Clinical and surgical outcome in patients with cervical spondylodiscitis-a single-center retrospective case series of 24 patients.

Objective: Cervical spondylodiscitis is a rare pathology, with an incidence of 0.5-2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity. Methods: In this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test. Results: Twenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised. Conclusion: Cervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Intraoperative radiotherapy combined with spinal stabilization surgery-a novel treatment strategy for spinal metastases based on a first single-center experiences.

INTRODUCTION: Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT. METHODS: Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR. RESULTS: 15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7-10] IQR. Most metastasis were located in the thoracic (n = 11, 73.3%) and the rest in the lumbar (n = 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 1.5 cm [1.1-1.9, IQR] depth during 2-6 min. The patients had Epidural Spinal Cord Compression score 1a-3. Seven patients (46.7%) experienced adverse events including 2 surgical site infection (one 65 days after surgery). CONCLUSION: 50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.

Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch.

BACKGROUND: There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT-guided epidural fibrin patch. METHODS: We present the case of a 47-year-old female patient with a suspected CSF fistula after endoscopic decompression for C7 foraminal stenosis. She was readmitted 8 days after surgery with dysesthesia in both upper extremities, orthostatic headache and neck pain, which worsened during mobilization. A CSF leak was suspected on spinal magnetic resonance imaging. A computer tomography (CT)-guided epidural blood patch was performed with short-term relief. A second CT-guided epidural fibrin patch was executed and the patient improved thereafter and was discharged at home without sensorimotor deficits or sequelae. We investigated the current literature for complications after endoscopic spine surgery and for treatment of postoperative CSF fistulas. RESULTS: Although endoscopic and open revision surgery with dura repair were described in previous studies, dural tears in endoscopic surgery are frequently treated conservatively. In our case, the patient was severely impaired by a persistent CSF fistula. We opted for a less invasive treatment and performed a CT-guided fibrin patch which resulted in a complete resolution of patient's symptoms. DISCUSSION AND CONCLUSION: CSF fistulas after cervical endoscopic spine procedures are rare complications. Conservative treatment or revision surgery are the standard of care. CT-guided epidural fibrin patch was an efficient and less invasive option in our case.

EFNS guidelines on cognitive rehabilitation: report of an EFNS task force.

Disorders of language, spatial perception, attention, memory, calculation and praxis are a frequent consequence of acquired brain damage [in particular, stroke and traumatic brain injury (TBI)] and a major determinant of disability. The rehabilitation of aphasia and, more recently, of other cognitive disorders is an important area of neurological rehabilitation. We report here a review of the available evidence about effectiveness of cognitive rehabilitation. Given the limited number and generally low quality of randomized clinical trials (RCTs) in this area of therapeutic intervention, the Task Force considered, besides the available Cochrane reviews, evidence of lower classes which was critically analysed until a consensus was reached. In particular, we considered evidence from small group or single cases studies including an appropriate statistical evaluation of effect sizes. The general conclusion is that there is evidence to award a grade A, B or C recommendation to some forms of cognitive rehabilitation in patients with neuropsychological deficits in the post-acute stage after a focal brain lesion (stroke, TBI). These include aphasia therapy, rehabilitation of unilateral spatial neglect (ULN), attentional training in the post-acute stage after TBI, the use of electronic memory aids in memory disorders, and the treatment of apraxia with compensatory strategies. There is clearly a need for adequately designed studies in this area, which should take into account specific problems such as patient heterogeneity and treatment standardization.

EFNS guidelines on cognitive rehabilitation: report of an EFNS task force.

In 1999, a Task Force was set up under the auspices of the European Federation of Neurological Societies with the aim to evaluate the existing evidence for the clinical effectiveness of cognitive rehabilitation. This review led to the development of a set of guidelines to be used in the management of adult patients with cognitive disorders due to acquired focal neurological damage.

The mind and brain scholar as a hitchhiker in the post-Gutenberg galaxy: publishing at 2000 and beyond.

Electronic journal (e-journal) publishing has started to change the ways we think about publishing. However, many scholars and scientists in the mind and brain sciences are still ignorant of the new possibilities and ongoing debates. This paper will provide a summary of the issues involved, give an update of the current discussion, and supply practical information on issues related to e-journal publishing and self-archiving relevant for the mind and brain sciences. Issues such as differences between traditional and e-journal publishing, open archive initiatives, worldwide conventions, quality control, costs involved in e-journal publishing, and copyright questions will be addressed. Practical hints on how to self-archive, how to submit to the e-journal Psycoloquy, how to create an open research archive, and where to find information relevant to e-publishing will be supplied.

Losing the error related negativity in the EEG of human subjects: an indicator for willed action.

When people make errors in a discrimination task, a negative-going waveform can be observed in scalp-recorded EEG that has been coined the error-related negativity (ERN). We hypothesized that the ERN only occurs with slips, that is unwilled action errors, but not if an error is committed willingly and intentionally. We investigated the occurrence of the ERN in a choice reaction time task that has been shown to produce an ERN and in an error simulation task where subjects had to fake errors while the EEG was recorded. We observed a loss of the ERN when errors were committed in willed actions but not in unwilled actions thus supporting the idea that the production of the ERN is tied to slips in unwilled actions but not mistakes in willed actions.

Discourse studies in neurologically impaired populations: a quest for action.

Organism and environment are in a state of constant interaction, and discourse is viewed as one form of manifestation of this interaction. Through the study of discourse insights can be gained into those components that bring about mental events. Verbal structure, communication of beliefs and action/interaction are highly interactive dimensions of discourse. Taking this perspective as a framework, the findings of discourse studies with a particular emphasis on right-hemisphere brain-damaged individuals are discussed. Neurolinguistic studies of discourse can be divided into four categories: (1) studies that focus primarily at providing a detailed description of the structural and interactional abilities of brain-damaged individuals, (2) studies that are mainly concerned with investigating the processing aspects of discourse, (3) studies that investigate the influence of cognitive systems such as attention or memory on discourse processing, and (4) studies that try to relate discourse processing mechanisms to underlying biological substrates or neurophysiological mechanisms. A quest is made for future research to base discourse studies on well-defined processing theories, to include different processing components and levels, and to systematically investigate the impact of facets of cognitive systems on such processing. Established methodological approaches should be complemented by electrophysiological procedures (such as the event related potentials technique) or functional imaging techniques (such as fMRI) to tackle relationships between discourse processing mechanisms, cognitive systems and underlying biological mechanisms. Consideration of the influence of biochemical processes (such as asymmetries of neurotransmitters, endocrine functions, or influence of pharmacological agents) on component processes may add to our insights.

Characterization of lymphocyte subtypes in scabietic skin lesions of naive and sensitized dogs.

We delineated the density of cells expressing CD4, CD8, CD21 and CD45RA antigens in the cellular infiltrates in the epidermis, dermis and follicular epithelium in scabietic skin lesions of naive hosts and sensitized hosts that expressed resistance to scabies infestation. No cells expressing CD21 (B-lymphocytes and follicular dendritic cells) were present in the epidermis and only a few were occasionally present in the dermis during both the first and second infestations. Naive T-cells (CD45RA+) and CD8+ cells (cytotoxic and suppressor T-lymphocytes) were present in varying densities in the infiltrates throughout the epidermis, dermis and follicular epithelium with no apparent differences in density and the rate of appearance between sensitizing and challenge infestations. CD4+ cells were abundant in fluctuating densities in the dermis, epidermis, and follicular epidermis during the sensitizing infestation and these cells became the dominant cell type early during the challenge infestation. The density of CD4+ cells in the infiltrate was much greater during the challenge than during the sensitization infestation. This population of CD4+ cells consisted of both T-helper/inducer cells and neutrophils and the large increase in their numbers during the challenge suggested they played a key role in the successful immune/inflammatory response that resulted in resistance to scabies infestation.

Characterization of antigen presenting cells and T-cells in progressing scabietic skin lesions.

Experimentally infested dogs expressed successful adaptive immunity and self-cured of scabies after previously having scabies that required treatment to cure. A biphasic increase and decrease of CD1a+ Langerhans cells (LCs) in the epidermis of hosts infested the first time (sensitized) and infested a second time (challenged) suggested that these cells were actively involved in the hosts' early immune response to scabies. In contrast, in the dermis CD1a+ cell densities during both infestations increased to a single peak that followed the first peak of these cells in the epidermis. In addition, there was an influx of T-lymphocytes (CD3 epsilon + cells) and CD11c+ cells into the dermis following the first peak of LCs in the epidermis. The influx of T-lymphocytes in the dermis coincided with the peak density of CD1a+ cells in the dermis and epidermis during the second infestation. In both the epidermis and dermis, MHC Class II+ cell density profiles were similar to that of CD1a during the first infestation and then exhibited single peaks during the second infestation. The increases in CD1a+, CD3 epsilon + (T-lymphocytes), CD11c+, and MHC Class II+ cell responses in the dermis occurred earlier and were more intense in the challenge infestation compared with the first infestation. These data indicate that T-lymphocytes (CD3 epsilon +), CD11c+, MHC Class II+, and CD1a+ cells in the dermis played a major role in the successful immune response to scabies mites.

Production and evaluation of requests by right hemisphere brain-damaged individuals.

Several researchers have investigated the comprehension of "indirect requests" by right hemisphere brain-damaged (RHD) individuals. Until the present, however, no sound description of the phenomenon under investigation has been reached and explanatory attempts of the observed behavior are diverse. Based on a theoretical framework issued from studies in cross-cultural pragmatics, the present study is an attempt to provide a systematic description of the production of request sequences and the evaluation of direct and nonconventionally indirect requests by RHD patients. The analyses of the production data showed that, relative to the control group, the RHD patients behaved differently concerning the application of nonconventionally indirect requests, the use of external request modifiers, the evaluation of nonconventionally indirect requests, and the use of propositions. No differences in production performance were observed with regard to direct requests, conventionally indirect requests, and internal request modifiers. Further, the RHD group and the control group behaved similarly in evaluating direct requests. The results are discussed in relation to previous findings and a mental model approach is proposed as an explanatory framework. The findings suggest that the RHD patients were able to build a mental representation at a text level and a situational level but may have had problems within the realm of monitoring or planning integration processes if more than one mental model is involved. There is some indication that attention and visuospatial abilities may have influenced the verbal and evaluation abilities of the RHD subjects. It seems a worthy endeavor to pursue this issue in future research.

Goussia aculeati from the three-spined stickleback (Gasterosteus aculeatus): field observations and ultrastructural features.

Goussia aculeati, a parasite of intestinal epithelial cells of the three-spined stickleback (Gasterosteus aculeatus) was found in 418 (47%) of 891 sticklebacks examined. The fish were obtained from 7 localities of waters in a natural resort area in North-West Germany. G. aculeati mainly infected juvenile fish (312 (53%) of 590 examined). During a 2-years observation period no impact of season on the infection rate was obvious. Ultrastructural studies on merogonic, gamogonic, and sporogonic developmental stages revealed that meronts gave rise to merozoites by ectomerogony; microgametes had one flagellum attached to the surface of the microgamete. Due to veil-like membraneous structures covering the sporocysts, this Goussia species was placed into the subgenus Plagula.

A pragmatic approach to neurolinguistics: requests (re)considered.

In recent years there has been a series of studies in the field of neurolinguistics and neuropsychology investigating the comprehension and interpretation of indirect requests predominantly in right brain-damaged individuals. Although the findings of these studies seem to suggest that indirect requests may be perceived, comprehended, judged, or interpreted differently by some right brain-damaged individuals, until today no coherent picture pertaining to the description of the phenomenon under investigation has emerged. One reason for this dissatisfying situation may be that the features contributing to the interpretation of a request in terms of its level of directness have not been sufficiently investigated. In addition, the stimuli on which the experiments were based are not always clear-cut or specific if viewed within the framework of pragmatic theory. The article provides an introduction to some aspects of pragmatic theory and discusses five major studies on request comprehension in brain-damaged patients with reference to the components relevant to the realization of requests. Finally, suggestions concerning future research are made.

Sarcoptes scabiei: the circulating antibody response and induced immunity to scabies.

Scabies is an important parasitic disease that continues to persist throughout the world despite the availability of acaricides to control it. The immune response mechanism to scabies and the possible development of a vaccine for control of scabies was investigated. This study demonstrated that hosts infested with scabies develop immunity (resistance) to reinfestation. All hosts developed scabies-specific elevated circulating antibody titers during scabies infestations that followed the classical pattern for primary and secondary infestations. Parallel elevated levels of complement C3 were also observed. The hosts that exhibited acquired immunity after their first infestations had antibody and complement levels during challenge infestations lower than those of the hosts that showed no immunity when reinfested. Induction of immunity coupled with generally elevated antibody levels for both immune and nonimmune hosts suggested that resistance to reinfestation was associated with a cell-mediated response. These data also suggested that vaccination with specific scabies tissue containing the relevant antigens or recombinant relevant antigens could enhance the cell-mediated response to protect the hosts against natural infestations.

From theory to practice: the unconventional contribution of Gottlieb Burckhardt to psychosurgery.

Gottlieb Burckhardt, a Swiss psychiatrist who practiced in the late 19th century, was the founder of modern psychosurgery. In 1891 he reported the results of cortical extirpations on six patients who evidently suffered from intractable psychiatric disease; two of these cases are discussed here to illustrate how Burckhardt employed contemporary brain models of language and cognition as the basis for removing specific areas of the cerebral cortex with the intention of ameliorating his patients' disturbed behavior.