the treatment of choice is complete resection. OBSERVATIONS: The authors presented a unique case of a 61-year-old man with a suspicious cystic lesion in the right orbital roof that was causing right-sided headaches with pressure and pain in the right eye. Both computed tomography and magnetic resonance imaging were used for further evaluation and showed a suspicious lytic bone lesion that had an epicenter within the orbital rim, which was highly suggestive of a tumor of interosseous origin. After removal, the tumor was identified by pathology as a craniopharyngioma. LESSONS: The importance of this case report is in documenting a unique case of an ectopic craniopharyngioma in the orbit, adding to current hypotheses of the pathogenesis of ectopic craniopharyngiomas, and presenting an extensive review of literature.

Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case.

BACKGROUND: Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS: A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS: The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature.

Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

Generation of catecholaminergic polymorphic ventricular tachycardia patient-specific induced pluripotent stem cell line.

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a genetic disorder characterized by ventricular tachycardia, that can cause the heart to stop beating leading to death. The prevalence is 1/10.000 and in approximately 60% of cases, the syndrome can be due to a mutation of the cardiac ryanodine receptor gene (RyR2). We derived an induced pluripotent stem cell (iPSC) line from an 11-year-old patient blood-cells, carrying a heterozygous missense mutation on the 8th exon of the RyR2 N-terminal part. This reprogramed CPVT line displayed normal karyotype, expressed pluripotent markers and had a capacity to differentiate in trilineage embryonic layers.

Spore-forming bacteria and their utilisation as probiotics.

In this review article, the beneficial application of bacterial spore formers as probiotics in the food industry is discussed based on the knowledge gleaned from current publications. The summary of new scientific results provides evidence of the advantages of the utilisation of Bacillus or Clostridium strains in the food industry. Both bacteria are able to produce a very stable duration form: the endospore. Compared to the widely used lactic acid bacteria, bacterial spores offer the advantage of a higher survival rate during the acidic stomach passage and better stability during the processing and storage of the food product. In many food products, germination of the spores does not occur. Hence the product quality of the food is not affected because of their inactive metabolism. Besides the possible utilisation and functional properties, an overview of the fast-developing knowledge about the mechanisms of the beneficial health effects of spore-forming bacteria is provided.

Malignant pleural mesothelioma cells resist anoikis as quiescent pluricellular aggregates.

Pleural fluid accumulation is a frequent clinical observation in diffuse malignant pleural mesothelioma (MPM). The cytological analysis of pleural fluid often reveals the presence of free spheroid aggregates of malignant cells, giving rise to the question of the ability of non-adherent tumor cells to resist the loss of anchorage-induced apoptosis (termed as anoikis), and to develop new tumor foci in the pleural cavity. Here, we show that MPM cells cultured under non-adherent conditions form well-organized aggregates composed of viable cells, which progressively enter in G(0). Although the PI3K/Akt, ERK and SAPK/JNK signaling pathways are activated in adherent MPM cells, loss of anchorage results in the inactivation of these pathways. By comparison, we show that the non-tumoral mesothelial cells MeT-5A enter anoikis in an SAPK/JNK-, Bim- and caspase-9-dependent pathway. The survival of MPM cells can be reversed by activating SAPK/JNK with anisomycin, according to a Bim-dependent mitochondrial pathway. Finally, our findings show that impairment of cell aggregation activates SAPK/JNK and Bim and induces anoikis. Our results underline the importance of intercellular contacts in the anoikis resistance of MPM cells.

Successful treatment of hypercalcemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism.

BACKGROUND: Cinacalcet lowers plasma parathyroid hormone (PTH) levels in primary and secondary hyperparathyroidism. The efficacy and safety of cinacalcet have not been examined in renal transplant patients with persistent hyperparathyroidism. The aim of this study was to evaluate the effect of cinacalcet as a novel therapy for the management of such patients. METHODS: Eleven renal allograft recipients with persistent hyperparathyroidism were treated with cinacalcet. The total study time was 10 weeks. Individual cinacalcet doses were adjusted to obtain a serum calcium in the predefined normal target range of 2.10-2.60 mmol/l. RESULTS: Serum calcium decreased significantly from 2.73+/-0.05 mmol/l to 2.44+/-0.05 and 2.42+/- 0.04 mmol/l after 2 and 10 weeks of treatment, respectively. All patients reached the target range rapidly and remained normocalcaemic throughout the study. Serum PTH significantly decreased 16.1 and 21.8% at study weeks 2 and 10, respectively, compared with week 0. Serum phosphate increased. Renal function remained stable and no allograft rejection was observed. From weeks 2 to 10, daily cinacalcet doses administered were 30 mg (n = 8), 15 mg (n = 1) and 60 mg (n = 1), respectively. CONCLUSION: Cinacalcet was effective in correcting the hypercalcaemia associated with persistent hyperparathyroidism after renal transplantation. It appears to be safe. Thus, cinacalcet represents a promising alternative for parathyroidectomy in these patients.

[Surgical treatment of a complication of Crohn's disease of the duodenum]. / Chirurgická lécba komplikací Crohnovy choroby duodena.

In 1995-1997 at the First Surgical Clinic, Medical Faculty, Palacký University and Faculty Hospital Olomouc three patients were treated on account of obstruction of the pyloroduodenal region caused by Crohn's disease. The condition was treated by anastomosis, possibly with vagotomy, depending on the site of stenosis. Clinical, laboratory and endoscopic control examinations after a 6-month to 3-year interval revealed good results of this approach.

[Surgical possibilities in the treatment of ulcerative colitis]. / Chirurgické moznosti lécení ulcerózní kolitidy.

During the five-year period between 1992-1996 at the First Surgical Clinic of the Medical Faculty, Palacký University and Faculty Hospital in Olomouc 22 patients were operated on account of ulcerative colitis. Twelve patients were subjected to primary operations on account of acute complications of the disease, ten patients are in the group of elective operations. As the incidence of ulcerative colitis in our population is not high there is little experience with treatment of this disease and ulcerative colitis is still a problem for gastroenterologists as well as surgeons. The authors draw attention to two factors which have an impact on surgical treatment of ulcerative colitis: 1. optimal time for indication of surgical treatment calls for treatment of patients in a specialized gastroenterological department, 2. Surgical treatment calls for a specialised team linked with the gastroenterological department concerned with treatment of ulcerative colitis.

Resistance to Leaf Scald Disease Is Associated with Limited Colonization of Sugarcane and Wild Relatives by Xanthomonas albilineans.

ABSTRACT A streptomycin- and rifampicin-resistant mutant of Xanthomonas al-bilineans was used to study symptom expression of leaf scald disease (LSD) and colonization of sugarcane (Saccharum spp.) and its wild relatives by this bacterial pathogen. A total of 40 sugarcane cultivars and 15 clones from the Saccharum complex that differed in resistance to LSD were inoculated by a decapitation technique in both field and greenhouse experiments. In the plant crop, disease severity varied between 0 for the most resistant genotypes and 100 for the most susceptible ones. Resistance to LSD was characterized by limited colonization of the host plant by X. albilineans. Although almost all genotypes were colonized by the pathogen, the greatest bacterial population densities were found in the susceptible cultivars. There was a high correlation between disease severity and pathogen population in the apex. Several genotypes exhibited no or slight symptoms even though they were highly colonized in the upper and/or basal nodes of stalks. Two mechanisms, therefore, may play an important role in resistance to LSD: resistance to colonization of the apex, which is characterized by absence of symptoms, and resistance to colonization of the upper and lower parts of the stalk. In contrast, disease severity and pathogen population densities in the first ratoon crop in the field were nil or very low in the stalks, except for the highly susceptible cv. CP68-1026. Sugarcane ratoons, therefore, may recover from the disease after plant cane infection. Nevertheless, because low levels of the pathogen were still detected in some stalks, it is possible that LSD could develop from latent infections if favorable environmental conditions occur.

Neuroblastoma: diagnostic imaging and staging.

Results of computed tomography (CT), scintigraphy, excretory urography, and other imaging tests used to diagnose and stage 38 cases of neuroblastoma prior to treatment were reviewed. Findings of these examinations were correlated with clinical data, laboratory data, results of biopsy, and surgical findings. CT was the most sensitive single test (100%) for the detection and delineation of the primary tumor. Calcifications that suggested the histologic diagnosis of neuroblastoma were present in 79% of the cases. Rim calcifications, the most specific pattern for neuroblastoma, were identified in 29% of all cases. CT alone accurately staged 82% of cases; when complemented by bone marrow biopsy, staging accuracy was 97%. CT alone was more accurate than any combination of imaging tests that excluded CT. An algorithm using CT is presented for the diagnosis and staging of neuroblastoma at reduced cost and with increased efficiency.

Recurrent neuroblastoma: the role of CT and alternative imaging tests.

One hundred twelve CT scans of 52 patients who were receiving treatment for neuroblastoma were reviewed for accuracy, and findings were correlated with data obtained from other imaging tests, physical examinations, laboratory tests, biopsies, surgery, and long-term clinical follow-up. CT was the most sensitive imaging test for tumor recurrence (85% detection rate), and it was also the most versatile in the ability to define recurrent disease in the retroperitoneum, liver, cranium, mediastinum, lymph nodes, and skeleton. All 30 tumor recurrences were detected by the combination of CT, bone-marrow biopsy, and selected spot radiographs at the sites of pain. CT was accurate and clinically useful both for assessing tumor response to therapy and for predicting findings at "second look" surgery (accuracy, 94%). CT is relatively cost effective by substituting for a more expensive but less accurate combination of competitive imaging studies.