Blood Flow Capacity Assessment of End-to-Side Arterial Anastomosis In Vivo in Rats.

Introduction The aim of this article was to assess the flow capacity of end-to-side arterial anastomosis depending on the method of its implementation. Materials and Methods The study was conducted on 30 live Wistar rats in vivo, which were randomly divided into three groups. In each group of animals, an end-to-side microanastamosis was performed using three methods of donor artery preparation: 45 degrees (group A), 90 degrees (group B), and arteriotomy according to the "fish mouth" type (group C). The determination of flow capacity of anastomosis by measuring the blood volume flow with transonic flowmeter was performed. Results The obtained average values after the anastomosis were, respectively, 7.335 mL/s (standard deviation [SD]: 2.0771; min: 4.05; max: 10.85), 7.36 mL/s (SD: 0.836 mi: 6.15; max: 8.75), and 6.37 mL/s (SD: 1.247; min: 5.05; max: 9.05). No statistically significant difference in the blood volume flow velocity between all types of anastomoses was obtained ( p = 0.251). Conclusion The flow capacity of end-to-side arterial anastomosis does not depend on the chosen method of anastomosis.

Consequences of polyploidy and divergence as revealed by cytogenetic mapping of tandem repeats in African clawed frogs (Xenopus, Pipidae).

Repetitive elements have been identified in several amphibian genomes using whole genome sequencing, but few studies have used cytogenetic mapping to visualize these elements in this vertebrate group. Here, we used fluorescence in situ hybridization and genomic data to map the U1 and U2 small nuclear RNAs and histone H3 in six species of African clawed frog (genus Xenopus), including, from subgenus Silurana, the diploid Xenopus tropicalis and its close allotetraploid relative X. calcaratus and, from subgenus Xenopus, the allotetraploid species X. pygmaeus, X. allofraseri, X. laevis, and X. muelleri. Results allowed us to qualitatively evaluate the relative roles of polyploidization and divergence in the evolution of repetitive elements because our focal species include allotetraploid species derived from two independent polyploidization events - one that is relatively young that gave rise to X. calcaratus and another that is older that gave rise to the other (older) allotetraploids. Our results demonstrated conserved loci number and position of signals in the species from subgenus Silurana; allotetraploid X. calcaratus has twice as many signals as diploid X. tropicalis. However, the content of repeats varied among the other allotetraploid species. We detected almost same number of signals in X. muelleri as in X. calcaratus and same number of signals in X. pygmaeus, X. allofraseri, X. laevis as in the diploid X. tropicalis. Overall, these results are consistent with the proposal that allopolyploidization duplicated these tandem repeats and that variation in their copy number was accumulated over time through reduction and expansion in a subset of the older allopolyploids.

Necessity of fusion following decompression surgery in patients with single-level lumbar stenosis: study protocol for an open-label multicentre non-inferiority randomized controlled clinical trial.

BACKGROUND: The necessity of spinal segment fusion after decompression is one of the most controversial and unresolved issues in single-level lumbar spinal stenosis surgery. To date, only one trial carried out 15 years ago focused on this problem. The key purpose of the current trial is to compare the long-term clinical results of the two surgical methods (decompression vs. decompression and fusion) in patients with single-level lumbar stenosis. METHODS: This study is focused on the non-inferior clinical results of decompression compared with the standard fusion procedure. In the decompression group, the spinous process, the interspinous and supraspinous ligaments, part of the facet joints, and corresponding parts of the vertebral arch are to be preserved intact. In the fusion group, decompression is to be supplemented with transforaminal interbody fusion. Participants meeting the inclusion criteria will be randomly divided into two equal groups (1:1), depending on the surgical method. The final analysis will include 86 patients (43 per group). The primary endpoint is Oswestry Disability Index dynamics at the end of the 24-month follow-up compared to the baseline level. Secondary outcomes included those estimated using the SF-36 scale, EQ-5D-5L, and psychological scales. Additional parameters will include sagittal balance of the spine, fusion results, total cost of surgery, and hospital stay followed by two-year treatment. Follow-up examinations will be performed at 3, 6, 12, and 24 months DISCUSSION: Authors suggest that this study will improve the evidence for application of various surgical techniques for lumbar spine stenosis surgery and verify the existing protocol for surgical management. TRIAL REGISTRATION: ClinicalTrials.gov NCT05273879 . Registered on March 10, 2022.

Teachability of lower cervical spine injury classifications / Educabilidad de las clasificaciones de lesiones de la columna cervical subaxial

Objectives To compare the teachability of the Allen–Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury Classification (CSISS) and to identify the classification that a group of residents and junior neurosurgeons find easiest to learn. Methods We used data from 64 consecutive patients. Answers of nine residents and junior neurosurgeons and four experienced surgeons in two assessment procedures were used. Six raters (workshop group) participated in special seminars between assessments. Three other raters formed the control group. Experienced surgeon's answers were used for comparison. Teachability was measured as the median value of the difference (ΔK) in the interrater agreement on the same patients by the same pairs of subjects. Results Median Δ K for the Allen–Ferguson, Harris, Argenson and AOSpine classifications were: (1) 0.01, 0.02, 0.29, and 0.39 for the workshop group; (2). 0.09, −0.03, 0.06 and 0.04 for the control group, respectively. Between numerical scales, median ΔK was higher for SLIC but did not exceed 0.16. Interrater consistency with expert's opinion was increased in the workshop group for Allen–Ferguson, Argenson and AOSpine and did not differ in either group for SLIC and CSISS. Conclusion The AOSpine classification was the most teachable. Among numeric scales, SLIC demonstrated better results. The successful application of these classifications by residents and junior neurosurgeons was possible after a short educational course. The use of these scales in educational cycles at the stage of residency can significantly simplify the communication between specialists, especially at the stage of patient admission (AU)

Objetivos Comparar la educabilidad de las clasificaciones de Allen-Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury Classification (CSISS) e identificar la clasificación que un grupo de residentes y neurocirujanos jóvenes encuentran más fácil para aprender. Métodos Usamos los datos de 64 pacientes consecutivos. Se utilizaron las respuestas de 9 residentes y neurocirujanos jóvenes y 4 cirujanos experimentados en 2 procedimientos de evaluación. Seis evaluadores (grupo de talleres) participaron en seminarios especiales entre evaluaciones. Otros 3 evaluadores formaron el grupo de control. Se utilizaron las respuestas de cirujanos experimentados a modo de comparación. La educabilidad se midió como el valor mediano de la diferencia (ΔK) en el acuerdo entre observadores sobre los mismos pacientes por los mismos pares de evaluadores. Resultados La mediana de ΔK para las clasificaciones de Allen-Ferguson, Harris, Argenson y AOSpine fue: 1) 0,01; 0,02; 0,29 y 0,39 para el grupo del taller; 2) 0,09; −0,03; 0,06 y 0,04 para el grupo de control, respectivamente. Entre las escalas numéricas, la mediana de ΔK fue mayor para SLIC pero no excedió 0,16. La coherencia entre evaluadores y los expertos aumentó en el grupo de taller para Allen-Ferguson, Argenson y AOSpine y no difirió en ninguno de los grupos para SLIC y CSISS. Conclusión La clasificación AOSpine tuvo la mejor educabilidad. Entre las escalas numéricas, SLIC demostró mejores resultados. La aplicación exitosa de estas clasificaciones por residentes y neurocirujanos junior fue posible después de un breve curso educativo. El uso de estas escalas en los ciclos educativos en la etapa de residencia puede simplificar significativamente la comunicación entre especialistas, principalmente en la etapa de ingreso del paciente (AU)

Teachability of lower cervical spine injury classifications.

OBJECTIVES: To compare the teachability of the Allen-Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury Classification (CSISS) and to identify the classification that a group of residents and junior neurosurgeons find easiest to learn. METHODS: We used data from 64 consecutive patients. Answers of nine residents and junior neurosurgeons and four experienced surgeons in two assessment procedures were used. Six raters (workshop group) participated in special seminars between assessments. Three other raters formed the control group. Experienced surgeon's answers were used for comparison. Teachability was measured as the median value of the difference (ΔK) in the interrater agreement on the same patients by the same pairs of subjects. RESULTS: Median Δ K for the Allen-Ferguson, Harris, Argenson and AOSpine classifications were: (1) 0.01, 0.02, 0.29, and 0.39 for the workshop group; (2). 0.09, -0.03, 0.06 and 0.04 for the control group, respectively. Between numerical scales, median ΔK was higher for SLIC but did not exceed 0.16. Interrater consistency with expert's opinion was increased in the workshop group for Allen-Ferguson, Argenson and AOSpine and did not differ in either group for SLIC and CSISS. CONCLUSION: The AOSpine classification was the most teachable. Among numeric scales, SLIC demonstrated better results. The successful application of these classifications by residents and junior neurosurgeons was possible after a short educational course. The use of these scales in educational cycles at the stage of residency can significantly simplify the communication between specialists, especially at the stage of patient admission.

Divergent subgenome evolution in the allotetraploid frog Xenopus calcaratus.

Allopolyploid genomes are divided into compartments called subgenomes that are derived from lower ploidy ancestors. In African clawed frogs of the subgenus Xenopus (genus Xenopus), allotetraploid species have two subgenomes (L and S) with morphologically distinct homoeologous chromosomes. In allotetraploid species of the sister subgenus Silurana, independently evolved subgenomes also exist, but their cytogenetics has not been investigated in detail. We used a diverse suite of cytogenetic and molecular FISH techniques on an allotetraploid species in Silurana-Xenopus calcaratus-to explore evolutionary dynamics of chromosome morphology and rearrangements. We find that the subgenomes of X. calcaratus have distinctive characteristics, with a more conserved a-subgenome resembling the closely related genome of the diploid species X. tropicalis, and a more rapidly evolving b-subgenome having more pronounced changes in chromosome structure, including diverged heterochromatic blocks, repetitive sequences, and deletion of a nucleolar secondary constriction. Based on these cytogenetic differences, we propose a chromosome nomenclature for X. calcaratus that may apply to other allotetraploids in subgenus Silurana, depending on as yet unresolved details of their evolutionary origins. These findings highlight the potential for large-scale asymmetry in subgenome evolution following allopolyploidization.

Efficacy and Safety of Goel-Harms Technique in Upper Cervical Spine Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVE: The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development. METHODS: A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate. RESULTS: This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications. CONCLUSIONS: The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.

Factors Affecting the Outcomes of Traumatic Atlanto-Occipital Dislocations in Adults: A Systematic Review.

OBJECTIVE: The objectives of this study were to conduct a systematic review of the literature to determine the optimal treatment method for patients with atlanto-occipital dislocation (AOD) and to identify possible factors influencing their outcomes. METHODS: We conducted a systematic review of the PubMed database between January 1966 and December 2020. The main inclusion criterion was articles that discussed AOD treatment methods, and outcome descriptions were selected for analysis. Intergroup differences were assessed using nonparametric statistical methods. RESULTS: Of the 657 articles identified initially, only 54 met the inclusion criteria, resulting in data from 139 patients. Type I or II AODs were more frequent in patients injured in road traffic accidents, whereas type III AODs were more frequent in patients with catatrauma (P = 0.027). Spinal cord injury was more frequently observed in patients with types I and II AODs than in those with type III AOD (P = 0.026). Improved outcomes were more common in the surgical treatment group (P < 0.001). Significant differences in treatment outcomes between the halo device and orthosis groups were not observed (P = 0.32). CONCLUSIONS: Prognosis of AOD is unfavorable in adults with dislocations resulting from road traffic accidents, those with types I and II AOD, and patients younger than 22 years and older than 47 years. Surgical treatment was optimal for adult patients with an AOD, and treatment outcomes did not depend on the number of occipitocervical fusion levels. Immobilization with the halo device showed no advantages over use of an external orthosis.

The Combined Use of 5-ALA and Chlorin e6 Photosensitizers for Fluorescence-Guided Resection and Photodynamic Therapy under Neurophysiological Control for Recurrent Glioblastoma in the Functional Motor Area after Ineffective Use of 5-ALA: Preliminary Results.

The treatment of glial brain tumors is an unresolved problem in neurooncology, and all existing methods (tumor resection, chemotherapy, radiotherapy, radiosurgery, fluorescence diagnostics, photodynamic therapy, etc.) are directed toward increasing progression-free survival for patients. Fluorescence diagnostics and photodynamic therapy are promising methods for achieving gross total resection and additional treatment of residual parts of the tumor. However, sometimes the use of one photosensitizer for photodynamic therapy does not help, and the time until tumor relapse barely increases. This translational case report describes the preliminary results of the first combined use of 5-ALA and chlorin e6 photosensitizers for fluorescence-guided resection and photodynamic therapy of glioblastoma, which allowed us to perform total resection of tumor tissue according to magnetic resonance and computed tomography images, remove additional tissue with increased fluorescence intensity without neurophysiological consequences, and perform additional therapy. Two months after surgery, no recurrent tumor and no contrast uptake in the tumor bed were detected. Additionally, the patient had ischemic changes in the access zone and along the periphery and cystic-glial changes in the left parietal lobe.

Xenogeneic Sertoli cells modulate immune response in an evolutionary distant mouse model through the production of interleukin-10 and PD-1 ligands expression.

BACKGROUND: Immunomodulatory mechanisms of Sertoli cells (SCs) during phylogeny have not been described previously. This study attempted to reveal mechanisms of SC immune modulation in an evolutionary distant host. METHODS: The interaction of the SC cell line derived from Xenopus tropicalis (XtSC) with murine immune cells was studied in vivo and in vitro. The changes in the cytokine production, the intracellular and surface molecules expression on murine immune cells were evaluated after co-culturing with XtSCs. Migration of XtSCs in mouse recipients after intravenous application and subsequent changes in spleen and the testicular immune environment were determined by flow cytometry. RESULTS: The in vitro co-culture model was established, allowing the study of XtSCs interaction with murine immune cells. Intracellular staining of interleukin (IL-)10 revealed a significant increase in its expression in macrophages and B cells co-cultured with XtSCs, compared to both unstimulated cells and xenogeneic control. On the contrary, a significant decrease in Th lymphocytes expressing interferon-gamma was observed. The expression of both PD-1 ligands (PD-L1 and PD-L2) was upregulated on the macrophage surfaces after co-culture with XtSCs, but not with the controls. XtSCs migrated specifically to testes when administered intravenously and modulated systemic and local testicular microenvironment; this was detected by the expression of molecules associated with suppressive phenotype by CD45+ cells in both spleen and testes. CONCLUSION: We have demonstrated for the first time that SCs can migrate and modulate immune response in a phylogenetically distant host. It was further observed that SCs induce expression of molecules associated with immunosuppression, such as IL-10 and PD-1 ligands.

A Pilot Study of Fluorescence-Guided Resection of Pituitary Adenomas with Chlorin e6 Photosensitizer.

Fluorescence diagnostics is one of the promising methods for intraoperative detection of brain tumor boundaries and helps in maximizing the extent of resection. This paper presents the results of a pilot study on the first use of the chlorin e6 photosensitizer and a two-channel video system for fluorescence-guided resection of pituitary adenomas. The study's clinical part involved two patients diagnosed with hormonally inactive pituitary macroadenomas and one patient with a hormonally active one. All neoplasms had different sizes and growth patterns. The data showed accumulation of chlorin e6 in tumor tissues in high concentrations: Patient 1: 2 mg/kg, Patient 2: 5 mg/kg, and Patient 3: 4 mg/kg. For Patient 1, the residual part of the tumor was not resected since it was intimately attached to the anterior genu of the internal carotid artery. For Patients 2 and 3, no regions of increased Ce6 accumulation were detected in the tumor foci after resection. Therefore, the use of the Ce6 and a two-channel video system helped to achieve a high degree of tumor resection in each case.

Posterior percutaneous transarticular stand-alone screw instrumentation of C1-C2 with endoscopic assistance: A report of two cases / Exploración instrumental percutánea posterior con tornillo independiente transarticular en C1-C2 mediante endoscopia: informe de dos casos

We present two cases of minimally invasive posterior transarticular screw fixation of C1-C2. The points for screw insertion were visualized by endoscopy via the instrumental port. A patient with a type III odontoid fracture with subluxation underwent a minimally invasive posterior stand-alone transarticular screw fixation. Despite the application of compression screws, for technical reasons, only minimal compression on the anterior third of the C1-C2 lateral joint was achieved. However, complete fracture fusion was achieved with stable fibrous C1-C2 fusion 2.5 years postoperatively. A second patient with a chronic type II odontoid fracture underwent percutaneous C1-C2 fixation by the same method. After 2 years, fracture fusion and C1-C2 lateral mass ankylosis were achieved. The use of a tubular retractor and endoscopy in stand-alone screw fixation of C1-C2 allows direct visualization of the screw entry point and decreases surgical trauma. This procedure might be an alternative to other methods of transarticular instrumentation (AU)

Presentamos dos casos de fijación posterior artroscópica con tornillo transarticular en C1-C2. Las ubicaciones para la inserción del tornillo se visualizaron mediante un trocar para el endoscopio. Un paciente con una fractura de apófisis odontoides de tipo III con luxación parcial se sometió a fijación posterior artroscópica con tornillo independiente transarticular. A pesar de la aplicación de tornillos de compresión y, por motivos técnicos, solo se logró una compresión mínima del tercio anterior de la articulación lateral C1-C2. Sin embargo, se logró la artrodesis completa de la fractura, con una artrodesis en C1-C2 fibrosa estable después de dos años y medio de la intervención quirúrgica. Un segundo paciente con una fractura de apófisis odontoides de tipo II crónica se sometió a fijación percutánea en C1-C2 con el mismo método. Después de dos años, se logró la artrodesis de la fractura y de la masa lateral en C1-C2. El uso de un separador tubular y de la endoscopia en la fijación con tornillo independiente en C1-C2 permite la visualización directa del punto de entrada del tornillo y disminuye el traumatismo quirúrgico. Este procedimiento puede ser una alternativa a otros métodos de exploración instrumental transarticular (AU)

Transcervical approach with endoscopic assistance for surgical treatment of patient with irreducible atlantoaxial dislocation: a case report / Abordaje transcervical con asistencia endoscópica para el tratamiento quirúrgico de pacientes con luxación atloaxoidea irreductible: un informe de caso

We demonstrate the case of a surgery in a patient with irreducible atlantoaxial dislocation (IrAAD) after C2 fracture. The challenges of this case were the flexed head in a forced position, impossibility of neck extension, and revision operation after posterior occipito-cervical fixation. The patient underwent the following surgeries: 1. A ventral release of C1-C2 using transcervical endoscopy; 2. Removal of occipito-cervical system and fibrous block resection in the posterior surfaces of the C1-C2; 3. Reducing of AAD and odontoid screw fixation; 4. Posterior C1-C2-C3 screw fixation. Ankylosing of C1-C2 and C2-C3-C4 fusion was verified by computed tomography scan. There was an improvement in patient status as observed by the increase of the SF-36 scale scores. The use of endoscopic transcervical approach is a good alternative to the transoral approach. Comparative studies of these methods should be performed regarding the choice of an optimal method of decompression in cases of IrAAD (AU)

Mostramos el caso de una cirugía de un paciente con luxación atloaxoidea irreductible (LAAIr) después de una fractura en C2. Las dificultades de este caso fueron la flexión de cabeza en posición forzada, la imposibilidad de extensión cervical y la intervención de revisión después de la fijación occipitocervical posterior. El paciente se sometió a las siguientes intervenciones: 1) Liberación ventral de C1-C2 mediante endoscopia transcervical; 2) Extracción del sistema occipitocervical y resección del bloque fibroso en las superficies posteriores de C1-C2; 3) Reducción de la LAA y fijación con tornillo de la odontoides, y 4) Fijación con tornillo de C1-С2-С3 posterior. El anquilosamiento de C1-C2 y la fusión de C2-C3-C4 se verificó mediante tomografía computarizada. Hubo una mejora en el estado del paciente, tal como mostró el aumento de las puntuaciones de la escala SF-36. El abordaje transcervical endoscópico es una buena alternativa al abordaje transoral. Deberán realizarse estudios comparativos de estos métodos en relación con la elección de un método óptimo de descompresión en casos de LAAIr (AU)

Fluoroscopic landmarks and trajectories for safe posterior percutaneous transarticular C1-C2 screw insertion: a CT-based simulation study.

PURPOSE: To determine the safe screw trajectory for posterior transarticular fixation of C1-C2 without direct visualisation of C2 lateral masses and by using fluoroscopic landmarks only. METHODS: Fluoroscopic models of the craniovertebral region in frontal and sagittal planes were reconstructed using 1-mm interval computed tomography scans of the cervical spine in 30 patients. The imitation model of the screw trajectory was then applied with verification of the exact screw localisation using multiplanar reconstruction. Twenty-seven trajectories for 60 oblique C1-C2 reformations were tested. RESULTS: In the frontal plane, all correct trajectories passed through the medial waistline point (WstP) of C3 and through the middle of the lateral mass of C1. In the lateral plane, the posterior spinal process-lateral mass (SpLM) point-middle C1 anterior tuberculum point (ATP), middle SpLM-upper ATP, and lower SpLM-odontoid point (ODP)-had relatively low rates of vertebral artery (VA) injury (2.3%, 4.6%, and 7%, respectively) and other screw malpositions (6.9%, 4.6%, and 4.6%, respectively). In cases of an isthmus height exceeding 8 mm, there were no incidences of VA injury. Patients with an isthmus width greater than 7 mm had a lower risk of screw malposition. CONCLUSION: We identified potentially safe trajectories for percutaneous posterior transarticular fixation of C1-C2. Using SpLM, ATP, and ODP landmarks in the lateral plane, and WstP and C1 middle landmarks in the frontal plane, it is possible to achieve an acceptable screw position without direct visualisation of the C2 lateral mass.

The impact of odontoid screw fixation techniques on screw-related complications and fusion rates: a systematic review and meta-analysis.

PURPOSE: The primary goal of this study was to conduct a systematic review and meta-analysis of articles focused on odontoid screw fixation (OSF) and screw-related complications or non-union rates. METHODS: We conducted a systematic review of the PubMed and Crossref databases between January 1982 and December 2019. Inclusion criteria comprised detailed descriptions of the surgical technique and screw-related complications (screw cut-out, loosening, breakage, malposition) or fusion rates. RESULTS: The initial selection consisted of 683 abstracts. A total of 150 full texts were chosen for detailed study, and 83 articles were included in the analysis. The point estimates for screw-related complications were as follows: 1. screw malposition frequency-4.8%; 2. screw cut-out rate-5.0%; 3. screw loosening/pull-out-3.8%; and 4. screw fracture rate-3.1%. The point estimate for the non-union rate was 9.7%. Statistical analysis of the screw-related complications rate based on surgical technique details was also performed CONCLUSIONS: Double-screw OSF performance in elder patients resulted in a higher risk of post-operative screw cut-out. In other cases, the development of screw-related complications did not depend on the method of intraoperative head fixation, selection of the implant entry point for OSF, type of the used screws, or cannulated instruments application. The outcomes of single-screw fixation through the anterior lip of the C2 vertebra were comparable to other techniques of OSF. Further, statistically reliable studies should be carried out to identify the optimal technique of OSF.

Transcervical approach with endoscopic assistance for surgical treatment of patient with irreducible atlantoaxial dislocation: a case report.

We demonstrate the case of a surgery in a patient with irreducible atlantoaxial dislocation (IrAAD) after C2 fracture. The challenges of this case were the flexed head in a forced position, impossibility of neck extension, and revision operation after posterior occipito-cervical fixation. The patient underwent the following surgeries: 1. A ventral release of C1-C2 using transcervical endoscopy; 2. Removal of occipito-cervical system and fibrous block resection in the posterior surfaces of the C1-C2; 3. Reducing of AAD and odontoid screw fixation; 4. Posterior C1-C2-C3 screw fixation. Ankylosing of C1-C2 and C2-C3-C4 fusion was verified by computed tomography scan. There was an improvement in patient status as observed by the increase of the SF-36 scale scores. The use of endoscopic transcervical approach is a good alternative to the transoral approach. Comparative studies of these methods should be performed regarding the choice of an optimal method of decompression in cases of IrAAD.

Posterior percutaneous transarticular stand-alone screw instrumentation of C1-C2 with endoscopic assistance: A report of two cases.

We present two cases of minimally invasive posterior transarticular screw fixation of C1-C2. The points for screw insertion were visualized by endoscopy via the instrumental port. A patient with a type III odontoid fracture with subluxation underwent a minimally invasive posterior stand-alone transarticular screw fixation. Despite the application of compression screws, for technical reasons, only minimal compression on the anterior third of the C1-C2 lateral joint was achieved. However, complete fracture fusion was achieved with stable fibrous C1-C2 fusion 2.5 years postoperatively. A second patient with a chronic type II odontoid fracture underwent percutaneous C1-C2 fixation by the same method. After 2 years, fracture fusion and C1-C2 lateral mass ankylosis were achieved. The use of a tubular retractor and endoscopy in stand-alone screw fixation of C1-C2 allows direct visualization of the screw entry point and decreases surgical trauma. This procedure might be an alternative to other methods of transarticular instrumentation.

External Multicenter Study of Reliability and Reproducibility for Lower Cervical Spine Injuries Classification Systems-Part 2: An Analysis of the Subaxial Cervical Spine Injury Classification and Cervical Spine Injury Severity Score Scale.

STUDY DESIGN: A multicenter observational survey. OBJECTIVE: To quantify and compare inter- and intraobserver reliability of the subaxial cervical spine injury classification (SLIC) and the cervical spine injury severity score (CSISS) in a multicentric survey of neurosurgeons with different experience levels. METHODS: Data concerning 64 consecutive patients who had undergone cervical spine surgery between 2013 and 2017 was evaluated, and we surveyed 37 neurosurgeons from 7 different clinics. All raters were divided into 3 groups depending on their level of experience. Two assessment procedures were performed. RESULTS: For the SLIC, we observed excellent agreement regarding management among experienced surgeons, whereas agreement among less experienced neurosurgeons was moderate and almost twice as unlikely. The sensitivity of SLIC relating to treatment tactics reached as high as 92.2%. For the CSISS, agreement regarding management ranged from medium to substantial, depending on a neurosurgeon's experience. For less experienced neurosurgeons, the level of agreement concerning surgical management was the same as for the SLIC in not exceeding a moderate level. However, this scale had insufficient sensitivity (slightly exceeding 50%). The reproducibility of both scales was excellent among all raters regardless of their experience level. CONCLUSIONS: Our study demonstrated better management reliability, sensitivity, and reproducibility for the SLIC, which provided moderate interrater agreement with moderate to excellent intraclass correlation coefficient indicators for all raters. The CSISS demonstrated high reproducibility; however, large variability in answers prevented raters from reaching a moderate level of agreement. Magnetic resonance imaging integration may increase sensitivity of CSISS in relation to fracture management.

Sex chromosome evolution in frogs-helpful insights from chromosome painting in the genus Engystomops.

The differentiation of sex chromosomes is thought to be interrupted by relatively frequent sex chromosome turnover and/or occasional recombination between sex chromosomes (fountain-of-youth model) in some vertebrate groups as fishes, amphibians, and lizards. As a result, we observe the prevalence of homomorphic sex chromosomes in these groups. Here, we provide evidence for the loss of sex chromosome heteromorphism in the Amazonian frogs of the genus Engystomops, which harbors an intriguing history of sex chromosome evolution. In this species complex composed of two named species, two confirmed unnamed species, and up to three unconfirmed species, highly divergent karyotypes are present, and heteromorphic X and Y chromosomes were previously found in two species. We describe the karyotype of a lineage estimated to be the sister of all remaining Amazonian Engystomops (named Engystomops sp.) and perform chromosome painting techniques using one probe for the Y chromosome and one probe for the non-centromeric heterochromatic bands of the X chromosome of E. freibergi to compare three Engystomops karyotypes. The Y probe detected the Y chromosomes of E. freibergi and E. petersi and one homolog of chromosome pair 11 of Engystomops sp., suggesting their common evolutionary origin. The X probe showed no interspecific hybridization, revealing that X chromosome heterochromatin is strongly divergent among the studied species. In the light of the phylogenetic relationships, our data suggest that sex chromosome heteromorphism may have occurred early in the evolution of the Amazonian Engystomops and have been lost in two unnamed but confirmed candidate species.

A Translational Study on Acute Traumatic Brain Injury: High Incidence of Epileptiform Activity on Human and Rat Electrocorticograms and Histological Correlates in Rats.

BACKGROUND: In humans, early pathological activity on invasive electrocorticograms (ECoGs) and its putative association with pathomorphology in the early period of traumatic brain injury (TBI) remains obscure. METHODS: We assessed pathological activity on scalp electroencephalograms (EEGs) and ECoGs in patients with acute TBI, early electrophysiological changes after lateral fluid percussion brain injury (FPI), and electrophysiological correlates of hippocampal damage (microgliosis and neuronal loss), a week after TBI in rats. RESULTS: Epileptiform activity on ECoGs was evident in 86% of patients during the acute period of TBI, ECoGs being more sensitive to epileptiform and periodic discharges. A "brush-like" ECoG pattern superimposed over rhythmic delta activity and periodic discharge was described for the first time in acute TBI. In rats, FPI increased high-amplitude spike incidence in the neocortex and, most expressed, in the ipsilateral hippocampus, induced hippocampal microgliosis and neuronal loss, ipsilateral dentate gyrus being most vulnerable, a week after TBI. Epileptiform spike incidence correlated with microglial cell density and neuronal loss in the ipsilateral hippocampus. CONCLUSION: Epileptiform activity is frequent in the acute period of TBI period and is associated with distant hippocampal damage on a microscopic level. This damage is probably involved in late consequences of TBI. The FPI model is suitable for exploring pathogenetic mechanisms of post-traumatic disorders.